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Online versus paper-based screening for depression and anxiety in adults with cystic fibrosis in Ireland: a cross-sectional exploratory study
  1. Jennifer Cronly1,
  2. Alistair J Duff2,
  3. Kristin A Riekert3,
  4. Ivan J Perry4,
  5. Anthony P Fitzgerald4,5,
  6. Aine Horgan1,
  7. Elaine Lehane1,
  8. Barbara Howe1,
  9. Muireann Ni Chroinin6,
  10. Eileen Savage1
  1. 1 School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
  2. 2 Department of Clinical Psychology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  3. 3 School of Medicine, John Hopkins University, Baltimore, Maryland, USA
  4. 4 School of Epidemiology and Public Health, Western Gateway Building, University College Cork, Cork, Ireland
  5. 5 Department of Statistics, Western Gateway Building, University College Cork, Cork, Ireland
  6. 6 Department of Paediatrics, Cork University Hospital, Cork, Ireland
  1. Correspondence to Professor Eileen Savage; e.savage{at}


Objective To compare online and paper-based screening for depression and anxiety in adults with cystic fibrosis (CF).

Design and setting Cross-sectional study in CF clinics in Ireland and through the Cystic Fibrosis Ireland online community.

Participants 160 adult patients aged 18 or above were recruited. Of these, 147 were included in the analysis; 83 online and 64 paper-based. The remaining 13 were excluded because of incomplete data.

Measures Depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Data on pulmonary function (forced expiratory volume in 1 s %) and body mass index were self-reported based on clinical assessments. Sociodemographic data were collected.

Results Compared with the paper-based participants, the online participants were more likely to be female (61.7% vs 48.4%), older (mean 32.2 vs 28.2 years) and were more likely to be married (32.5% vs 15.6%), living with their spouse or partner (42.5% vs 22.6%) and working either full time (33.7% vs 15.9%) or part time (30.1%vs 17.5%). The prevalence rates of elevated anxiety and depression were not significantly different (P=0.71 and P=0.56). HADS anxiety and depression scores were not statistically different between online (P=0.83) and paper-based (P=0.92) participants based on Mann-Whitney U test. A significant negative correlation was found between depression and pulmonary function (r=−0.39, P=0.01) and anxiety and pulmonary function (r=−0.36, P=0.02). Based on Cronbach’s alpha, there were no statistically significant differences between the online and paper-based participants on the internal consistency of the HADS anxiety (P=0.073) and depression (P=0.378) scales.

Conclusions Our findings suggest that online and paper-based screening for depression and anxiety in adult patients with CF yield comparable findings on prevalence rates and scores, associations with health and internal consistency of subscales. This study highlights that online screening offers an alternative method to paper-based screening. Further research with a larger sample and assessment of measurement equivalence between online and paper based screening is needed to confirm our results.

  • anxiety
  • cystic fibrosis
  • depression
  • online versus paper based screening
  • prevalence
  • pulmonary function

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  • Contributors ES, IJP, AJD, KAR, APF, MNC contributed to design and application for funding. ES and JC prepared for ethical approval and negotiated access to CF centres in Ireland. JC and BH collected data. JC conducted data analysis supported by APF and EL. AH and AJD offered critical insights into mental health screening. All authors contributed to the interpretation of results. JC and ES drafted the manuscript. All authors have read, edited and approved the manuscript.

  • Funding This work was supported by a research grant jointly funded by the Health Research Board, Ireland and Cystic Fibrosis Ireland (grant file reference: MRCG/2011/9).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Clinical Research Ethics Committee, University College Cork (Ref no: ECM4(ii)04/12/12, and amended for online data collection-(Ref no: ECM4(ii)03/03/15).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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