Researchers recently found that the psychosocial toll of the pandemic on patients with rheumatic disease supports the need for care teams to assess and address mental health side effects.

“Research shows people with rheumatic conditions may be more susceptible to severe illness from COVID-19 due to their immunocompromised state,” explained the study authors. “The COVID-19 pandemic has been associated with negative impacts on mental health & there is higher prevalence of depression & anxiety in patients with rheumatic illness.”

The researchers explained that past studies have focused on the medical impact of the pandemic and less is known about the impact on mental health among patients with rheumatic disease. 

To assess the psychosocial impact, a 95-item online survey with Likert scale and open-ended questions was distributed. The survey was sent to patients with rheumatic disease who were 18 years of age and older. The survey questions included questions on the following: 

• physical and mental health; 
• illness management;
• access to care;
• social environment; and 
• resources. 

“The Patient Health Questionnaire-4 (PHQ-4) & the Hospital Anxiety & Depression Scale (HADS) assessed [mental health], they explained. “A comparative analysis was conducted for those who reported a change in emotional health (ECs) vs. those who did not (NECs). Independent samples t-tests & chi-square tests were used to examine differences.”

The authors received 382 responses to the survey. The participants consisted of adults 35 years of age and older (79%), were mostly female (91%), and non-Hispanic (77%). Furthermore, 46% were White, 9% Asian, 8% African American, and 6% other, and 96% had health insurance while 50% were employed.

The findings of the survey showed a majority of participants had SLE (67%), RA (19%), & Sjogren’s syndrome (8%) with a mean of 13 years since diagnosis. More than half of the survey group (63%) answered that they experienced a flare since the start of the pandemic, and 16% received a COVID-19 diagnosis. Additionally, 19% of the group said they experienced no changes in care during the pandemic, 33% said their care was switched to telehealth, and 19% said they experienced postponed appointments. 

“Most (76%) reported a change in their mood and/or emotional health, with 81% indicating that this change was due to the pandemic,” the authors reported. “The mean PHQ-4 score for all respondents was 4.3 (SD: 3.5) with 31% scoring moderate/severe for psychological distress. The mean HADS Anxiety & HADS Depression scores were 8.2 (SD: 4.9) & 7 (SD: 4.3) with 54% & 43% scoring borderline/abnormal.”

Based on the survey findings, negative emotional changes were linked with higher PHQ-4 & HADS scores (P <.001). 

“Significant differences were found across these areas: higher % switching to telehealth (45% v 23%, P=0.001), receiving [mental health] services (31% v 7%, P< 0.001), taking medication for their [mental health] (29% v 5%, P< 0.001) & starting counseling (14% v 0%, P=0.001).”

Of important note, half of the participants reporting emotional changes said they would desire a support program. The authors explained that this helps support the need for virtual programs on coping with illness, mental health resources, and virtual support groups. 

“Despite limitations due to a convenience sample, results contribute to research on the psychosocial impact of the pandemic on rheumatic disease patients—the toll on emotional health & increased isolation,” the authors concluded. “The significant differences found in those who reported an emotional change vs. those who did not support the need for the care team to assess and address [mental health] issues during the pandemic.”

—Julie Gould 

Reference:
Flores M, Toral P, Horton R, et al. The psychosocial impact of the COVID-19 pandemic on the rheumatology patient experience. Presented at: American College of Rheumatology Convergence 2021; November 5-9, 2021; virtual. Abstract 0266.