ABSTRACT
Background: COVID-19 outbreak is a public emergency that forced people to a radical change in their daily life, generating great insecurities and concerns about health, work, and social relationships [1]. Quarantine measures were responsible for detrimental effects on mental health of the general population, leading to the exacerbation of stress, depression and anxiety [2]. Psychological impact might be even more severe on fragile people such as those suffering from rheumatic diseases (RDs), for whom previous evidence demonstrated a negative effect of psychological stressors on outcome disease [3]. Objective: The aim of the present study is to identify the factors associated with higher levels of perceived stress in patients affected by RDs during the COVID-19 pandemic. Methods: This cross-sectional study analyzed data from an anonymous online survey about mental health of people with RDs. Participants were enrolled through several RD patients’ associations between May and September 2020, after the first pandemic wave in Italy. They filled out a questionnaire including demographic and clinical information, mental health issues and the Perceived Stress Scale (PSS). Perceived stress levels were stratified as follows: low (<14), moderate (14-26) and high (>27). Descriptive analyses were performed on the total sample;one-way analyses of variance (ANOVA) and Pearson's correlation were used to compare PSS scores between groups defined by qualitative and quantitative variables. Finally, multivariate regression analyses were performed to identify independent variables associated with higher PSS scores. Results: 507 patients with RDs participated in the survey: 419 females (82.6%) and 88 males (17.4%) with a mean age of 53.06 years and mean disease duration of 13.74 years. As regard PSS scores, total sample mean (SD) was 18.1 ± 8.1. Specifically, 154 patients (30,4%) reported low, 264 (52.1%) moderate and 89 (17.6%) high levels of stress. PSS scores resulted significantly different with regard to: gender (F=18.32, P<0.01), residence in Lombardy (F=14.90, P<0.01), diagnostic group (F=6.20, P<0.01), hypertension (F=4.06, P=0.04), gastritis (F=3.83, P=0.05), bowel diseases (F=9.74, P<0.01), overweight/obesity (F=5.96, P=0.02), COVID-19 infection (F=4.32, P=0.01), depressive symptoms (F=17.18, P<0.01), anxiety symptoms (F=19.79, P<0.01), prescription of psychiatric therapy before COVID-19 (F=30.90, P<0.01), type of pre-existing psychiatric symptoms (F=12.41, P<0.01), use of psychiatric compounds before COVID-19 (F=36.39, P<0.01), type of psychiatric compounds before COVID-19 (F=13.53, P<0.01), current prescription of psychiatric compounds (F=44.68, P<0.01), type of ongoing psychiatric compounds (F=15.18, P<0.01), anxiety sources (F=30.90, P<0.01). Independent variables associated with higher PSS scores were: female gender (β=0.12, P<0.01), younger age (β=-0.23, P<0.01), residence outside Lombardy (β=-0.09, P=0.03), presence of overweight/obesity (β=0.11, P=0.01), current prescription of psychiatric compounds (β=0.26, P <0.01) and financial difficulties (β=0.19, P <0.01). Conclusion: Our findings highlight the considerable psychological impact derived from COVID-19 pandemic on people affected by RDs. In addition, different factors resulted to be predictive of significant levels of perceived stress in these patients. A multidisciplinary approach, including mental health support, should be considered in order to improve the psychological well-being of fragile patients during traumatic events such as pandemics. No conflict of interest
ABSTRACT
Background: Post-traumatic stress disorder (PTSD) is a psychiatric condition that may develop after exposure to a traumatic event [1];COVID-19 pandemic could be defined as a traumatic experience since it has resulted in either direct (e.g. the fear of contagion and the risk of death) or indirect aftermaths (e.g. psychological distress, depression and anxiety) [2]. Besides, it has been shown that PTSD, promoting inflammatory responses, might worsen the prognosis of patients affected by illnesses characterized by systemic inflammation such as rheumatic diseases (RDs) [3]. Objective: The aim of the present study is to verify the presence of PTSD symptoms and related factors in patients suffering from RDs during the COVID-19 pandemic. Methods: This cross-sectional study analyzed data from an anonymous online survey about mental health of people with RDs. Participants were enrolled through several RD patients’ associations between May and September 2020, after the first pandemic wave in Italy. They filled out a questionnaire including demographic and clinical information, mental health issues and the 22-items of the Impact of Event Scale-Revised (IES-R). The total score ranges from 0 to 88;a score ≥ 33 defines patients at risk of PTSD. Descriptive analyses were performed on the total sample: one-way analyses of variance (ANOVAs) were used to compare IES-R scores between groups defined by qualitative variables;Pearson's correlations were performed to study the relation between rating scale scores and quantitative variables. Finally, multivariate regression analyses were performed to identify independent variables associated with IES-R scores. Results: 507 patients with RDs participated in the survey: 419 females (82.6%) and 88 males (17.4%) with a mean age of 53.06 years and mean disease duration of 13.74 years. As regard IES-R scores, total sample mean (SD) was 29.7 ± 17.5;of note, 209 participants (41.2%) had scores ≥33. IES-R scores resulted to be significantly different according to: gender (F=14.75, P<0.01), residence in Lombardy (F=8.22, P<0.01), diagnostic group (F=4.17, P= 0.02), prescription of psychiatric therapy before COVID-19 (F=17.87, P<0.01), type of pre-existing psychiatric symptoms (F=7.59, P<0.01), use of psychiatric compounds before COVID-19 (F=27.17, P<0.01), type of psychiatric compounds before COVID-19 (F=14.58, P<0.01), current prescription of psychiatric compounds (F=29.30, P<0.01), type of ongoing psychiatric compounds (F=13.81, P<0.01), anxiety source (F=20.81, P<0.01), and the presence of overweight/obesity (F=7.60, P< 0.01), bowel diseases (F=8.00, P<0.01), depressive symptoms (F=5.74, P=0.02), anxiety symptoms (F=26.81, P<0.01). Independent variables associated with higher IES-R scores were: female gender (β=0.14, P <0.01), living outside Lombardy (β=-0.10, P=0.02), intestinal diseases (β=0.10, P=0.03), anxiety (β=0.19, P <0.01) and health related concerns (β=0.13, P <0.01). Conclusion: These findings point out high rate of severe self-reported distress among Italian RD patients in response to the pandemic. Given that psychological and emotional stressors strictly affect disease severity leading to poorer quality of life, our study sustains the necessity to implement support measures for fragile patients during traumatic events. No conflict of interest
ABSTRACT
Background: A considerable psychosocial burden is one of the relevant consequences of the COVID-19 pandemic. In particular, quarantine measures have been related to negative psychological effects, including symptoms of post-traumatic stress disorder, stress, anxiety, and depression (1). This rise in mental health disorders might be even worse among people more vulnerable to psychological stress such as patients suffering from chronic rheumatic diseases (RDs). Objectives: The present Italian nationwide survey engages patients with rheumatic conditions through eleven associations of RD patients. It is conducted to establish the COVID-19 related self-reported poor mental health symptoms and to identify potential factors associated with these concerns among RDs who experienced the COVID-19 quarantine in Italy. Methods: We collected data from May to September 2020 from RD patients living in Italy during the COVID-19 quarantine by an ad-hoc online survey. By using their mailing list and the related webpage and social network, eleven patients' associations sent a call to RD patients asking them to complete an anonymous online survey which included the Perceived Stress Scale (PSS), and the Impact Event Scale-Revised (IES-R). χ2 tests were performed to detect statistically significant differences in both rating scale scores between groups defined by qualitative variables. Correlation analyses were realized with quantitative variables and rating scale scores. Variables significant in univariate analyses were then inserted in multivariate regression models. Results: In total, 507 RD patients completed to the survey. 375 (73.9%) patients had inflammatory arthritis (243 rheumatoid arthritis, 76 psoriatic arthritis, 49 ankylosing spondylitis, and 7 Still's disease), and 96 (18.9%) with connective tissue diseases or systemic vasculitis. 31 (6.1%) patients had primary fibromyalgia and 5 osteoarthritis or crystal arthropathies. Self-reported major sources of anxiety are reported in the Figure 1 below. The mean (SD) scores of the PSS-10 and the IES-R were 18.1 ± 8.1 and 29.7 ± 17.5, respectively. With regard to the IES-R subscale scores, the total sample did not show a prominence of one of the three main domains (intrusion, avoidance and hyperarousal). Higher PSS scores were significantly associated with younger age (p<0.01), female gender (p<0.01), living outside Lombardy (p=0.03), presence of overweight/obesity (p=0.01), ongoing psychopharmacotherapy (p<0.01), and anxiety for loss of incomes (p<0.01). Female gender (p<0.01) and living outside Lombardy (p=0.02) were associated also with higher IES-R scores, together with the presence of intestinal diseases (p=0.03), anxiety disorders (p<0.01), and worries about health (p<0.01). Conclusion: This nationwide study revealed a high impact of self-reported distress, anxiety, and perceived stress among rheumatic patients after confinement during COVID-19 pandemic in Italy. Different factors were found to be predictive of poor mental health such as having female gender, younger age, living outside Lombardy, having overweight/obesity, or intestinal diseases, having a history of psychiatric symptoms (e.g. anxiety). Moreover, the lockdown experience worsened psychiatric symptoms and increased the assumption of psychopharmacotherapy in this vulnerable population. Prevention strategies focused on specific variables should be implemented to ameliorate psychological well-being of fragile patients during pandemics.