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Background: The COVID-19 pandemic has taken a toll on the mental health of the general population. Patients with systemic lupus erythematosus (SLE) were particularly exposed due to many uncertainties linked to the virus and their immunosuppression as well as difficulties to access medical care and their treatment (eg, hydroxychloroquine) during the early pandemic.
Objectives: To evaluate the difficulties encountered by SLE patients during the early COVID-19 pandemic, and evaluate their impact on patient mental health.
Methods: We conducted a nationwide survey including SLE patients from France metropolitan and overseas territories, recruited by their treating specialist or through a patient association (AFL+). The survey was administered online or in paper form between November 2020 and April 2021, and included questions aiming at evaluating the difficulties encountered during the early COVID-19 pandemic (March to August 2020). The impact on mental health was evaluated using Hospital Anxiety and depression scale (HADS) and post-traumatic stress disorder (PTSD) Checklist for DSM-5 (PCL-5).
Results: 536 SLE patients (91.9% women) of mean age 50 (±14.1) years responded to the survey. The main reported difficulties were issues to access medical care (n = 136, 25.4%) or to obtain hydroxychloroquine treatment (n = 98/389, 25.2%), the loss of employment (n = 85/349, 24.4%) and financial difficulties (n = 75/536, 11%). Hydroxychloroquine shortage was responsible for difficulties in obtaining the drug for 25.2% (98/389) of HCQ-treated patients, and 57 had to interrupt HCQ treatment for a median of 7 days (IQR: 3-17). In the 342 patients with complete assessment, 161 (47.2%) screened positive for anxiety, 141 (41.2%) for depressive syndrome and 128 (38.7%) for PTSD. Multivariate analysis showed that female sex (OR=4.29 [95%CI: 1.39-13.24]), financial issues (OR=2.57 [1.27-5.22]), difficulties to access medical care (OR=2.15 [1.26-3.69]), or to obtain hydroxychloroquine treatment (OR=1.90 [1.06-3.40]) were independently associated with a positive screening for PTSD.
Conclusion: The COVID-19 pandemic resulted in a severe burden in SLE patients, including difficulties in access to care and treatment along with high psychological distress. Better understanding these difficulties will allow better prevention and care in times of crisis.
Factors associated with the development of anxiety, depression or PTSD. Odds ratio (CI95%) using multivariate logistic regression are shown.
| Patient and pandemic-associated factors | Odds ratio (95%CI) for anxiety | Odds ratio (95%CI) for depression | Odds ratio (95%CI) for PTSD |
|---|---|---|---|
| Female sex | 2.25 (0.97-5.25), p = 0.058 | ns | 4.29 (1.39-13.24 ) p = 0.01 |
| Financial difficulties | ns | 2.59 (1.31-5.11 ) p = 0.006 | 2.57 (1.27-5.22 ) p = 0.009 |
| Difficulties to obtain HCQ | 1.70 (0.97-2.98 ) p = 0.065 | ns | 1.90 (1.06-3.40 ) p = 0.03 |
| Difficulties to access medical care | 1.94 (1.15 3.25 ) p = 0.012 | 2.57 (1.53-4.33 ) p < 0.0001 | 2.15 (1.26-3.69 ) p = 0.005 |
Acknowledgements: Antonin Folliasson for his help.
Disclosure of Interests: Marc SCHERLINGER: None declared, naimah zein: None declared, Jacques-Eric Gottenberg: None declared, Marianne Riviere: None declared, Jean François Kleinmann: None declared, Jean Sibilia: None declared, Laurent Arnaud Speakers bureau: Alexion, Amgen, Astra-Zeneca, Abbvie, Biogen, BMS, Boehringer-Ingelheim, Cêmka, Kezar, GSK, Grifols, Janssen, LFB, Lilly, Menarini France, Medac, Novartis, Oséus, Pfizer, Roche-Chugaï, Sêmeia, UCB., Consultant of: consultant for Alexion, Amgen, Astra-Zeneca, Abbvie, Biogen, BMS, Boehringer-Ingelheim, Cêmka, Kezar, GSK, Grifols, Janssen, LFB, Lilly, Menarini France, Medac, Novartis, Oséus, Pfizer, Roche-Chugaï, Sêmeia, UCB.