ABSTRACT
Background: Mental disorders constitute a serious and underestimated problem in Latin America and they could have worse features in comparison with Europe or North America (1);that was the case even before the COVID-19 epidemic ensued in 2020. Objectives: The objective of this study was to determine the factors associated with the occurrence of mental health disorders (MHD) in patients with autoimmune rheumatic disease (ARD) from Perú, a high COVID-19 incidence country. Methods: Patients with ARD from a single center (Hospital Guillermo Almenara-EsSalud, Lima-Perú) were included during the frst and second waves of the COVID-19 pandemic (March to November 2020). Interviews, medical records reviews, and an electronic survey were performed. MHD explored were depression (assessed with the Patient Health Questionnaire 9: PHQ-9), anxiety (ascertained with the Generalized Anxiety Disorder-7: GAD-7) and post-traumatic stress disorder: PTSD (evaluated with the Event Scale-Revised: IES-R). Variables examined were sociodemographic (age, gender, educational level, marital status, living alone, job status, religiosity), previous diagnosis and treatment for mental disorders, living with a COVID-19 patient, COVID-19 diagnosis (current or past), fear of COVID-19 (assessed with the COVID-19 Scale: FCV-19S) and the ARD type. Multivariable logistic regression models using backward elimination procedure were performed to determine the variables associated with depression, anxiety, and PTSD. (See Table 1). Results: Nine hundred and thirteen ARD patients were evaluated. The most frequent diagnosis was rheumatoid arthritis in 446(48.8%) patients followed by systemic lupus erythematosus in 279 (30.6%). Depression, anxiety, and PTSD were observed in 128 (14.0%), 112 (12.30%) and 485 (53.1%) patients, respectively. In the multivariable analyses, previous treatment for mental disorders and fear of COVID-19 were associated with depression: OR=2.35 (95% CI 1.37-4.03;p=0.002) and OR=1.07 (95% CI 1.05-1.10;p<0.001) respectively;also with anxiety: OR= 2.42 (95% CI 1.37-4.26;p=0.002) and OR=1.09 (95% CI 1.06-1.12;p <0.01) and with PSTD: OR=2.42 (95% CI 1.39-4.21;p=0.002) and OR=1.41 (95% CI=1.11-1.17;p<0.001). A diagnosis of COVID-19 was associated with PTSD: OR=1.75 (95% CI 1.06-2.89, p=0.028), while being single was associated with a decreased probability of PTSD occurrence: OR=0.57 (95% CI=0.35-0.96;p=0.03). Finally, having a high educational level was associated with less anxiety: OR=0.43 (95% CI=0.82-0.21;p=0.009), for university/postgraduate studies and OR=0.52 (CI 95%=0.28-0.95;p=0.032) for secondary studies. Conclusion: Fear of COVID-19 and previous treatment for mental disorder were associated with all MHD explored on our ARD patients during the COVID-19 pandemic.