Changes in mental health symptoms from pre-COVID-19 to COVID-19 among participants with systemic sclerosis from four countries: A Scleroderma Patient-centered Intervention Network (SPIN) Cohort study

J Psychosom Res. 2020 Dec;139:110262. doi: 10.1016/j.jpsychores.2020.110262. Epub 2020 Oct 3.

Abstract

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.

Keywords: Adult; Anxiety; COVID-19; Clinical epidemiology; Depressed mood; Depressive symptoms; Epidemiology; Pandemic; Scleroderma; Systemic sclerosis.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • COVID-19 / epidemiology
  • COVID-19 / psychology*
  • COVID-19 / therapy
  • Canada / epidemiology
  • Cohort Studies
  • Female
  • France / epidemiology
  • Humans
  • Longitudinal Studies
  • Male
  • Mental Disorders / epidemiology
  • Mental Disorders / psychology*
  • Mental Disorders / therapy
  • Mental Health / trends*
  • Middle Aged
  • Patient-Centered Care / methods
  • Patient-Centered Care / trends*
  • Scleroderma, Systemic / epidemiology
  • Scleroderma, Systemic / psychology*
  • Scleroderma, Systemic / therapy
  • United Kingdom / epidemiology
  • United States / epidemiology