Difficulties and Psychological Impact of the SARS-CoV-2 Pandemic in Patients with Systemic Lupus Erythematosus: A Nationwide Patient Association Study

Marc Scherlinger, Naimah Zein, Jacques-Eric Gottenberg, Marianne Rivière, Jean-François Kleinmann, Jean Sibilia, Laurent Arnaud, Marc Scherlinger, Naimah Zein, Jacques-Eric Gottenberg, Marianne Rivière, Jean-François Kleinmann, Jean Sibilia, Laurent Arnaud

Abstract

Objectives: We aimed to evaluate the difficulties encountered by systemic lupus erythematosus (SLE) patients during the early COVID-19 pandemic and to evaluate their impact on patient mental health.

Methods: We conducted a nationwide survey including SLE patients from France, recruited by their treating specialist or through a patient association. 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 the Hospital Anxiety and Depression Scale (HADS) and the 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 regarding access to medical care (n = 136, 25.4%) or hydroxychloroquine treatment (n = 98/389, 25.2%), the loss of employment (n = 85/349, 24.4%), and financial difficulties (n = 75/536, 11%). In 328 patients with complete mental health assessments, 161 (47.2%) screened positive for anxiety, 141 (41.2%) screened positive for depressive syndrome, and 128 (38.7%) screened positive for PTSD. The multivariate analysis showed that female sex (OR = 4.29 [95%CI: 1.39-13.24]), financial issues (OR = 2.57 [1.27-5.22]), and difficulties accessing medical care (OR = 2.15 [1.26-3.69]) or hydroxychloroquine treatment (OR = 1.90 [1.06-3.40]) were independently associated with a positive screening for PTSD.

Conclusions: The COVID-19 pandemic resulted in a severe burden in SLE patients, including difficulties accessing care and treatment along with high psychological distress. Better understanding these difficulties will allow for better prevention and care in times of crisis.

Keywords: SARS-CoV-2; pandemic; patient perspective; systemic lupus erythematosus.

Conflict of interest statement

Laurent ARNAUD is a 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, and UCB. Jacques-Eric Gottenberg has received research grant (unrelated to this work) from Research grants: BMS, PFIZER; consulting fees: Abbvie, Biogen, BMS, Galapagos, Gilead, Lilly, Pfizer, Roche-Chugai, Sanofi, UCB. The other authors have no conflicting interests.

Figures

Figure 1
Figure 1
Prevalence of psychiatric disorders in SLE patients during the COVID-19 pandemic. Columns show mean and bars represent the standard deviation. Abbreviation: PTSD, post-traumatic stress disorder.

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