Background/Purpose: The novel coronavirus disease 2019 (COVID-19) pandemic has significantly affected all aspects of society, especially in the epicenters of New York City (NYC) and the Bronx.  The Bronx patient population is characterized by a high percentage of individuals from racial/ethnic minorities and low socioeconomic status. Black and Hispanic individuals have been disproportionately affected by COVID morbidity and mortality, with the Bronx accounting for the highest number of cases per capita in NYC.  Low-income Bronx residents also may have been more susceptible to financial losses brought on by the pandemic.  With the added concern of increased risk of infection and poorer outcomes in rheumatology patients, Bronx rheumatology patients may be particularly susceptible to emotional suffering during the COVID-19 pandemic.  We sought to investigate the burden of mental health symptoms on rheumatology patients and the association with COVID-related distress from the Bronx following the peak of the outbreak.

Methods: A registry was created of Montefiore Medical Center (MMC) rheumatology patients consisting of 1,692 adult and pediatric patients.  Patients were contacted over email or phone to consent and participate in a survey on the impact of the COVID-19 pandemic.  Participants completed surveys by email or phone. To assess stress we used the Perceived Stress Scale (PSS), to assess depression symptoms we used the Patient Health Questionnaire 8-item depression screen (PHQ-8), and to assess anxiety we used the Generalized Anxiety Disorder-7 item screen (GAD-7). The PSS, GAD and PHQ-8 are all scales (0-40, 0-21, 0-27, respectively) and can be categorized as mild, moderate, severe. Participants were asked to rate their distress related to the COVID pandemic over the last 30 days on a scale from 0-10 (0 no distress, 10 extreme distress). Spearman rank correlations were used to determine whether COVID-related distress scores were correlated to mental health scales.

Results: Of the 361 survey participants , 202 (56%) had complete data on mental health scales.  Among those with complete data, 123 (56%) had at least mild symptoms of depression, 36 (16%) had moderate, 27 (12%) had severe, with median score 5 (IQR 2, 11); 106 (48%) had at least mild symptoms of anxiety, 31 (14%) had moderate, 20 (9%) had severe, median score 4 (IQR 1,9). Based on the Perceived Stress Scale, 182 (83%) had moderate stress, and 32 (15%) had severe stress, median score 21 (IQR 18-24) .  The median level of COVID-related distress was 6 (IQR 3,8). All mental health scales were moderately correlated with the COVID-related distress scale; PSS (rho 0.6, p< 0.0001), PHQ-8 (rho 0.5, p< 0.0001), GAD-7 (rho 0.7, p< 0.0001).   

Conclusion: Surveyed rheumatology patients reported high levels of COVID-related distress and perceived stress. COVID-related distress levels correlated with levels of anxiety, depression, and overall perceived stress. These results underscore the importance of addressing mental health symptoms in rheumatology patients during the pandemic.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/covid-related-distress-and-mental-health-in-adult-rheumatology-patients-during-the-covid-19-pandemic/