Remote assessment of the impact of lockdown measures on mental health in multiple sclerosis patients

ABSTRACT

Background: Post-traumatic stress disorder (PTSD) has been reported in up to 15% ofgeneral population during and after the first wave of the COVID-19 pandemic. The pandemic has acted as a catalyst for the application of telemedicine in neurology. Objective(s) to evaluate the presence of PTSD symptoms as effect of the lockdown measures in people with MS (PwMS) using an e-health application specifically built for remote management of PwMS, SMcare2.0 application. Method(s) Between March 4, 2020 and July 5, 2020 (T0) PwMS who were using (n=290) the app were asked to fill in the Impact of Event Scale - Revised (IES-R) questionnaire to evaluate the presence of PTSD symptoms. The IES-R has 3 subscales intrusion, hyperarousal, avoidance. The total IES-R score ranges from 0 to 88. A cut-off value of 33 of the total score was used to define the presence of PTSD symptoms (PTSD+). Only those PwMS who filled-in the questionnaire the first time were asked to answer again it when the lockdown measures were abolished (T1). Clinical and demographic data were extracted from the Italian MS register application and linked to the IES-R results. Baseline clinical characteristics of PwMS (classified on the basis of IES-R score) and the proportion of PTSD+, the subscales and the total score at T0 and T1 were compared. Result(s) During the lockdown 90 PwMS (31% response rate) completed the IES-R (62 F;mean (SD) age 40.1(1.0) years;median (IQR) EDSS score 2.3 (1-8);mean disease duration (SD) 10.7 (0.7)). Mean (SD) baseline subscales values were intrusion 15.9 (7.1), hyperarousal 10.7 (5.0), avoidance 15.4 (6.7). Mean (SD) total IES-R score was 42.0 (17.0), 63 (70%) patients scored above 33 and were identified as having recently developed PTSD symptoms. No significant difference were found between PTSD+ and PTSD- patients in terms of age, EDSS and disease duration. At T1, when the lockdown measures were removed, the IES-R scores were significantly reduced in comparison to T0 scores (intrusion 8.6 (8.9), hyperarousal 6.0 (5.8), avoidance 8.4 (8.5), total score 4.8 (1.9), p<0.0001). The number of patients classified as PTSD+ was significantly reduced in comparison to T0 (16 (17.8%), p<0.0001). Conclusion(s) Our study demonstrated that PwMS during and after lockdown manifested post-traumatic stress symptoms. Furthermore, our results show how e-data collected can be useful in remotely monitoring patients and can be easily linked to clinical data collected by disease registries.