Study: Pandemic Increases Anxiety, But Not Depression, in Scleroderma Patients

Following the onset of the COVID-19 pandemic, people with scleroderma experienced substantial increases in anxiety, but not depression, a new study has found.

Results also show that older patients and those with greater financial resources experienced smaller increases in anxiety.

The study, “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,” was published in the Journal of Psychosomatic Research.

The COVID-19 pandemic has had a profound impact on daily life for people around the world. Emerging research has suggested the outbreak has negatively affected mental health in the general population, but studies in people at increased risk from COVID-19 complications are lacking.

People with scleroderma commonly have interstitial lung disease and use immune-suppressing medications, which may increase risks from COVID-19.

The Scleroderma Patient-centered Intervention Network (SPIN) conducts an ongoing study to collect data on people living with scleroderma. As part of this study, participants complete mental health surveys every three to six months.

Using such data, the researchers compared scores on the PROMIS Anxiety 4a v1.0 scale (which measures anxiety symptoms) and the Patient Health Questionnaire-8 (which assesses depression symptoms) over a one-year period that ended in April. In both measurements, higher scores indicate more severe symptoms.

In total, the scientists assessed data for 435 people with SSc — 98 from Canada, 159 from France, 128 from the U.S., and 50 from the U.K. The group was predominantly female (88.5%), the mean age was 56.9 years, and the mean time since scleroderma diagnosis was 12.1 years. Also, 35.2% had interstitial lung disease, and 48.1% were using immune-suppressing medications.

The mean anxiety score increase during the pandemic was 4.9 points. Notably, on the PROMIS scale, a change of four points is considered clinically meaningful.

By country, mean increases were 3.1 points for France, 4.4 points for Canada, 6.2 points for the U.K., and 6.9 points for the U.S. Statistical analyses showed that the anxiety increase in France was significantly lower than in the other three countries.

Further analyses indicated significant negative associations between anxiety score increases and both age and financial resources. In other words, people who were older or who had access to greater financial resources were statistically more likely to report a smaller increase in anxiety, relative to those who were younger or had less resources.

“The consistent finding that symptoms were associated with adequacy of financial resources to meet current needs underlines the financial implications of the pandemic and the role of economics in mental health,” the researchers wrote.

Data on depression were available for only 388 participants. Results showed no statistically significant change in depression scores, compared to before the pandemic.

“Our study is one of the first to report mental health symptom changes during COVID-19 in a vulnerable population with a pre-existing medical condition and the first to compare symptom changes across countries,” the investigators wrote.

Prior research on university students had suggested an increase in symptoms of depression, but not anxiety, with the onset of the pandemic. According to the team conducting the current study, the different results may be due to the specificities of the two studies’ populations.

“University students may primarily be experiencing consequences of public health interventions, including interruption of academic programs, loss of work to support their studies, and reduced social connectedness. People with [scleroderma] and others with pre-existing medical conditions who are at risk of severe complications or death if infected likely perceive a greater threat from the virus than young adults of university age,” the research team wrote.

The researchers also said that differences in anxiety across countries are likely attributable to responses from governments. They wrote that France “undertook some of the most restrictive measures internationally to attempt to reduce the spread of the virus,” which may have eased anxiety for vulnerable populations.

Collectively, these findings “suggest that the nature of mental health implications for different populations may reflect specific concerns in COVID-19,” the scientists added. “More research is needed on this topic.”