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

Brett D Thombs; Linda Kwakkenbos; Richard S Henry; Marie-Eve Carrier; Scott Patten; Sami Harb; Angelica Bourgeault; Lydia Tao; Susan J Bartlett; Luc Mouthon; John Varga; Andrea Benedetti; SPIN Patient Advisors; SPIN Investigators

doi:10.1016/j.jpsychores.2020.110262

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.

Authors

Collaborators

Catherine Fortuné¹⁰, Amy Gietzen¹¹, Geneviève Guillot¹², Nancy Lewis¹³, Michelle Richard¹⁴, Maureen Sauvé¹⁰, Joep Welling¹⁵, Kim Fligelstone¹⁶, Karen Gottesman¹¹, Catarina Leite¹⁷, Elisabet Pérez¹⁸, Murray Baron¹⁹, Vanessa Malcarne²⁰, Maureen D Mayes²¹, Warren R Nielson²², Robert Riggs²⁰, Shervin Assassi²¹, Carolyn Ells¹⁹, Cornelia van den Ende²³, Tracy Frech²⁴, Daphna Harel²⁵, Monique Hinchcliff²⁶, Marie Hudson¹⁹, Sindhu R Johnson²⁷, Maggie Larche²⁸, Christelle Nguyen²⁹, Janet Pope³⁰, François Rannou³¹, Tatiana Sofia Rodriguez Reyna³², Anne A Schouffoer³³, Maria E Suarez-Almazor³⁴, Christian Agard³⁵, Alexandra Albert³⁶, Elana J Bernstein³⁷, Sabine Berthier³⁵, Lyne Bissonnette³⁸, Alessandra Bruns³⁸, Patricia Carreira³⁹, Benjamin Chaigne⁴⁰, Lorinda Chung⁴¹, Chase Correia⁴², Christopher Denton⁴³, Robyn Domsic⁴⁴, James V Dunne⁴⁵, Bertrand Dunogue⁴⁰, Dominique Farge-Bancel⁴⁰, Paul R Fortin⁴⁶, Jessica Gordon⁴⁷, Brigitte Granel-Rey⁴⁸, Pierre-Yves Hatron⁴⁹, Ariane L Herrick⁵⁰, Sabrina Hoa⁵¹, Niall Jones⁵², Artur Jose de B Fernandes³⁸, Suzanne Kafaja⁵³, Nader Khalidi²⁸, David Launay⁴⁹, Joanne Manning⁵⁴, Isabelle Marie⁵⁵, Maria Martin⁵⁶, Arsene Mekinian⁴⁰, Sheila Melchor³⁹, Mandana Nikpour⁵⁷, Louis Olagne³⁵, Susanna Proudman⁵⁸, Alexis Régent⁴⁰, Sébastien Rivière⁴⁰, David Robinson⁵⁹, Esther Rodriguez³⁹, Sophie Roux³⁸, Vincent Sobanski⁴⁹, Virginia Steen⁶⁰, Evelyn Sutton⁶¹, Carter Thorne⁶², Pearce Wilcox⁴⁵, Mara Cañedo Ayala⁶³, Andrea Carboni-Jiménez⁶³, Maria Gagarine⁶³, Julia Nordlund⁶³, Nora Østbø⁶³, Danielle B Rice⁶³, Kimberly A Turner⁶³, Nicole Culos-Reed⁶⁴, Laura Dyas⁶⁵, Ghassan El-Baalbaki⁶⁶, Shannon Hebblethwaite⁶⁷, Laura Bustamante⁶⁷, Delaney Duchek⁶⁴, Kelsey Ellis⁶⁴

Affiliations

¹ Lady 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. Electronic address: [email protected].
² Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Montessorilaan 3, 6525 HR, Nijmegen, the Netherlands.
³ Lady 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.
⁴ Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1E4, Canada.
⁵ Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada; Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada.
⁶ Department of Medicine, McGill University, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada; Research Institute of the McGill University Health Centre, Centre for Outcomes Research and Evaluation, 5252 de Maisonneuve #3D.57, Montreal, Quebec H4A 2S5, Canada.
⁷ Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, 3 Avenue Victoria, 75004 Paris, France; Service de Médecine Interne, Centre de Reference Maladies Systémiques Autoimmunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France.
⁸ Northwestern Scleroderma Program, Feinberg School of Medicine, Northwestern University, 675 North St. Clair, Chicago, IL 60611, USA.
⁹ 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; Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, 5252 boulevard de Maisonneuve, Montreal, Quebec H4A 3S5, Canada.
¹⁰ Scleroderma Society of Ontario, Hamilton, Ontario, Canada.
¹¹ Scleroderma Foundation, Tri-State Chapter, Binghamton, NY, USA.
¹² Sclérodermie Québec, Longueuil, Quebec, Canada.
¹³ Toronto, Ontario, Canada.
¹⁴ Scleroderma Atlantic, Halifax, Nova Scotia, Canada.
¹⁵ NVLE Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, the Netherlands.
¹⁶ Scleroderma & Raynaud's UK, London, United Kingdom.
¹⁷ University of Minho, Braga, Portugal.
¹⁸ Asociación Española de Esclerodermia, Madrid, Spain.
¹⁹ McGill University, Montreal, Quebec, Canada.
²⁰ San Diego State University, San Diego, CA, USA.
²¹ University of Texas McGovern School of Medicine, Houston, TX, USA.
²² St. Joseph's Health Care, London, ON, Canada.
²³ Sint Maartenskliniek, Nijmegen, the Netherlands.
²⁴ University of Utah, Salt Lake City, UT, USA.
²⁵ New York University, New York, New York, USA.
²⁶ Yale School of Medicine, New Haven, CT, USA.
²⁷ Toronto Scleroderma Program, Mount Sinai Hospital, Toronto Western Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
²⁸ McMaster University, Hamilton, Ontario, Canada.
²⁹ Université Paris Descartes, Paris, France; Assistance Publique - Hôpitaux de Paris, Hôpital Cochin, Paris, France.
³⁰ University of Western Ontario, London, Ontario, Canada.
³¹ Université Paris Descartes, Paris, France.
³² Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
³³ Leiden University Medical Center, Leiden, the Netherlands.
³⁴ University of Texas MD Anderson Cancer Center, Houston, TX, USA.
³⁵ Centre Hospitalier Universitaire - Hôtel-Dieu de Nantes, Nantes, France.
³⁶ Université Laval, Quebec, Quebec, Canada.
³⁷ Columbia University, New York, NY, USA.
³⁸ Université de Sherbrooke, Sherbrooke, Quebec, Canada.
³⁹ Servicio de Reumatologia del Hospital, 12 de Octubre, Madrid, Spain.
⁴⁰ Assistance Publique - Hôpitaux de Paris, Hôpital Cochin, Paris, France.
⁴¹ Stanford University, Stanford, CA, USA.
⁴² Northwestern University, Chicago, IL, USA.
⁴³ Royal Free London Hospital, London, UK.
⁴⁴ University of Pittsburgh, Pittsburgh, PA, USA.
⁴⁵ St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
⁴⁶ CHU de Québec - Université Laval, Quebec, Quebec, Canada.
⁴⁷ Hospital for Special Surgery, New York City, NY, USA.
⁴⁸ Assistance Publique - Hôpitaux de Paris, Hôpital Cochin, Paris, France; Aix Marseille Université, Marseille, France.
⁴⁹ Centre Hospitalier Régional Universitaire de Lille, Hôpital Claude Huriez, Lille, France.
⁵⁰ University of Manchester, Salford Royal NHS Foundation Trust, Manchester, UK.
⁵¹ Centre hospitalier de l'université de Montréal - CHUM, Montreal, Quebec, Canada.
⁵² University of Alberta, Edmonton, Alberta, Canada.
⁵³ University of California, Los Angeles, CA, USA.
⁵⁴ Salford Royal NHS Foundation Trust, Salford, UK.
⁵⁵ CHU Rouen, Hôpital de Bois-Guillaume, Rouen, France.
⁵⁶ Servicio de Reumatologia del Hospital, 12 de Octubre, Madrid, Spain; François Maurier, Hôpitaux Privés de Metz, Hôpital Belle-Isle, Metz, France.
⁵⁷ St Vincent's Hospital and University of Melbourne, Melbourne, Victoria, Australia.
⁵⁸ Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia.
⁵⁹ University of Manitoba, Winnipeg, Manitoba, Canada.
⁶⁰ Georgetown University, Washington, DC, USA.
⁶¹ Dalhousie University, Halifax, Nova Scotia, Canada.
⁶² Southlake Regional Health Centre, Newmarket, Ontario, Canada.
⁶³ Jewish General Hospital, Montreal, Quebec, Canada.
⁶⁴ University of Calgary, Alberta, Canada.
⁶⁵ Scleroderma Foundation Michigan Chapter, Southfield, MI, USA.
⁶⁶ Université du Québec à Montréal, Montreal, Quebec, Canada.
⁶⁷ Concordia University, Montreal, Quebec, Canada.

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

Grants and funding

KL2 TR003168/TR/NCATS NIH HHS/United States