COVID-19 pandemic psychological effects on patients with inflammatory bowel disease in Tunisia

Introduction: The COVID-19 pandemic is having a major clinical and also organizational impact on national health care systems which has led to dramatically change in management of patients with chronic diseases such as inflammatory bowel disease. (IBD). The national lockdown, the social isolation, the fear of COVID-19 and the intolerance of uncertainty are likely to contribute to the developing or the exacerbation of symptoms of anxiety and depression. These symptoms are already reported to be prevalent among people with IBD and are associated with active disease, complications and relapses. Aims & Methods: This study aimed to explore both the clinical and psychological effects of the first wave of COVID-19 in Tunisia on patients with IBD. We included 110 patients followed in our unit for IBD. For each patient, we retrospectively determined the clinical, biological and endoscopic features preceding the pandemic outbreak in Tunisia (from March to Mai 2020) (P1) and compared them to the features noted during the next succeeding period (P2). Patients were then contacted by phone and they were asked to report data about their isolation context, the socioeconomic impact of the pandemic, contact with COVID-19, concerns, information-seeking behaviors, risk perception, medication and adherence. Results: Among the 110 patients included in the study, 50 were male (45.5%). The median age in our population was 40 years, interquartile range (IQR) [30-48]. Around sixty percent of our patients (n=68) had Crohn disease (CD). All patients included in the study stopped working during the national lockdown as none of them was an essential worker. Eleven patients (10%) stopped taking their medications after the first wave, 8 of which could not access the treatment and 3 were afraid of the drugs' possible side effects. HADS-A scores consistent with a diagnosis of anxiety were reported in 18,2% (n=20) of patients. No patients reported scores consistent with depression. Twenty percent of patients (n=22) experienced lack of sleep and excessive fear of contracting the COVID-19 infection and considered themselves at higher risk for severe COVID-19 infection than the general population. Based on a multiple logistic regression analysis, patients with anoperineal lesions were more likely to express anxiety (p:0.003). Patients who underwent surgery and those on immunosuppressive agents were more likely to perceive themselves as a high-risk profile (p: 0,035;0,01). Conclusion: The COVID-19 pandemic seems to be affecting both drugs accessibility and adherence. IBD health care professionals should be attentive of patients' psychological response to this pandemic and its possible effects on disease progression.