SARS‐CoV‐2 Vaccination Among Immunocompromised Patients Helps Mental Health

Dr Patricia Katz sheds light on the cohort analysis findings that suggest a positive correlation between mental wellbeing—a common burden among patients with chronic inflammatory diseases—and COVID-19 vaccination.

Patricia Katz, PhD, is a professor of medicine and health policy at the University of California San Francisco.

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Transcript:

Disclaimer:
Any views and opinions expressed are those of the authors and/or participants, and do not necessarily reflect the views, policy or position of the Rheumatology and Arthritis Learning Network or HMP Global, its employees and affiliates.

RALN:
Welcome to this podcast from the Rheumatology and Arthritis Learning Network. I'm your host, Priyam Vora, and we are talking with Dr. Patricia Katz, a professor of medicine and health policy at the University of California San Francisco. Today we are going to discuss her research into how sleep disturbances and anxiety decreased considerably among immunocompromised patients who received two doses of COVID-19 vaccination. Thank you for joining us today, Dr. Katz.

Dr. Patricia Katz:
Thank you for inviting me.

RALN:
So why did you choose to conduct research into this topic?

Dr. Patricia Katz:
Well, I want you to cast your mind back to 2020 when we were all terrified of COVID and when the vaccines, when we heard vaccines were coming out, I think there was this hope that we would all be safe again. But there were concerns about people who had chronic immune conditions because we didn't know how the vaccines would affect them, how their therapies might affect the effectiveness of the vaccines if they might be more prone to have side effects. We were getting information at that time that people that had these conditions some of them were at greater risk for bad outcomes from COVID. It depended in part on the medications that they were taking, but there wasn't this perception of increased risk. So I think people were really looking forward to this. So this study was intended to look both at the biological mechanisms around the COVID vaccine and its effects, and also just to look at the effects on the person from their own perception, so that that's the background of the study.

RALN:
Okay. So before we get into the study, how did the pandemic negatively impact patients who have chronic inflammatory diseases?

Dr. Patricia Katz:
I think we were, at that time, we were all, we had high levels of anxiety about going out, just living our lives, going to the grocery store, seeing other people. And so people who had some sort of compromise to their immune system had, I think, particularly high concern about those things. So they were probably more isolated than many of the rest of us, and I think their levels of anxiety around becoming ill with COVID were probably higher.

Priyam Vora:
Would you be able to give us an overview of the study?

Dr. Patricia Katz:
Sure. So we started collecting data in December of 2020 when we heard vaccines were about to come out. So this was a real seat of the pants research effort, and it was a collaboration between UCSF and Washington University in St. Louis collecting data from employees, staff, and patients in the various clinics of those groups, people who were patients and had one of these conditions. Primarily the conditions that were the most prevalent were inflammatory bowel disease, rheumatoid arthritis, and so we ended up with about 300 people. The number varied. We collected data before people got their vaccine, both we got data and samples after their first dose of the vaccine. And then the second dose, if you remember, I had to think about this for a minute because it's been a while.

It was four weeks later I think. And then we got another data collection and sample after that second dose. So there's some work that's been done looking at the biological aspects that I'm not going to talk about. That's not my area. I couldn't talk to you coherently and accurately about that. But we did, the questionnaires that we included, were looking at some of the symptoms and concerns that people typically have, chronic inflammatory disease. And so it was things like pain and fatigue and physical function. But we also asked questions about anxiety, depression, participation in social life and sleep disturbance. So we had those at the three time points as well.

RALN:
And what did you find?

Dr. Patricia Katz:
We found that if we looked at the group as a whole, we saw decreases in sleep disturbance for the whole group. And we saw some other small changes that weren't really meaningful, but that was the thing that really stood out was the changes in the sleep disturbance. We had. Also, it looked like we were seeing a decrease in anxiety as well. After thinking about the results, just wondered if there was a difference in the people who had very high levels of anxiety at baseline versus compared to the people who had more moderate or lower levels. And we did find that the people who had high anxiety at baseline had significant decreases in their anxiety. We didn't see a change in the people who had lower levels. We saw sleep disturbance improvements in both groups though. And then also in the high anxiety group, we saw improvements in social participation, and we saw a few changes in other things, but again, they weren't really meaningful changes. So the big issue was the decrease in anxiety among this high anxiety group and the improvement in sleep.

Priyam Vora:
Would you say these findings are still relevant today and to booster doses?

Dr. Patricia Katz:
That's a really good question. My guess is that we may not see the same kind of effect because I don't think people have the same amount of concern and basically fear around COVID that we once did. There's some people that still will because they're really highly immunocompromised. And I think those people still have concerns, but I'm not sure that the booster doses are going to get the same reaction. At the same time, I think that we often underestimate the stress and anxiety that just having a chronic immune condition can create for people. And anything that people can perceive is going to make them healthier in the long run may reduce some of that stress or anxiety. So in that way, it may help, but I don't think we would see the dramatic results that we saw at this point in time.

RALN:
So these outcomes, the good outcomes that we talked about, what other factors might have helped improve these outcomes? Could it be the sense of security from being vaccinated or the belief that the pandemic is behind us, or both?

Dr. Patricia Katz:
Again, I think there was some sort of sense of security. I don't know if you remember when you got your first vaccine, but when I got mine, it was just this sense of there's an end to this. Also, remember how socially isolated we all were, and social isolation is not good for one's mental health. And so I think that perception that we're going to be able to see people and go back to some parts of our normal life, I think that that was probably a big part of it. And that would, I think, improve people's sleep as well, because not as worried about dying from COVID or getting really sick from COVID, and you can see your friends again and your family. I mean, that was a hard time. If we look back at, I think we have all tried to put it in the rearview mirror, but it was hard.

RALN:
Trying to block that memory. I know.

Dr. Patricia Katz:
Yeah.

RALN:
Any advice for rheumatologists or general practitioners?

Dr. Patricia Katz:
As I said, I think we underestimate the stress and anxiety that these conditions can cause people, and I think that stress and anxiety can lead to greater fatigue. It leads to more anxiety, it leads to more depression. And I think that... And it leads to sleep problems and sleep problems, it's this big naughty combination of factors. So we shouldn't underestimate the stresses that people are under just because they have one of these conditions and that stress can lead to other kinds of bad outcomes. So it's something to consider. I mean, we found that in lupus, people who have high levels of stress are more likely to have flares, for example.

RALN:
Do you have any plans to expand this to a broader study?

Dr. Patricia Katz:
No. I do have some work that's going on in stress and trauma in lupus in particular, but I think this was a point in time and it's a lesson for the future, but I don't really plan to expand this research.

RALN:
Just last question. Any parting thoughts for patients who have anxiety or sleep disturbance?

Dr. Patricia Katz:
I would say if you're having anxiety and sleep disturbance, talk to your rheumatologist or even your general practitioner. Anxiety and sleep disturbance. Both can permeate other aspects of life. Sleep disturbance can increase inflammatory activity, which has the potential to increase disease activity, anxiety can affect sleep. So it's, again, I would say if those things are going on in your life, talk to your physician about them and see if you can come up with a plan.

RALN:
Thank you so much for taking the time to talk to us. Once again for our listeners that was Dr. Patricia Katz explaining how patients with chronic inflammatory diseases were more likely to emotionally and psychologically benefit from the COVID-19 vaccination. Thank you, Dr. Katz.

Dr. Patricia Katz:
Thank you, Priyam.

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