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You don’t need to conduct a scientific study to have an inkling that many people have become more depressed and anxious as a result of the COVID-19 pandemic. Fears about contracting the virus (and having serious complications), distancing measures that have physically separated families and friends, and major disruptions to the way we work, travel, shop, and perform other daily activities have all taken a toll. You’d be hard-pressed to find someone who hasn’t felt at least a little more stressed, sad, or angry as a result of the coronavirus.
But how severely have these changes impacted people with rheumatic conditions specifically?
There are a few reasons that these groups may be uniquely affected by COVID19 stress:
- Many patients take immunosuppressive medications and have had concerns that these medications can make them more susceptible to infection. (Research so far seems to indicate that most rheumatic disease medications have not, with the exception of corticosteroids.)
- Many have comorbid conditions — such as heart and lung disease — that are associated with worse COVID-19 outcomes.
- Many have higher rates of mental health problems, such as anxiety and depression, long before the pandemic began.
Numerous rheumatologists and public health experts have been attempting to answer that question, primarily by surveying patients about their mindset throughout the pandemic.
Several of their studies were presented at ACR Convergence 2020, the American College of Rheumatology’s annual (virtual) meeting.
While most of these studies have concluded — not surprisingly — that it’s common for people with rheumatic disease to be depressed or anxious during this time, there were a few interesting glimmers of positivity that are worth noting.
1. Being used to isolation and anxiety may be normalizing the patient experience
One study, which focused on lupus patients in Georgia, found that a significant number of people with lupus actually experienced improvements in their mental and emotional wellbeing during the earliest days of the pandemic. The authors speculated that this might have occurred because lupus patients were already used to the isolation and anxiety that the general population was experiencing for the first time, and that the narrowing of this gap “may have made those with [lupus] feel closer to the norm while limiting opportunities for certain negative experiences, including discrimination.”
2. Getting infected with COVID actually improved mental health
Other research, based on the COVID-19 Global Rheumatology Alliance Patient Experience Survey, found that people with rheumatic disease who survived COVID-19 infection reported that their mental health had improved in the aftermath. “It is possible that these patients perceived a reduced mortality risk, despite the consequences to their physical health,” the authors suggested.
Overall, however, the findings weren’t quite so sunny.
3. Stress affected disease activity and other symptoms
One study of lupus patients in California determined that “psychological stress during the COVID-19 pandemic [was] independently associated with worse [patient-reported outcomes] including self-reported disease activity, fatigue, and cognitive dysfunction.”
And the above-mentioned COVID-19 Global Rheumatology Alliance Patient Experience Survey determined that people who were having trouble connecting with their rheumatologist as during the pandemic had worse physical health, probably thanks to stress. Those who were quarantining, either as a precautionary measure or because they had contracted coronavirus, also fared more poorly.
4. A combination of factors seems to contribute to high rates of anxiety and depression
In another study, which focused on rheumatology patients in the Bronx, New York, researchers led by rheumatologist Shereen Mahmood, MD, Assistant Professor at Montefiore Medical Center/Albert Einstein College of Medicine, found that 56 percent of rheumatology patients surveyed had at least mild symptoms of depression and 48 percent had at least mild symptoms of anxiety.
Dr. Mahmood notes that the combination of the pandemic, living with a chronic physical ailment, and residing in a diverse, low-income area might all conspire to worsen mental health outcomes.
“Despite great advances in early diagnosis and treatment [of rheumatic disease], there is still a significant burden of chronic pain, disability, and long-term medications that may have a financial stress added to it,” says Dr. Mahmood. “Further, in certain rheumatic diseases, there is evidence for a primary inflammatory component contributing to the high rates of depression and anxiety seen.”
Dr. Mahmood continues, “there is [also] evidence that people who come from disadvantaged backgrounds, such as low-income populations and/or marginalized populations, have higher rates of stress, anxiety, and depression.”
Although this particular study only aimed to capture patients’ current mental health status, other research was able to examine patients’ mental health over time to see how the pandemic might have changed it.
5. Medical worries and questions have added to COVID-related stress
A study led by Patricia Katz, PhD, Professor of Medicine and Health Policy at the University of California San Francisco, used data from FORWARD, The National Databank for Rheumatic Diseases. This ongoing registry has been surveying patients every six months, so Dr. Katz and her colleagues were able to compare recent pre-COVID responses to responses that were recorded during the pandemic.
According to the study — which included more than 1,500 respondents with rheumatoid arthritis, osteoarthritis, or lupus — “substantial increases in symptoms of both anxiety and depression” had occurred during the pandemic.
The researchers also included a few COVID-specific questions in the most recent surveys in an attempt to distinguish between general stress and stress that was specifically linked to the pandemic. “People were much more stressed about COVID,” Dr. Katz says.
“People with rheumatic disease have a lot of concerns, particularly about their medications,” she says. “Many wondered if they were more vulnerable to COVID, or if there were going to be drug shortages” as a result of others experimenting with rheumatic medications like hydroxychloroquine as a COVID treatment. (Research has since shown that hydroxychloroquine is not an effective COVID treatment.)
6. Staying home as much as possible can lead to loneliness
At the same time, many of these patients who fear for their health have been especially strict about social isolation, which can lead to loneliness, Dr. Katz adds. Others might be missing out on exercise and other activities that they enjoy.
As the pandemic continues, Dr. Katz says that people with rheumatic disease should check in with their rheumatologists about their physical health risks but not forget about their emotional needs.
“I think it’s important to try to reach out and create community where you can so you have some social supports,” she says. “You should also continue with whatever physical activity you can, because it helps you cope with stress. Try to find positive things to do.”
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Katz P, et al. Changes in Mental Health During the COVID-19 Pandemic Among Individuals with Rheumatic Disease [abstract]. Arthritis & Rheumatology. November 2020. https://acrabstracts.org/abstract/changes-in-mental-health-during-the-covid-19-pandemic-among-individuals-with-rheumatic-disease.
Interview with Patricia Katz, PhD, Professor of Medicine and Health Policy at the University of California San Francisco
Interview with Shereen Mahmood, MD, Assistant Professor at Montefiore Medical Center/Albert Einstein College of Medicine in Bronx, New York
Kennedy K, et al. Modeling the Effects of Covid-19 Protective Behaviors and Healthcare Delivery on the Health of Patients with Rheumatic Disease [abstract]. Arthritis & Rheumatology. November 2020. https://acrabstracts.org/abstract/modeling-the-effects-of-covid-19-protective-behaviors-and-healthcare-delivery-on-the-health-of-patients-with-rheumatic-disease.
Lim S, et al. Unexpected Changes in Physical and Psychological Measures Among Georgia Lupus Patients During the Early Weeks of the COVID-19 Pandemic in the United States, March 30–April 21, 2020 [abstract]. Arthritis & Rheumatology. November 2020. https://acrabstracts.org/abstract/unexpected-changes-in-physical-and-psychological-measures-among-georgia-lupus-patients-during-the-early-weeks-of-the-covid-19-pandemic-in-the-united-states-march-30-april-21-2020.
Mahmood S, et al. COVID-Related Distress and Mental Health in Adult Rheumatology Patients During the COVID-19 Pandemic [abstract]. Arthritis & Rheumatology. November 2020. https://acrabstracts.org/abstract/covid-related-distress-and-mental-health-in-adult-rheumatology-patients-during-the-covid-19-pandemic.
Patterson S, et al. Perceived Stress During the COVID-19 Pandemic Independently Associates with Worse Patient-Reported Outcomes in Systemic Lupus Erythematosus (SLE) [abstract]. Arthritis & Rheumatology. November 2020. https://acrabstracts.org/abstract/perceived-stress-during-the-covid-19-pandemic-independently-associates-with-worse-patient-reported-outcomes-in-systemic-lupus-erythematosus-sle.