Impact of the COVID-19 pandemic on mental health, physical activity and sleep in children with neuroinflammatory disorders

ABSTRACT

Objective: To assess changes in anxiety, fatigue, depression, physical activity, and sleep associated with the COVID-19 pandemic in youth with neuroinflammatory disorders. Background: Children with neuroinflammatory disorders have high rates of anxiety, depression, and fatigue, plus reduced physical activity compared to healthy counterparts. We examined whether patients with neuroinflammatory disorders would show changes in the above domains associated with COVID-19, hypothesizing poorer outcomes in patients with chronic/recurrent disease. Design/Methods: Children with neuroinflammatory disorders completed questionnaires from March-August 2020 (n=129) Screen for Childhood Anxiety and Related Disorders, Centre for Epidemiologic Studies Depression scale for Children, Pediatric Quality of Life Multidimensional Fatigue Scale, Godin Leisure-Time Exercise Questionnaire, and Children's Sleep Habits Questionnaire. Clinical/demographic data were collected via standardized Case Report Form. We used pre-pandemic data for paired analysis where available (n=87). Results: Participants were 57% female (mean age 13±4 years). Children with monophasic Acquired Demyelinating Syndrome (monoADS) engaged in moderate/vigorous physical activity a mean of 6±4 times/week pre-pandemic (n=61), and 5±4 during the pandemic (n=62). Children with chronic/recurrent neuroinflammation (crNI;Multiple Sclerosis (MS) and neuroinflammation with systemic involvement) exercised 4±3 times/week pre-pandemic (n=21 (14 MS)), and 4±2 during (n=25 (15 MS)) (monoADS vs crNI p=0.076). Across all groups, the pandemic brought a rise in sleep time (9±1 versus 10±2 hours, p<0.001), and improved sleep-rest fatigue (p=0.05). Despite this, children with MS reported more sleep-rest fatigue compared to monoADS (p=0.043). Average rates of depression and anxiety were similar pre/post-pandemic (29%/31%, p=0.507;16%/17%, p=0.857). During the pandemic, however, rates of depression/anxiety were significantly different by disease type systemic involvement (60%/50%), MS (33%/27%), monoADS (22%/16%)(Chi-square, p=0.048/0.049). Conclusions: With the pandemic, despite increased sleep, youth with neuroinflammatory disorders continued to display high rates of depression/anxiety and reduced physical activity. There were significantly different rates of depression/anxiety between disease types. Individuals with recurrent disease had more fatigue than those with monophasic disease.