P095 The impact of COVID-19 lockdown on clinical care, self-management, and mental health in patients with inflammatory arthritis

Abstract Background/Aims COVID-19 lockdown affected access to clinical care for many vulnerable patients, including those with inflammatory arthritis (IA). It also had the potential to alter self-management behaviours. These changes could in turn impact mental health, especially given that IA patients are already at higher risk of mental health disorders. Thus, the aims of this study were to determine how IA care and self-management were affected by lockdown and assess the impact of these changes on disease outcomes and mental health. Methods Online questionnaires were completed by 338 participants between June and July 2020. The questionnaires assessed demographics, IA condition, IA self-management, COVID-19 clinical information, quality of life, and mental health. Visual analogue scale (VAS) scores for patient global assessment (PGA) of disease activity, pain, fatigue, and emotional distress were completed relating to the previous week and retrospectively for pre-lockdown (March) and early-lockdown (April). Improvement/worsening in each VAS was considered as a change of 10 points or more from pre-lockdown to the current rating. Linear regressions were conducted to determine factors associated with worse outcomes, controlling for potential confounders including self-reported pre-lockdown status. Results Mean VAS scores worsened during lockdown for all outcome measures, with over half reporting a more than 10-point worsening (Table 1). Changes to clinical care affected 87% of patients. The most commonly affected services were hospital outpatient appointments (77%), GP appointments (59%), and blood tests (53%). Changes to clinical care were significantly associated with worse PGA (b = 8.95, p=0.01), pain (b = 7.13, p=0.05), fatigue (b = 17.01, p<0.00) and emotional distress (b = 12.78, p<0.01). Regarding self-management, 64% of patients reported changes to diet while 51% reduced physical activity. Change in diet was not significantly associated with any of the outcomes, whereas physical activity was associated with PGA (b=-2.42, p<0.01), pain (b=-2.43, p<0.01), fatigue (b=-2.5, p < 0.01), and emotional distress (b=-2.41, p<0.01). Conclusion Most patients (87%) had at least one area of clinical care affected by the lockdown. These changes in IA clinical care were associated with worse disease outcomes across all measures and greater emotional distress. In self-management, reduced physical activity was associated with worse outcomes in all physical and mental health measures. P095 Table 1:Mean VAS (0-100) scores and percent changesPGAMarch April June/JulyMean (SD) 44.51 (23.70) 53.18 (24.67) 57.69 (25.29)Better Same WorsePercent 7.9936.6855.33[95% CI] [5.33-11.41][31.54-42.07][49.85-60.71]PainMarch April June/July42.60 (25.60) 51.11 (26.01) 56.66 (26.40)Better Same Worse7.6937.8754.44[5.09-11.07] [32.68-43.28][48.96-59.84]FatigueMarch April June/July46.86 (26.17) 57.11 (25.83) 61.35 (26.51)Better Same Worse10.0634.0255.92[7.07-13.77] [28.98-39.35][50.44-61.29]Emotional DistressMarch April June/July30.96 (26.28) 49.06 (29.09) 48.75 (29.15)Better Same Worse8.2833.14 58.58[5.58-11.75] [28.14-38.43][53.12-63.88] Disclosure M. Sweeney: None. L. Carpenter: None. S. de Souza: None. H. Chaplin: None. H. Tung: None. E. Caton: None. J. Galloway: None. A. Cope: None. M. Yates: None. S. Norton: None.

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The impact of COVID-19 on clinical care, self-management, and mental health of patients with inflammatory arthritis

Rheumatology Advances in Practice ◽

10.1093/rap/rkab095 ◽

2021 ◽

Author(s):

Melissa Sweeney ◽

Lewis Carpenter ◽

Savia de Souza ◽

Hema Chaplin ◽

Hsiu Tung ◽

...

Keyword(s):

Mental Health ◽

Physical Activity ◽

Emotional Distress ◽

Inflammatory Arthritis ◽

Clinical Care ◽

Care Quality ◽

Self Management ◽

Physical And Mental Health ◽

Disease Outcomes ◽

The Impact

Abstract Objectives The COVID-19 lockdown and ongoing restrictions in the UK affected access to clinical care, self-management, and mental health for many patients with Inflammatory Arthritis (IA). This study aimed to determine the impact of lockdown on IA clinical care, self-management, disease outcomes, and mental health. Methods In total, 338 people with IA participated in a prospective study completing a series of online questionnaires. The questionnaires assessed demographics, IA condition and management, clinical care, quality of life, and mental health. Visual analogue scales (VAS) were completed at each assessment. Linear regression, controlling for confounders, was conducted to determine factors associated with physical and mental health outcomes. Results Over half of participants reported worsening VAS by more than 10 points for Patient Global Assessment (PGA), pain, fatigue, and emotional distress during the initial lockdown. Changes in clinical care were associated with worse PGA (b = 8.95, p = 0.01), pain (b = 7.13, p = 0.05), fatigue (b = 17.01, p < 0.01) and emotional distress (b = 12.78, p < 0.01). Emotional distress and depression were also associated with worse outcomes in PGA, pain, and fatigue, while loneliness was not. In contrast, physical activity seemed to mitigate these effects. Loneliness did not show any associations with outcomes. Over time, these effects decreased or disappeared. Conclusions Changes to clinical care due to lockdown were associated with worse disease outcomes in patients with IA. There has been a clear impact on mental health as well, with possibly complex relationships between mental health and psychosocial factors. Physical activity emerged as a key influence on disease outcomes and mental health.

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O25 The impact of COVID-19 lockdown on mental health and quality of life in patients with inflammatory arthritis

Rheumatology ◽

10.1093/rheumatology/keab246.024 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Melissa Sweeney ◽

Lewis Carpenter ◽

Savia de Souza ◽

Hema Chaplin ◽

Hsiu Tung ◽

...

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Physical Health ◽

Emotional Distress ◽

Inflammatory Arthritis ◽

Mental Health Disorder ◽

Online Questionnaire ◽

Health Measures ◽

The Impact

Abstract Background/Aims COVID-19 lockdown has affected the mental health of many people around the world. People with inflammatory arthritis (IA) are at a higher risk of mental health and psychosocial consequences of the pandemic compared with the general population, since they are potentially more vulnerable to COVID-19 and experience higher rates of existing comorbid mental health disorder. Furthermore, vulnerable patients were advised to self-isolate for 12 weeks, which could further exacerbate emotional distress. This study aimed to explore the impacts of lockdown on mental health and wellbeing, and to determine which factors were associated with worse disease outcomes. Methods An online questionnaire was completed by 338 participants in the UK with an IA condition between June and July 2020. The questionnaire, designed with input from a service user, assessed various aspects of the impact of the pandemic on the quality of life of people with IA, including their mental health. Self-reported visual analogue scales (VAS) for patient global assessment (PGA) of disease activity, pain, fatigue, and emotional distress were completed relating to the previous week, and retrospectively for pre-lockdown (March) and early-lockdown (April). Specific mental health outcomes were further captured using the 8-item Patient Health Questionnaire (PHQ8) and the short UCLA loneliness scale. Linear regressions were conducted to determine mental health factors associated with worse outcomes on physical health measures (PGA, pain, and fatigue), controlling for fear of COVID-19 and COVID-19 status. Results Overall, 49% of participants met the PHQ8 criteria for moderate to severe depressive symptoms and 58% reported their mental health had worsened by more than 10 points on the emotional distress VAS during lockdown. Finally, 37% reported they were concerned about loneliness, with 26% indicating this had worsened during lockdown. Emotional distress VAS was significantly associated with PGA (b = 0.21, p< 0.01), pain (b = 0.24, p<0.01), and fatigue (b = 0.36, p<0.01). Similarly, depression was also associated with PGA (b = 0.95, p<0.01), pain (b = 0.92, p<0.01), and fatigue (b = 1.56, p<0.01). However, loneliness was not associated with any of the physical health VAS scores but was associated with the emotional distress VAS (b = 1.83, p=0.00). These results remained consistent for emotional distress, depression, and loneliness as predictors when accounting for fear of COVID-19 and COVID-19 status. Conclusion There has been a clear impact of the pandemic on the mental health of people with IA, and this should be taken into consideration by clinicians, especially as it appears to be related to worse overall reported physical health. The mixed results for loneliness in comparison to other mental health measures may illustrate the inter-relatedness of these aspects of mental and physical health, particularly in the context of lockdown. Disclosure M. Sweeney: None. L. Carpenter: None. S. de Souza: None. H. Chaplin: None. H. Tung: None. E. Caton: None. J. Galloway: None. A. Cope: None. M. Yates: None. S. Norton: None.

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Will Nothing Be the Same Again?: Changes in Lifestyle during COVID-19 Pandemic and Consequences on Mental Health

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18168433 ◽

2021 ◽

Vol 18 (16) ◽

pp. 8433

Author(s):

Emanuele Caroppo ◽

Marianna Mazza ◽

Alessandra Sannella ◽

Giuseppe Marano ◽

Carla Avallone ◽

...

Keyword(s):

Mental Health ◽

Physical Activity ◽

Social Isolation ◽

Dietary Habits ◽

Eating Habits ◽

Social Activity ◽

Risk Groups ◽

Sedentary Behaviors ◽

Reduced Physical Activity ◽

The Impact

Social isolation caused by the COVID-19 pandemic has drastically affected lifestyles: from sedentary behaviors to reduced physical activity, from disrupted sleep patterns to altered dietary habits. As a consequence, serious mental and emotional responses have been registered. There was a significant decline in physical and other meaningful activities of daily living, leisure, social activity, and education. In children, collateral effects of the pandemic include inadequate nutrition with a risk of both overweight and underweight, addiction to screens, lack of schooling, and psychosocial difficulties. Older adults are frequently unable to adapt to lockdown measures and suffer from depression and cognitive complaints. Recent studies focusing on changes in lifestyle during the Covid-19 pandemic and consequences on mental health have been identified in PubMed/Medline, Scopus, Embase, and ScienceDirect. All the available literature has been retrospectively reviewed. The results of the present narrative review suggest that mental distress caused by social isolation seems to be linked not only to personality characteristics but also to several lifestyle components (sleep disruption, altered eating habits, reduced physical activity). This review aims to explore major changes in the lifestyle and quality of life and the impact of these changes on mental health, and to inform clinicians and policymakers about elements that may reduce the negative psychological effects of the quarantine period imposed during this worldwide crisis. There is an urgent need for tailored preventive, diagnostic, and therapeutic mental health interventions for the general population and for higher risk groups.

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P068 Exploring the impact of COVID-19 on self-management and healthcare provision in people with Inflammatory Arthritis: A qualitative study

Rheumatology ◽

10.1093/rheumatology/keab247.066 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Emma Caton ◽

Hema Chaplin ◽

Lewis Carpenter ◽

Melissa Sweeney ◽

Hsiu Tung ◽

...

Keyword(s):

Physical Activity ◽

Inflammatory Arthritis ◽

Negative Impact ◽

Survey Study ◽

Self Management ◽

Baseline Survey ◽

Severe Illness ◽

Healthcare Provision ◽

The Uk ◽

The Impact

Abstract Background/Aims Inflammatory arthritis (IA) patients have been identified as being at greater risk of severe illness from COVID-19. It is likely that lockdown restrictions enforced by the UK government in response to the COVID-19 pandemic, and subsequent changes made to healthcare provisions, could impact patients’ abilities to effectively manage their condition. The aim of this study was to qualitatively explore the impact of COVID-19 and lockdown on self-management behaviours and healthcare provision in people with IA. Methods Semi-structured interviews were conducted with 21 patients with IA from across the UK (as part of a larger longitudinal survey study exploring the impact of COVID-19 on health-related quality of life for people with IA). Participants who gave consent for contact, following the completion of the baseline survey study, were approached to take part in the qualitative interviews. The interview schedule was developed with a Patient Research Partner and consisted of eight main questions to explore participants’ experiences of the COVID-19 pandemic, including the impact of COVID-19 on their self-management behaviours and access to healthcare services. The interviews were conducted via telephone and were recorded and transcribed before being analysed using inductive thematic analysis. Results Participants were aged between 24-72 (mean age 50.0, SD 15.6) and were mostly female (71%) and White British (86%). Four main themes were identified: impact of COVID-19 on medication adherence, impact of COVID-19 on physical activity, impact of COVID-19 on diet, and impact of COVID-19 on healthcare access. Subthemes focused on positive and negative changes made to these areas, as well as behaviours which remained consistent. Some participants expressed that the lockdown period had enabled them to increase their physical activity, improve their diet and maintain their usual medication regimen, whilst others noted that lockdown had had a negative impact on their self-management behaviours. For example, some patients decided to discontinue their medication during the pandemic due to concerns that it would make them more susceptible to severe consequences from COVID-19. In relation to healthcare provision, the most commonly reported change was the introduction of telephone appointments to replace face-to-face consultations. Several patients found the telephone appointments ineffective, especially if their disease was relatively uncontrolled. Nevertheless, participants understood why a remote approach had been implemented during the pandemic. Conclusion COVID-19 has had an impact on patients’ abilities to manage their IA. Healthcare professionals need to recognise the impact of COVID-19 on patient self-management and healthcare provision to ensure that adequate understanding and support is available to patients who may have inadequate disease control as a result. Disclosure E. Caton: None. H. Chaplin: None. L. Carpenter: None. M. Sweeney: None. H. Tung: None. S. de Souza: None. S. Norton: None.

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How is the COVID-19 lockdown impacting the mental health of parents of school-age children in the UK? A cross-sectional online survey

BMJ Open ◽

10.1136/bmjopen-2020-043397 ◽

2021 ◽

Vol 11 (5) ◽

pp. e043397

Author(s):

Austen El-Osta ◽

Aos Alaa ◽

Iman Webber ◽

Eva Riboli Sasco ◽

Emmanouil Bagkeris ◽

...

Keyword(s):

Mental Health ◽

Physical Activity ◽

Social Isolation ◽

Online Survey ◽

Female Gender ◽

School Age Children ◽

School Age ◽

Cross Sectional ◽

The Uk ◽

The Impact

ObjectiveInvestigate the impact of the COVID-19 lockdown on feelings of loneliness and social isolation in parents of school-age children.DesignCross-sectional online survey of parents of primary and secondary school-age children.SettingCommunity setting.Participants1214 parents of school-age children in the UK.MethodsAn online survey explored the impact of lockdown on the mental health of parents with school-age children, and in particular about feelings of social isolation and loneliness. Associations between the UCLA Three-Item Loneliness Scale (UCLATILS), the Direct Measure of Loneliness (DMOL) and the characteristics of the study participants were assessed using ordinal logistic regression models.Main outcome measuresSelf-reported measures of social isolation and loneliness using UCLATILS and DMOL.ResultsHalf of respondents felt they lacked companionship, 45% had feelings of being left out, 58% felt isolated and 46% felt lonely during the first 100 days of lockdown. The factors that were associated with higher levels of loneliness on UCLATILS were female gender, parenting a child with special needs, lack of a dedicated space for distance learning, disruption of sleep patterns and low levels of physical activity during the lockdown. Factors associated with a higher DMOL were female gender, single parenting, parenting a child with special needs, unemployment, low physical activity, lack of a dedicated study space and disruption of sleep patterns during the lockdown.ConclusionsThe COVID-19 lockdown has increased feelings of social isolation and loneliness among parents of school-age children. The sustained adoption of two modifiable health-seeking lifestyle behaviours (increased levels of physical activity and the maintenance of good sleep hygiene practices) wmay help reduce feelings of social isolation and loneliness during lockdown.

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The impact of sitting time and physical activity on mental health during COVID-19 lockdown

Sport Sciences for Health ◽

10.1007/s11332-021-00791-2 ◽

2021 ◽

Author(s):

Matthew Pears ◽

Susanna Kola-Palmer ◽

Liane Beretta De Azevedo

Keyword(s):

Mental Health ◽

Physical Activity ◽

Health Outcomes ◽

Online Survey ◽

Depression Score ◽

Sitting Time ◽

Multiple Stepwise Regression Analysis ◽

Previous Diagnosis ◽

The Uk ◽

The Impact

Abstract Objective The primary aim of this study was to investigate the association between physical activity (PA) and sitting time on adults’ mental health (i.e., depression, anxiety and wellbeing) and the influence of mediators and confounders. Methods An online survey was disseminated in the UK between May and June 2020. A total of 284 participants (33.5 ± 12.4 years) self-reported their PA, sitting time and mental health through validated questionnaires. Results Multiple stepwise regression analysis revealed that being of younger age, female, on a lower income, with one or more comorbid health conditions, with a previous diagnosis of mood disorder and increased sitting time independently correlated with higher depression scores (F (13,219) = 12.31, p < 0.001), and explained 42% of the variance. Similar results were found for wellbeing where socio-demographic, health outcomes and sitting time influenced the subjective wellbeing (F (14,218) = 5.77, p < 0.001, 27% variance), although only socio-demographic and health outcomes contributed to the variation in anxiety score (F (13,219) = 7.84, p < 0.001, 32% variance). PA did not explain variation when sitting time was taken into account in any of the models. Combined analysis revealed that participants with lower sedentary time (< 8 h) and with both low or moderate and high PA presented a significantly lower depression score [low PA: (B = −2.7, 95% CI −4.88, −0.52); moderate and high PA (B = −2.7, −4.88, −0.52)]. Conclusion Sitting time was strongly associated with adverse mental health during COVID-19 lockdown and should be considered in future public health recommendations.

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The Association between Physical Activity and Selected Parameters of Psychological Status and Dementia in Older Women

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18147549 ◽

2021 ◽

Vol 18 (14) ◽

pp. 7549

Author(s):

Angelika Cisek-Woźniak ◽

Kinga Mruczyk ◽

Rafał W. Wójciak

Keyword(s):

Mental Health ◽

Physical Activity ◽

Cognitive Impairment ◽

Cognitive Functioning ◽

Cognitive Functions ◽

Protective Factor ◽

The Elderly ◽

Regular Physical Activity ◽

Psychological Status ◽

The Impact

Physical activity has an unquestionable impact on broadly understood human health. One interesting issue related to this is the importance of movement on mental health and cognitive functioning. Research shows that regular physical activity improves the cognitive functioning of adults and people with mental disorders. Regular physical activity can be an important and powerful protective factor in cognitive impairment and dementia in the elderly, and exercise is an important non-pharmacological treatment for mild cognitive impairment or neurodegenerative diseases. This study aims to present the impact of physical activity on selected cognitive functions in physically active women over 60 years of age. The research was carried out in a group of 110 generally healthy women from the area of western Poland over 60 years of age, who were divided into four groups based on the intensity of their physical activity. A pedometer (sport watch) and a physical activity diary were used to measure physical activity. Body Mass Index was assessed. Selected cognitive functions were assessed using the MMSE test, motor and psychomotor skills were measured, and Luria’s auditory memory test and recall test, a clock drawing test, and a GDS test were performed. There were statistically significant relationships between the level of physical activity and the effectiveness of cognitive processes. These results show that about 5000 steps a day is enough to see a positive effect on the mental health and cognitive functioning of this group of the elderly population. The women had an average BMI of 28.1 ± 4.7. BMI, indicating an overweight condition (over 30 kg/m2), was observed in 31% of women. The results of this study lead the authors to conclude that physical activity positively influences cognitive function and can be recommended for all seniors who do not have other serious comorbidities that would prevent them from playing sports.

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Physical, cognitive and mental health impacts of COVID-19 following hospitalisation: a multi-centre prospective cohort study

10.1101/2021.03.22.21254057 ◽

2021 ◽

Author(s):

Rachael Andrea Evans ◽

Hamish McAuley ◽

Ewen M Harrison ◽

Aarti Shikotra ◽

Amisha Singapuri ◽

...

Keyword(s):

Mental Health ◽

Clinical Care ◽

Acute Illness ◽

Physical And Mental Health ◽

White Ethnicity ◽

Reactive Protein ◽

Active Approach ◽

Health Related ◽

Biochemical Testing ◽

The Impact

Background The impact of COVID-19 on physical and mental health, and employment following hospitalisation is poorly understood. Methods PHOSP-COVID is a multi-centre, UK, observational study of adults discharged from hospital with a clinical diagnosis of COVID-19 involving an assessment between two- and seven-months later including detailed symptom, physiological and biochemical testing. Multivariable logistic regression was performed for patient-perceived recovery with age, sex, ethnicity, body mass index (BMI), co-morbidities, and severity of acute illness as co-variates. Cluster analysis was performed using outcomes for breathlessness, fatigue, mental health, cognition and physical function. Findings We report findings of 1077 patients discharged in 2020, from the assessment undertaken a median 5 [IQR4 to 6] months later: 36% female, mean age 58 [SD 13] years, 69% white ethnicity, 27% mechanical ventilation, and 50% had at least two co-morbidities. At follow-up only 29% felt fully recovered, 20% had a new disability, and 19% experienced a health-related change in occupation. Factors associated with failure to recover were female, middle-age, white ethnicity, two or more co-morbidities, and more severe acute illness. The magnitude of the persistent health burden was substantial and weakly related to acute severity. Four clusters were identified with different severities of mental and physical health impairment: 1) Very severe (17%), 2) Severe (21%), 3) Moderate with cognitive impairment (17%), 4) Mild (46%), with 3%, 7%, 36% and 43% feeling fully recovered, respectively. Persistent systemic inflammation determined by C-reactive protein was related to cluster severity, but not acute illness severity. Interpretation We identified factors related to recovery from a hospital admission with COVID-19 and four different phenotypes relating to the severity of physical, mental, and cognitive health five months later. The implications for clinical care include the potential to stratify care and the need for a pro-active approach with wide-access to COVID-19 holistic clinical services. Funding: UKRI and NIHR

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The impact of diet and lifestyle on wellbeing during COVID-19-lockdown

10.31234/osf.io/erta5 ◽

2021 ◽

Author(s):

Anne Muth ◽

Annabel B Losecaat Vermeer ◽

Damiano Terenzi ◽

Soyoung Q Park

Keyword(s):

Mental Health ◽

Physical Activity ◽

Social Interactions ◽

Vegetable Intake ◽

Lifestyle Factors ◽

Activity Level ◽

Fruit And Vegetable Intake ◽

Fruit And Vegetable ◽

The Impact ◽

Diet And Lifestyle

A healthy diet and lifestyle may protect against adverse mental health outcomes, which is especially crucial during stressful times, such as the COVID-19 pandemic. This preregistered longitudinal online study explored whether diet and lifestyle (physical activity, sleep, and social interactions) could predict wellbeing and mood during a light lockdown in Germany. Participants (N = 117, 72 males; 28 9 years old) answered mental health and lifestyle questionnaires (social connections, sleep, activity) followed by submitting one week of food and mood-lifestyle diary (food intake, positive and negative mood, mental wellbeing, sleep quality, physical activity level, quantity and quality of social interactions) via a smartphone app. We used multivariate linear and mixed-effects models to predict mood and wellbeing by using dietary components and lifestyle factors. Inter-individual analyses revealed that sleep and social interaction significantly impacted mood and wellbeing. Interestingly, fruit and vegetable intake predicted wellbeing, even when controlling for all lifestyle factors. Fruit and vegetable intake also significantly predicted daily fluctuations in wellbeing within individuals next to sleep, physical activity, and social interactions. We observed gender differences in fruit and vegetable intake and anxiety levels. Our results emphasize the importance of diet contributing to individual wellbeing, even in the challenging times of a pandemic.

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