Background/Purpose: Psychological symptoms are common in childhood-onset systemic lupus erythematosus (cSLE) and may impact other psychological and health-related outcomes. Mental health problems such as anxiety have increased throughout the COVID-19 pandemic and may be correlated to pandemic-related distress. The current study examines COVID-related distress in youth with cSLE, the relationship between anxiety and COVID-distress, and whether COVID-distress is associated with other aspects of mental health and health-related functioning when controlling for patient-reported anxiety symptoms.

Methods: Fifty-nine participants between the ages of 12 and 22, diagnosed with cSLE per American College of Rheumatology Classification Criteria, were recruited from August 2020-November 2022 across seven pediatric rheumatology clinics in the United States and Canada as part of a larger psychological treatment study. Youth completed a baseline assessment and reported COVID-related distress on a visual analog scale with scores ranging from 0 indicating “no distress” to 100 indicating “extreme distress.” Several mental health and health-related factors were also measured via validated questionnaires: anxiety (Screen for Child Anxiety Related Disorders, [SCARED]), depressive symptoms (Childrens Depression Inventory 2, [CDI-2] or Beck Depression Inventory II, [BDI-II]), disease activity (SLE Disease Activity Index, [SLEDAI]), pain (0-10 numeric rating scale), and fatigue (Pediatric Fatigue Short Form or Adult Short Form, [PROMIS]). Descriptive data and bivariate correlations were conducted. COVID-distress was compared based on sociodemographic factors including race, ethnicity, and income. Then, separate multiple regressions were conducted to examine the impact of COVID-related distress in predicting depression, fatigue, disease activity, and pain when accounting for patient-reported anxiety.

Results: The average age of participants was 16.34 years (SD = 1.99), 94.9% of which were female. Participants reported an average CDI of 63.54 (SD = 9.68), BDI of 62.19 (SD = 12.46), and SCARED of 33.64 (SD = 14.94) with a mean SLEDAI of 4.43 (SD = 5.15; median = 2.00). Participants reported moderate levels of COVID-related distress (Mean = 51.58, SD = 23.30), which was correlated with anxiety (r = 0.35, p < 0.05) and depressive symptoms (r = 0.28, p < 0.05), but not other study variables. COVID-distress rates were comparable between race, ethnicity, and income groups. When examining the simultaneous impact of both COVID-related distress and anxiety on outcomes via multiple regression analyses, the overall models were significant for depressive symptoms, F (2, 36) = 4.84, p < 0.05, and fatigue, F (2, 36) = 5.26, p < 0.05, but not for pain nor disease activity. Further, only anxiety (and not COVID-distress) significantly predicted depressive symptoms (beta = 0.45, p < 0.01) and fatigue (beta = 0.49, p < 0.01).

Conclusion: Findings suggests moderate levels of COVID-related distress in cSLE patients, which was correlated with other aspects of mental health functioning. Interestingly, anxiety and not COVID-distress was a more robust predictor of depression and fatigue in cSLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/covid-distress-in-children-with-systemic-lupus-erythematosus-during-the-covid-19-pandemic/