POST-TRAUMATIC STRESS DISORDER and SYMPTOMS in PATIENTS with RHEUMATIC and MUSCULOSKELETAL DISEASES during the COVID-19 PANDEMIC: PRELIMINARY RESULTS from the PERMAS STUDY

Background: The COVID-19 pandemic, with its uncertainties, fears of contagion, mass lockdowns and containment measures, has dramatically impacted on people's everyday lives leading to an increased risk of mental disorders, particularly Post-Traumatic Stress Disorder (PTSD). Despite evidence in general population and healthcare workers1,2, scant data emerged on vulnerable populations, such as of patients with chronic illness, particularly rheumatic and musculoskeletal diseases (RMDs)3,4, who also underwent difficulties in the management and treatment of their disorders. Objectives: To assess PTSD and post-traumatic stress symptoms in a sample of patients with RMDs, during the COVID-19 pandemic in Italy. Methods: PERMAS is a monocentric prospective observational study led by the Rheumatology Unit, the Psychiatric Clinic and the Institute of Management of the School of Advanced Studies. Patients with a RMD diagnosis, were consecutively enrolled from May 2021 to January 2022. During the visit, sociodemographic characteristics and psychopathological data were collected through online survey, whereas clinical data were collected by physician. The survey included the Trauma and Loss Spectrum-Self Report (TALS-SR) and the Impact of Event Scale-Revised (IES-R), aimed to assess symptomato-logical PTSD and post-traumatic stress symptoms related to the impact of the COVID-19 pandemic. Results: A total of 194 eligible patients, with a mean age of 50.3±12.17 years, was included: 142 (73.19%) were females;112 (57.74%) patients reported connective tissue diseases (CTD), 63 (32.47%) arthritis and 19 (9.8%) vasculitis. A total of 33 (17%) subjects reported a symptomatological PTSD by means of the TALS-SR. The prevalence of Partial PTSD (defned by at least 2 out of the 4 criteria for DSM-5 diagnosis of the disorder) was 56.7%, with signifcant higher rates among females (90, 81.8%) with respect to males (20, 18.2%) (p=.013). Accordingly, a IES-R mean total score of 21.90 ±15.98 was found in the total sample and a gender difference emerged, with higher mean scores among females rather than males (23.42 ±16.26 vs 21.90 ±15.98, p=.031). Conclusion: The present fndings point out high prevalence rates of symptoma-tological PTSD among patients suffering from RMDs, highlighting the potentially traumatic burden of the COVID-19 pandemic in this particular population, especially among females, suggesting the need of further investigations to address tailored prevention and intervention strategies.

IMPACT of COVID-19 PANDEMIC on HEALTHCARE RESOURCE USE and CLINICAL OUTCOMES in A COHORT of PATIENTS with SYSTEMIC AUTOIMMUNE DISEASES-AN INTERIM ANALYSIS from the PERMAS PROJECT

Background: Management of the health emergency caused by COVID-19 pandemic majorly disrupted the delivery of healthcare services to patients with chronic conditions like Systemic Autoimmune Diseases (SAD), both because resources were mainly channeled towards the care of infected patients, but also because patients tended to avoid seeking medical care for fear of becoming infected. PER-MAS is a 2-year project aimed at assessing the clinical, psychopathological, and socio-economic impact of COVID-19 in a cohort of patients with SAD. Objectives: To assess the impact of COVID-19 pandemic on drug withdrawal, disease fares and hospitalizations for disease exacerbation in a cohort of patients with SAD through an interim analysis of data from the PER-MAS project. Methods: A sample of 214 consecutive patients was recruited in a reference center for rare and complex autoimmune diseases from April 2021 to January 2022. Inclusion criteria were definite diagnosis of SAD (Connective Tissue Disease (CTD), Inflammatory Arthritis (IA) or Vasculitis), regular follow-up and at least 2 years of disease. Patients were asked to fill out an extensive self-administered questionnaire on disease activity and healthcare resource use during the pandemic (March 2020-moment of assessment). Pre-pandemic (March 2019-February 2020) and early pandemic (March 2020-February 2021) clinical data were recorded through retrospective chart review and patient interview. Results: At enrolment, 119 patients were affected by CTDs (55.6%), 71 by IA (33.18%), 24 by vasculitis (11.21%), with mean age 50.44± 12.97, and mean disease duration 11.17 ± 8.94. 30.37% took steroids, 39.7% hydroxy-chloroquine, 61.68% DMARDs, and 9.3% vasoactive drugs. Overall, disease course was similar in pre-pandemic and early pandemic phase: in the first period, rheumatologic condition was stable in 57.35% of patients, persistently active in 27.3% and 35.61% had ≥ 1 episode of disease exacerbation (mean 0.665±1.15, range 0-6);in the second period, 60.56% of patients was stable, 24.88% persistently active, and 39.44% had ≥1 exacerbation (mean 0.49 ±0.77, range 0-4). Mean number of visits (2.56±2.57 and 2.61±2.79), hos-pitalizations (0.168±0.698 and 0.14±0.473, p=0.6), number of patients with outpatient visits=0 (7.47 vs 7%), and number of patients with ≥ 1 hospital admission (10.28 vs 11.6%) were also similar, while the number of patients with hospital admissions for disease exacerbation was significantly higher in the second period (6.1 vs 11.21%, p=0.001). 170 patients completed the survey: from March 2020 to enrolment, 18.2% suspended ≥1 anti-rheumatic drug (6.25% of them for fear of contracting COVID-19 disease, 15.6% for difficulty in obtaining medications), 20% self-managed ≥ 1 disease exacerbation, and 40% had ≥ 1 telemedicine consult. From March to July 2020, 41.76% had their visit rescheduled (35.23% for hospital access restrictions, 5.3% for travel restrictions, 1.17% for fear). Conversely, only 14.7% of patients had their visit rescheduled (8.23% for hospital access restrictions, 4.7% for other reasons) from July 2020 to enrolment. Conclusion: In the early pandemic phase, overall disease course was similar to the pre-pandemic phase, but we observed an increase in the number of patients with ≥ 1 hospitalization for disease. Moreover, despite our efforts, patients reported a non-negligible rate of drug discontinuation for non-medical indication and difficulty to get access to rheumatologic consultation, highlighting the need of alternative organizational models in case of future pandemics.

Post-traumatic stress, anxiety, and depressive symptoms in caregivers of children tested for COVID-19 in the acute phase of the Italian outbreak.

BACKGROUND: The recent COVID-19 pandemic pointed out new burdens for researchers on mental health and that evidence-based (EB) studies on vulnerable populations are timely needed. The present paper aims at analysing the impact of suspicious of SARS-COV-2 infection in a cohort of parents presented at 3 major hospitals (spread between north and center of Italy) during the Italian COVID-19 pandemic phase 1. METHODS: Participants of the present cross-sectional, multicenter study were parental couples of children suspected to have COVID-19 who underwent testing with nasopharyngeal swabbing. All subjects were assessed by means of the: Impact of Event Scale-Revised (IES-R), Generalized Anxiety Disorder 7-Item (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) in order to evaluate Post-traumatic stress (PTSS), anxiety, and depressive symptoms, respectively. OUTCOMES: Results evidenced that parents whose children tested positive for COVID-19 were more prone to developing PTSS, anxiety and depressive symptoms. The same results emerged for parents who had quarantined as opposed to those who had not. Moreover, patients who suffered economic damage showed a higher prevalence of anxiety and depressive symptoms, whereas PTSS was more common among unemployed subjects and among mothers. INTERPRETATION: This study identified a mental health strain represented by parenting a child who tested positive for SARS-CoV-2 infection. Further EB research is needed to develop evidence-driven strategies to reduce adverse psychological impacts and related psychiatric symptoms in caregivers of COVID-19 infected children during the next phases of the pandemic.

P.602 Burnout and post-traumatic stress spectrum in 110 emergency operators in Italy: a preliminary report

Background: Post-Traumatic Stress Disorder (PTSD) is a severe psychiatric disorder, developed in response to the exposure to one or more traumatic events, and characterized by typical disabling symptoms, chronic course, significant deterioration in the quality of life and a high suicidal risk [1]. Healthcare emergency personnel are a high-risk category for the development of PTSD, due to the repeated exposure to stressful and traumatic experiences during their work activities [2]. In such healthcare professionals can frequently occur also a Burnout Syndrome, that is a condition resulting from a work-related stress-causing process, determining a combination of emotional exhaustion, depersonalization and a reduction of personal abilities [3]. PTSD and Burnout present a complex, and not fully explored, relationship, because of the shared risk factors and overlapping symptomatic manifestations [4]. Objective: The aim of this study is to investigate PTSD, post-traumatic stress spectrum symptoms, Burnout Syndrome, and their relationship, in a sample of emergency operators of a major University Hospital of Italy. Methods: The study sample included 110 emergency operators (Emergency Room, Emergency Medicine, Intensive Care Unit) of the “Azienda Ospedaliero-Universitaria Pisana” (A.O.U.P., Pisa, Italy). Participants were administered the Trauma and Loss Spectrum - Self Report (TALS-SR), to investigate full or partial DSM-5 PTSD and posttraumatic stress spectrum symptoms related to the work activity, and the Professional Quality of Life Scale - Revision IV (ProQOL R-IV), to examine Compassion satisfaction, Burnout and Compassion fatigue related to work. We used the Kruskal-Wallis test for independent samples to evaluate the differences in ProQOL scales between subjects with full PTSD, partial PTSD and without PTSD. Spearman's correlation coefficients were used to verify the possible associations between the TALS-SR symptomatological domains and the three dimensions of ProQOL. Results: Fifteen subjects reported a full (15.05%) and 25 a partial (26.88%) symptomatological DSM-5 PTSD. The ProQOL Compassion Satisfaction subscale mean score did not show statistically significant differences between the three groups. Healthcare operators with PTSD reported higher scores with respect to individuals without PTSD in the ProQOL Burnout and the Compassion Fatigue subscales (18.6±4.9 versus 13.9±4.4, p=0.014;and 14.38±4.073 versus 9.9±3.9, p=0.001 respectively). Pearson's linear correlation between the TALS-SR symptomatological domains, and the ProQOL subscales highlighted significant relationships between Burnout and Reactions to losses or upsetting events (r=0.236, p=0.035), Re-experiencing (r=0.248, p=0.027) or Avoidance and numbing (r=0.319, p=0.004);and between Compassion fatigue and Reactions to losses or upsetting events (r=0.293, p=0.008), Re-experiencing (r=0.359, p=0.001) or Avoidance and numbing (r=0.406, p<0.001). Conclusions: This work underlines a positive correlation between Burnout Syndrome and Post-traumatic stress spectrum symptoms in emergency operators, highlighting the clinical importance of a deeper assessment of work-related trauma and post-traumatic stress manifestations in these subjects to improvethe well-being and to prevent Burnout Syndrome. In this regard, increasing attention is required particularly in healthcare emergency operators due to COVID-19 pandemic, in order to strengthen the training of psychological skills aimed at mitigating the impact of a such stressful and traumatic event [5]. No conflict of interest