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Mental Health Issues Common in Arthritis art

This article has been updated to reflect new information as of March 23, 2020.

Although the U.S. Centers for Disease Control and Prevention recently updated its recommendations for immunocompromised patients and those at high-risk for coronavirus complications, saying that these more vulnerable people should “stay home as much as possible,” by the time this guidance came out, you were likely already engaging in what infectious disease and public health experts call social distancing practices.

This means staying away from crowded places like malls, concerts, and sporting events games and avoiding unnecessary interactions with others.

However, it’s important to acknowledge that staying home — especially for long periods of time and during an unprecedented public health crisis like this one — can take an emotional toll. Social distancing can quickly lead to feelings of loneliness.

“I’m an extrovert, so self-containing at home is hard socially,” shared rheumatoid arthritis patient Cheryl Crow during a recent #CreakyChats Twitter chat about the coronavirus impact on chronic illness patients.

“As human beings, we are not wired to be all by ourselves. We are animals that need contact, so finding ways to connect with people — even if you’re not physically connecting with them — is really important,” says Laurie Ferguson, PhD, clinical psychologist and Vice President of Research and Education for the Global Healthy Living Foundation.

Social isolation and loneliness can lead to other health concerns, too.

“We know there’s a big link between loneliness and depression,” says Katie Willard Virant, LCSW, a psychotherapist in St. Louis, Missouri who herself has Crohn’s disease. People with chronic conditions are already more vulnerable to anxiety and depression, partly because of the pain that comes with these diseases, says Dr. Ferguson. Studies bear this out: Swiss researchers found that up to 50 percent of people with autoimmune disorders had depressive-like symptoms, for example. Another study found that between 13 and 42 percent of those with rheumatoid arthritis (RA) experience depression.

You may be used to hunkering down at home whenever you experience a flare in symptoms. “When you live with a chronic illness, you get pretty good at using various tools to stay in touch with people, reading books to keep yourself engaged, watching films,” says Virant. But the heightened anxiety and uncertainty surrounding this specific coronavirus outbreak — which, at times, can feel all-consuming — can make it harder to navigate your fears.

First, realize that you’re not alone. Many patients in the Global Healthy Living Foundation and CreakyJoints patient communities are reporting similar concerns and fears.

“I feel a bit more isolated,” said CreakyJoints member @PsAMermaid during the #CreakyChat. “It has been tough for me and my immediate family and friends because they are all worried about giving me something.”

CreakyJoints member @VenZenix agreed. “I find that I feel more stress, especially going out into crowded places. I am staying home much more now, which is giving me cabin fever.”

Next, use your tried-and-true tactics for keeping connected to others and trying to stay on an even keel emotionally, whether it’s taking a short walk near your home or binge watching shows that have nothing to do with coronavirus. And because everyone can benefit from expand their emotional health toolbox of coping techniques, read on for more tactics for preventing loneliness.

Ways to Fight Loneliness from Social Isolation

Tap into your virtual network

Social media is often maligned but it can become a godsend during times when you have to stay put and want to stay connected to the world outside, says Virant. One idea from Linda Mona, PhD, a licensed clinical psychologist with Inclusivity Clinical Consulting Services, whose research focuses on the diverse life experiences of individuals living with chronic health conditions/disability: Use FaceTime, Skype, Zoom, or other group chat platforms to have a “happy hour” online with other friends. CreakyJoints maintains active communities on Twitter, Facebook, and Instagram, where you can connect with other patients about issues both related to coronavirus fears, or about anything else to help take your mind off those fears.

Get to know your neighbors

“Maybe you can’t go to a public place, but you and your neighbors can chat outside from a safe distance where it doesn’t feel quite so closed in. Those kinds of contacts can be nourishing,” says Dr. Ferguson.

Use phone chats to reconnect with longtime friends

Many of us struggle to maintain regular phone calls with longtime friends or loved ones. Text messaging and online messaging through social media platforms have replaced many casual “catch-up” calls that were routine just a few years ago. Now is a good time to rekindle them. A half-hour phone chat with a friend whose voice you haven’t heard in months or years can go a long way to making you feel less isolated.

Ask about digital versions of community events

If you normally attend religious services but need to avoid them for the time being, ask your house of worship if it can make services or sermons available on its website or even live-streams services, as Pope Francis just did from Rome this past weekend. If you’re part of other local groups that meet regularly, such as a parent-teacher organization, ask if meetings can be live-streamed or have a phone dial-in so you can feel like you’re in the loop.

Remind yourself that this situation is different and unprecedented

Chronic illness has its usual ebb and flow of loneliness. It is normal to feel isolated and down when your condition has you missing events or fatigue makes it too hard to stay in touch with others. When this happens, it’s easy to blame yourself, feel depressed, or be worried that your condition is making your life different from that of those around you. During the coronavirus outbreak, remind yourself that millions of people are taking the same precautionary steps that you are.

Even if you feel alone, know that you’re in this with a lot of people who all want the same things for themselves and others: to stay healthy and safe and feel protected and loved.

The Importance of Self Mental Health Check-Ins

Because those with chronic conditions are more vulnerable to depression and anxiety, be vigilant about your emotional state right now.

One way to monitor your feelings: Take a few deep cleansing breaths and allow yourself to be present in your body, says Virant. Acknowledge that this is an anxious time and let those feelings wash through you. Be gentle with yourself. Then check in to see whether that practice is helping to ease your feelings or whether it makes them worse, she explains. If you’re still jittery or sad, then you know you’re not in a healthy place.

Know the symptoms of depression, says Dr. Ferguson: “Hopelessness, an existential feeling of aloneness, which is different than just loneliness — that ‘I really am all alone and nobody really knows what I’m going through.’ And then with that, a feeling of helplessness, that ‘there’s really nothing I can do about it.’ If you find yourself continually running doomsday scenarios, either for yourself or for the world, those are signs that you are mentally moving in kind of a circular direction.”

Other signs of depression include such symptoms as these, lasting most days for more than two weeks:

  • Feelings of sadness, tearfulness, emptiness, or hopelessness
  • Anger, irritability, or frustration
  • Loss of interest or pleasure in most or all normal activities
  • Fatigue, tiredness, and lack of energy
  • Sleeping too little or too much
  • Changes in appetite, including eating too little or too much
  • Anxiety, agitation or restlessness
  • Trouble concentrating and making decisions
  • New physical problems, such as back pain, digestive issues, or headaches
  • Suicidal thoughts or attempts

If you or someone you know is exhibiting any of the above depression symptoms, tell your health care provider, contact a mental health professional right away, call your local suicide hotline (1-800-273-8255), or go to the emergency room.

You can also call a free 24-hour Disaster Distress Helpline from the Substance Abuse and Mental Health Services Administration (SAMHSA), at 1800-985-5990, if you feel lonely or need support. SAMHSA is part of the U.S. Department of Health and Human Services.

Other crisis lines to try:

  • Crisis Chat: 1-800-273-TALK (8255) or text MHA to 741741
  • Crisis Text Line: Text HOME to 741741 for free, confidential crisis counseling 24/7
  • IMAlive: online chat service at imalive.org
  • National Alliance on Mental Illness (NAMI): 1-800-950-NAMI (6264)

Managing Necessary Outings

Unless you are under a strict quarantine, you may still have to leave the house sometimes, but it can be tough to know what is truly a high-risk situation and what just feels dangerous. This can also depend on your specific geographic environment and how widespread the coronavirus is in your area.

Check in with your health care provider, says Dr. Mona. “Say, ‘I’m hearing that people with chronic illnesses should avoid going out in public. What does this mean for me? What should I be doing differently?”

Depending on your specific medical history and current environment, they should counsel you on which activities may be OK and which should be avoided. For example, maybe it is prudent to run a short local errand during off-peak hours but you should avoid taking public transportation or attending large gatherings.

These are personal choices that are informed by your specific health situation and lifestyle needs.

If these high-priority outings still feel fraught, talk yourself through it with a mental script to help with your anxiety, says Dr. Ferguson. Say: “I know I’m stepping out here and I’m going to be very careful. I’m not going to touch anybody. I’m going to wash my hands thoroughly before I go out and when I come back, but I am going to take a few steps into the world.”

Remember to be vigilant about handwashing if you’re out of the house and avoid hand-to-hand contact, hugs, kisses, or other close-contact greetings.

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Depression. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007.

Interview with Katie Willard Virant, LCSW, a psychotherapist in St. Louis, Missouri

Interview with Laurie Ferguson, PhD, clinical psychologist and Vice President of Research and Education for the Global Healthy Living Foundation

Interview with Linda Mona, PhD, a licensed clinical psychologist with Inclusivity Clinical Consulting Services

Margaretten M, et al. Depression in patients with rheumatoid arthritis: description, causes and mechanisms. International Journal of Clinical Rheumatology. December 2011. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3247620/#R1

People at Higher Risk for COVID-19 Complications. Coronavirus Disease 2019. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html.

Pryce CR. Depression in Autoimmune Diseases. Inflammation-Associated Depression: Evidence, Mechanisms and Implications. May 2016. Doi: https://doi.org/10.1007/7854_2016_7.

Taking Care of Your Behavioral Health: Tips for Social Distancing, Quarantine, and Isolation During an Infectious Disease Outbreak. Substance Abuse and Mental Health Services Administration. U.S. Department of Health and Human Services. https://store.samhsa.gov/system/files/sma14-4894.pdf.

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