Table 1

Consensus statements

Recommendation statement	Consensus (%)
Prevention
1. For all individuals with CF and caregivers, the CFF/ECFS International Committee on Mental Health in CF (ICMH) recommends that ongoing education and preventative, supportive interventions, such as training in stress management and the development of coping skills, aligned with appropriate developmental stage and disease events be offered.	100
2. For all individuals with CF undergoing medical procedures, the ICMH recommends that behavioural approaches be used to reduce the risk of distress.	100
Screening
3. The ICMH recommends that children with CF ages 7–11 be clinically evaluated for depression and anxiety when caregiver depression or anxiety scores are elevated, or when significant symptoms of depression or anxiety in the child are reported or observed by patients, caregivers or members of the CF multidisciplinary team.	100
4. The ICMH recommends annual screening for depression and anxiety with the PHQ-9 and GAD-7 for adolescents and adults with CF (ages 12–adulthood).	100
5. The ICMH recommends offering annual screening for depression and anxiety to at least one primary caregiver of children and adolescents with CF (ages 0–17) using one of the following approaches listed below, depending on staffing and resources: ▸ Screening with the PHQ-9 and GAD-7 ▸ Screening with the PHQ-8 and GAD-7 ▸ Screening with the PHQ-2 and GAD-2	100
Clinical Assessment
6. The ICMH recommends that any treatment for depression and anxiety in individuals with CF and caregivers be based on clinical diagnosis. ▸ A healthcare provider with appropriate training and expertise should evaluate the clinical significance of elevated screening scores and presenting symptoms to perform a differential diagnosis before initiating treatment.	100
7. For caregivers of individuals with CF who have clinically significant symptoms of depression/anxiety, the ICMH recommends referral for treatment to primary care or mental health services after initial assessment with the CF team.	100
Intervention
8. For all individuals with CF and symptoms of depression/anxiety, the ICMH recommends a flexible, stepped care model of clinical intervention developed and implemented in close collaboration with patients and caregivers, the multidisciplinary CF team and other treatment providers or consultants, such as primary care or mental health specialists. ▸ CF teams must identify who will be responsible to initiate and coordinate care and monitor treatment effects.	100
9. The ICMH recommends that in children with CF ages 7–11, who have clinically significant depression or anxiety, evidence-based psychological interventions are recommended as the first-line treatment.	100
10. For individuals with CF ages 12–adulthood and mild depression or anxiety symptoms, the ICMH recommends education about depression/anxiety, preventative or supportive interventions and rescreening at the next clinic visit.	100
11. For individuals with CF ages 12–adulthood and moderate depression or anxiety, the ICMH recommends offering or providing a referral for evidence-based psychological interventions, including CBT or IPT. ▸ When psychological intervention is unavailable, declined or not fully effective, antidepressant treatment should be considered.	100
12. For individuals with CF ages 12–adulthood and severe depression, the ICMH recommends use of combined evidence-based psychological interventions and antidepressant pharmacotherapy.	100
13. For individuals with CF ages 12–adulthood and severe anxiety, the ICMH recommends offering exposure-based CBT. ▸ When exposure-based CBT is unavailable, declined or not fully effective, antidepressant medications can be considered.	100
14. The ICMH recommends that the SSRIs citalopram, escitalopram, sertraline and fluoxetine are appropriate first-line antidepressants for most individuals with CF, ages 12–adulthood, requiring pharmacotherapy. ▸ In selecting an antidepressant and adjusting its dosage, close monitoring of therapeutic effects, adverse effects, drug–drug interactions and medical comorbidities is recommended.	100
15. The ICMH recommends that lorazepam be considered for short-term use in individuals with CF with moderate-to-severe anxiety symptoms, associated with medical procedures, who have not responded to behavioural approaches.	100

CBT, cognitive behavioural therapy; CF, cystic fibrosis; CFF, Cystic Fibrosis Foundation; ECFS, European Cystic Fibrosis Society; GAD, Generalised Anxiety Disorder Questionnaire; IPT, interpersonal therapy; PHQ, Patient Health Questionnaire; SSRIs, selective serotonin reuptake inhibitors.