The impact of COVID-19 lockdown on mentalhealth and quality of life in patients withinflammatory arthritis

Background/AimsCOVID-19 lockdown has affected the mental health of many peoplearound the world. People with inflammatory arthritis (IA) are at a higherrisk of mental health and psychosocial consequences of the pandemiccompared with the general population, since they are potentially morevulnerable to COVID-19 and experience higher rates of existingcomorbid mental health disorder. Furthermore, vulnerable patientswere advised to self-isolate for 12 weeks, which could furtherexacerbate emotional distress. This study aimed to explore theimpacts of lockdown on mental health and wellbeing, and to determinewhich factors were associated with worse disease outcomes.MethodsAn online questionnaire was completed by 338 participants in the UKwith an IA condition between June and July 2020. The questionnaire, designed with input from a service user, assessed various aspects ofthe 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 theprevious week, and retrospectively for pre-lockdown (March) andearly-lockdown (April). Specific mental health outcomes were furthercaptured using the 8-item Patient Health Questionnaire (PHQ8) and theshort UCLA loneliness scale. Linear regressions were conducted todetermine mental health factors associated with worse outcomes onphysical health measures (PGA, pain, and fatigue), controlling for fearof COVID-19 and COVID-19 status.ResultsOverall, 49% of participants met the PHQ8 criteria for moderate tosevere depressive symptoms and 58% reported their mental healthhad worsened by more than 10 points on the emotional distress VASduring lockdown. Finally, 37% reported they were concerned aboutloneliness, 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 physicalhealth VAS scores but was associated with the emotional distress VAS(b = 1.83, p=0.00). These results remained consistent for emotionaldistress, depression, and loneliness as predictors when accounting forfear of COVID-19 and COVID-19 status.ConclusionThere has been a clear impact of the pandemic on the mental health ofpeople with IA, and this should be taken into consideration byclinicians, especially as it appears to be related to worse overallreported physical health. The mixed results for loneliness in comparison to other mental health measures may illustrate the interrelatedness of these aspects of mental and physical health, particularlyin the context of lockdown.