EVALUATION OF MENTAL STATE AND CLINICAL SYMPTOMS OF CORONAVIRUS PANDEMIC IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE

ABSTRACT

Background Coronavirus disease 2019 (COVID-19) has spread worldwide and the World Health Organization declared COVID-19 a pandemic on March 11th, 2020. In Japan, there have been more than 135,000 infected patients and 1950 deaths at late-November 2020. It remains unclear whether COVID-19 affects the clinical course of patients with chronic diseases, including inflammatory bowel disease (IBD). We previously reported that 75% in 1078 IBD patients believe that psychologic stress triggered an exacerbation of their disease, and that a worsened mental state corresponds with disease activity in IBD patients, especially in those who believe that their disease is exacerbated by psychologic stress (Araki M, et al. PLoS One, 2020). The aim of this study was to assess an association of psychologic stress /mental state and clinical symptoms of IBD patients during the COVID-19 pandemic. Methods IBD outpatients were recruited to obtain questionnaires about clinical symptoms, lifestyle habit, medication status, psychologic stress and mental state in Osaka University Hospital from May to June 2020, which was at the end of the first peak of COVID-19 pandemic in Osaka, Japan (pandemic period). As for mental state, the center for epidemiologic studies depression (CES-D) score of 7 points or higher was defined as depression, and the CES-D scores at the pandemic period were compared with those obtained in the previous survey performed from 2015 to 2017. The clinical activity indices [partial Mayo score for ulcerative colitis (UC) and Crohn’s disease activity index for Crohn’s disease (CD) ]at the pandemic period were compared with those from December 2019 to February 2020 (pre-pandemic period). Results A total of 99 adult IBD patients, comprising 38 patients with UC and 61 with CD, were recruited. The mean age (± SD) of the patients was 47.5 (± 14.7) years, and the age at diagnosis was 30.9 (± 13.9) years. No patients were diagnosed as COVID-19. Eighty-four percent of the patients reported as mentally stressed in the questionnaire. The average CES-D score was 5.89 (± 3.41) during the pandemic, which was significantly higher than the previous survey (2.27 ± 3.44, p <.001). The proportion of depressed patients was 40% (38/96), which was also significantly higher than the previous survey [13% (16/122), p <.001]. The mean values of partial Mayo score, Crohn’s disease activity index, and CRP during the pandemic period were 1.29 (± 1.78), 118 (± 85.0), and 0.23 (± 0.52) mg/dl, respectively, all of which were comparable with those in the pre-pandemic period [1.74 (± 2.16), 115 (± 76.8), 0.47 (± 1.18) mg/dl, respectively]. Conclusion During the COVID-19 pandemic, IBD patients were mentally stressed, although their clinical activities were not significantly changed during the short-term period.