Published November 25, 2015
Beth A. Smith, MD, clinical associate professor of psychiatry, has helped develop international guidelines for the screening and treatment of depression and anxiety in people with cystic fibrosis.
Published in Thorax, the guidelines advise cystic fibrosis centers to offer voluntary annual mental health screenings to patients 12 and older, and their caregivers, among other recommendations.
“There are 150 centers accredited by the Cystic Fibrosis Foundation in the United States alone, and these guidelines are expected to be integrated into all of them,” Smith says.
In the decade since she graduated from the University at Buffalo’s child and adolescent psychiatry fellowship, Smith has emerged as an influential expert on depression in CF patients.
In addition to serving on the multidisciplinary committee that developed the guidelines, she chaired its screening subgroup and wrote the section on screening for Thorax.
In October, she delivered the plenary presentation on the guidelines at the 29th annual North American Cystic Fibrosis Conference.
To facilitate implementation of the new guidelines, the Cystic Fibrosis Foundation is inviting its centers to apply for three-year grants to hire mental health coordinators.
The foundation has tapped Smith to chair the review committee evaluating the applications.
She also chairs the foundation’s mental health task force. As such, she’s responsible for supporting the addition of mental health coordinators and disseminating resources to help centers put the guidelines into practice.
These resources have their roots in Buffalo, Smith notes: Three years ago, the foundation awarded her a grant to develop and implement routine mental health screenings at the Cystic Fibrosis Center in Women and Children’s Hospital of Buffalo.
“We’ve been screening in Buffalo all along, so we’ve already developed the protocols,” she says.
“Our center is a trailblazer in this regard. It’s long been known for its cystic fibrosis research, but now it’s known for mental health research as well.”
Very few physical illnesses have accompanying guidelines on mental health screening. Of those that do, health care professionals grapple with how to incorporate them into practice.
“You need to determine how to implement the guidelines: which screening tools to use, who will collect the data and who will score it,” Smith says.
“It’s a lot to ask clinicians to also evaluate the mental wellness of their patients. It takes a team effort and a culture shift. But it’s important to patients’ health — especially when you consider that a patient’s well-being includes their physical and mental health.”
In the case of cystic fibrosis, research has shown that people with the disease are at greater risk for depression and anxiety.
When they have one or both mental health disorders, they’re less likely to perform their daily care plans and more likely to have lower lung function, lower body mass index, more frequent hospitalizations and higher health care costs than the general CF population.
Smith developed an interest in the mental health status of CF patients as a UB fellow. During the second year of her training, she received a grant to investigate how depression in cystic fibrosis impacts patients’ adherence to treatment regimens.
“Youth with cystic fibrosis are sometimes asked to do up to two hours of treatment a day, and I started wondering how they do it,” says Smith, who also received her medical degree from UB.
As a result of her investigation — which has been cited more than 50 times in the cystic fibrosis literature — Buffalo was selected as one of the clinical sites for TIDES, a nine-country epidemiological study that found elevated levels of depression and anxiety in more than 6,000 CF patients and more than 4,000 parent-caregivers.
From there, she was named site principal investigator for the iCARE study, an intervention to improve treatment adherence and clinical outcomes for CF patients.
On numerous occasions over the past decade, Smith has shared her research with national and international audiences.
Recent presentations have included a symposium on the initiatives she’s launched in Buffalo, a short course on psychopharmacology for cystic fibrosis and a talk on postpartum depression in CF patients.
“What I've been saying all along is that we have to pay attention to this issue now. CF patients are living into adulthood, and depression is impacting their health outcomes and quality of life,” Smith says.
“The cost of depression compounds the cost of cystic fibrosis. If we can address these mental health needs, we have the potential of changing somebody’s course.”