Mental Health Problems Experienced by Patients with Rheumatic Diseases During COVID-19 Pandemic

Background: Patients with rheumatic diseases are more likely to suffer from anxiety, depression and insomnia. Yet, little is known about mental health status during COVID-19 pandemic. Objective: This study aims to measure the prevalence of mental health disorders among patients with rheumatic diseases in the era of COVID-19 pandemic and to determine potential risk factors for major symptoms of depression, anxiety, and insomnia in participants. Methods: Participants with rheumatic diseases were asked to complete a questionnaire using a telephonic interview. Sociodemographic and rheumatic disease characteristics were recorded. Mental health status was assessed by the patient health questionnaire-9 (PHQ-9), generalized anxiety disorder (GAD)-7, and insomnia severity index (ISI) questionnaires to detect depression, anxiety and insomnia symptoms, respectively. Results: We included 307 patients in the survey. Rheumatoid arthritis was the most frequent diagnosis (55%). Of all participants, 7.5% had known depression and 5.5% known anxiety. Mental health disorders were insomnia (34.9%), anxiety (33.2%), and depression (24.4%). Major symptoms of insomnia, anxiety, and depression were noted in respectively, 19.9%, 12.4%, and 7.8% of participants. Risk factors for major insomnia were male gender (OR= 4.36, 95% CI 2.06 to 9.25; p<0.0001), low socioeconomic status (OR= 2.64, 95% CI 1.44 - 4.83; p<0.002) and having rheumatoid arthritis (OR= 2.00, 95% CI 1.04 to 3.84; p<0.036). Major anxiety was associated with low monthly income (OR=1.79, 95% CI 1.07 to 3.01; p<0.026), and higher Numerical Rating Scale (NRS) of pain (OR=1.795, 95% CI 1.074 to 2.994 ; p<0.026). Major depression was associated with the worsening of rheumatic disease (OR=1.86, 95% CI 1.06 to 3.26; p<0.03). Conclusion: A high frequency of undiagnosed depression, anxiety and insomnia symptoms was found in rheumatic patients. Rheumatologists should be aware of these comorbidities, especially in the era of COVID-19 pandemic.