Abstract
Background
Patients with chronic diseases, particularly those requiring immunosuppression, are thought to be at increased risk of poor mental health during the COVID-19 pandemic. However, few studies have assessed the mental health of such patients during the current or past pandemics.
We aimed to assess the incidence of depression, anxiety & stress in a cohort of inflammatory bowel disease (IBD) patients early during the COVID-19 pandemic, & explore for association with risk of severe COVID-19 based on British Society of Gastroenterology guidelines, & other factors.
Methods
A survey including the Patient Health Questionnaire-9, General Anxiety Disorder-7, & Perceived Stress Scale tools for depression, anxiety & stress, respectively, was administered to a cohort of IBD patients from a tertiary centre in London, United Kingdom, in June 2020.
Results
274 patients responded to the survey (57% response rate), including 54 low risk, 152 moderate risk, & 68 high risk for severe COVID-19. Moderate-severe depression was observed in 61 (22.5%), moderate-severe anxiety in 49 (18%), while 39 (14%) had both diagnoses (Table). Mean (SD) stress score was 16.2 (7.4). There was no association between degree of severe COVID-19 risk & psychological morbidity. Flare symptoms & fatigue were associated with worse psychological morbidity across all measures, while accessibility of information regarding COVID-19 risk & reducing that risk was protective for depression (OR 0.56 [0.33–0.94], p=0.03), anxiety (OR 0.62 [0.4–0.96], p=0.03), & stress (standardized β-coefficient -0.15 [-0.28--0.03], p=0.02) (Figure). 79 (30%) respondents were interested in receiving psychological support during the pandemic, while 200 (76%) expressed interest beyond the pandemic.
Table:
Depression, anxiety & stress, stratified by risk category
| Low Risk (n=52) | Moderate Risk (n=151) | High Risk (n=68) | Between groups p-value | p-value for trend | |
| Depression | |||||
| None-Mild, n (%) | 43 (82.6) | 120 (79.4) | 47 (69.1) | 0.56 | 0.06 |
| Moderate-Severe, n (%) | 9 (17.3) | 31 (20.5) | 21 (30.8) | ||
| Anxiety | |||||
| None-Mild, n (%) | 42 (80.7) | 127 (84.1) | 52 (76.5) | 0.80 | 0.58 |
| Moderate-Severe, n (%) | 10 (19.2) | 24 (15.9) | 15 (22.1) | ||
| Perceived Stress Scale Score | |||||
| Mean (SD) | 16.9 (7.7) | 15.6 (7.3) | 17 (7.6) | 0.30 | 0.69 |
Figure:
Association between access to COVID-19 risk information & at least moderate depression (A), anxiety (B), & Perceived Stress Scale score (C)
Conclusion
Depression, anxiety & stress among IBD patients during the pandemic are common, however their frequency is similar to pre-pandemic rates & general population levels reported during the same period. Ensuring easy access to personalized risk information with targeted psychological support may mitigate psychological burden as patients reintegrate into society & deal with future COVID-19 waves or variants.