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Background The CF Foundation and European CF Society seek unified consensus on standards of care, yet differences remain and psychosocial disparities in patients may exist. Objective We compare anxiety, depression, coping strategies, and quality of life (QOL) in children with CF between Belgium and the USA. Method We recruited 20 Belgian and 17 American children with CF (ages 8–12), and a matched (nationality, age, & sex) control group of healthy children, from hospitals and schools in Belgium and USA. Using a cross-sectional design, all children completed the State-Trait Anxiety Inventory for Children (STAIC), Children's Depression Inventory (CDI), Kidcope, and Quality of Life Systemic Inventory for Children (QLSI-C; modular approach). Data collection in the United States is on going and a sample of 20–25 American children with CF is expected for this presentation. Results Though some results are statistical trends, Americans with CF had lower emotional distress (CDI: p = 0071) as well as better QOL ( p = 0028) than Belgians with CF and, surprisingly, healthy American children (STAIC: p = 0038; CDI: p = 0072; QOL: p = ns). For QOL, Americans with CF reported less emotional problems than Belgians ( p = 0078). Americans (47%) use more social withdrawal coping than Belgians with CF (10%) ( p = 0011). Emotional regulation coping is related to higher anxiety ( p = 0017) and worse QOL ( p = 0038) in Americans with CF. Conclusion These preliminary findings suggest cultural differences regarding psychosocial outcomes in children with CF. Future research should examine the impact of emotion-related differences on treatment adherence and medical outcomes in CF. [ABSTRACT FROM AUTHOR]