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Changes in mental health symptoms from pre-COVID-19 to COVID-19 among participants with systemic sclerosis from four
Brett D Thombs1, Linda Kwakkenbos2, Richard S Henry3
1Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1E4, Canada; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada; Department of Medicine, McGill University, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada; Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Quebec H3A 1G1, Canada; Department of Educational and Counselling Psychology, McGill University, 3700 McTavish Street, Montreal, Quebec H3A 1Y2, Canada; Biomedical Ethics Unit, McGill University, 3647 Peel Street, Montreal, Quebec H3A 1X1, Canada.
Introduction:
No studies have reported mental health symptom comparisons prior to and during COVID-19 in vulnerable medical populations.
Objective:
To compare anxiety and depression symptoms among people with a pre-existing medical condition and factors associated with changes.
Methods:
Pre-COVID-19 Scleroderma Patient-centered Intervention Network Cohort data were linked to COVID-19 data from April 2020. Multiple linear and logistic regression were used to assess factors associated with continuous change and ≥ 1 minimal clinically important difference (MCID) change for anxiety (PROMIS Anxiety 4a v1.0; MCID = 4.0) and depression (Patient Health Questionnaire-8; MCID = 3.0) symptoms, controlling for pre-COVID-19 levels.
Results:
Mean anxiety symptoms increased 4.9 points (95% confidence interval [CI] 4.0 to 5.7). Depression symptom change was negligible (0.3 points; 95% CI -0.7 to 0.2). Compared to France (N = 159), adjusted anxiety symptom change scores were significantly higher in the United Kingdom (N = 50; 3.3 points, 95% CI 0.9 to 5.6), United States (N = 128; 2.5 points, 95% CI 0.7 to 4.2), and Canada (N = 98; 1.9 points, 95% CI 0.1 to 3.8). Odds of ≥1 MCID increase were 2.6 for the United Kingdom (95% CI 1.2 to 5.7) but not significant for the United States (1.6, 95% CI 0.9 to 2.9) or Canada (1.4, 95% CI 0.7 to 2.5). Older age and adequate financial resources were associated with less continuous anxiety increase. Employment and shorter time since diagnosis were associated with lower odds of a ≥ 1 MCID increase.
Conclusions:
Anxiety symptoms, but not depression symptoms, increased dramatically during COVID-19 among people with a pre-existing medical condition.
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