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Mental health of people with chronic health conditions during a health crisis caused by COVID-19 pandemic

  • May 2022
  • Conference: 22nd PSYCHOLOGY DAYS IN ZADAR: Book of Selected Proceedings
  • At: Zadar
Authors:
Krešimir Prijatelj at University of Zadar
Krešimir Prijatelj
Gordana Buljan Flander at Child Protection Center of Zagreb
Gordana Buljan Flander
  • Child Protection Center of Zagreb
Mirna Čagalj Farkas at Zagreb Child and Youth Protection Center
Mirna Čagalj Farkas
  • Zagreb Child and Youth Protection Center
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Abstract

Previous research and clinical practice have shown that people with history of chronic diseases are more likely to develop certain mental health difficulties during pandemic. The aim of this study was to examine the relationship between chronic health conditions and mental health indicators during COVID-19. The data were collected as part of a broader research project of the Zagreb Child and Youth Protection Center. The study involved 1482 healthy individuals and 205 having a chronic disease. The assessments included sociodemographic data, the Hope for the Future and the Depression-Anxiety and Stress Scale-21. Results have shown statistically significant differences aspects of mental health in relation to living with chronic disease, in anxiety, stress and depression. In all scales, people with chronic disease achieved worse outcomes. Furthermore, chronic diseases lead to significant moderating effect on the relationship between hope for the future and anxiety. The negative correlation between hope for the future and mental health indicators is greater in people who have a chronic illness.
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
Original research
11
Mental health of people with chronic health
conditions during a health crisis caused by
COVID-19 pandemic
Krešimir Prijatelj
University of Zadar, Department of Psychology, Zadar, Croatia
Gordana Buljan Flander
Zagreb Child and Youth Protection Center, Zagreb, Croatia
Mirna Čagalj Farkas
Zagreb Child and Youth Protection Center, Zagreb, Croatia
Abstract
Previous research and clinical practice have shown that people with history of chronic diseases are more likely
to develop certain mental health difficulties during pandemic. The aim of this study was to examine the relation-
ship between chronic health conditions and mental health indicators during COVID-19. The data were collected
as part of a broader research project of the Zagreb Child and Youth Protection Center. The study involved 1482
healthy individuals and 205 having a chronic disease. The assessments included sociodemographic data, the Hope
for the Future and the Depression-Anxiety and Stress Scale-21. Results have shown statistically significant differ-
ences aspects of mental health in relation to living with chronic disease, in anxiety, stress and depression. In all
scales, people with chronic disease achieved worse outcomes. Furthermore, chronic diseases lead to significant
moderating effect on the relationship between hope for the future and anxiety. The negative correlation between
hope for the future and mental health indicators is greater in people who have a chronic illness.
Keywords: mental health, chronic diseases, COVID-19

Introduction

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     
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
 

population.






 



Material and methods
Participants



 

Measures
 


 Scale
           




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  
     
       



Results
Statistical analysis





Results
     

SDSD


 SD 



Table 1
Sociodemographic characteristics of the sample
N M SD %
Age  
   
Male  
Marital status
Married  
Divorced  
Single  
  

No  
Yes  
  
  
 No  
Yes  
 No  
Yes  
Note. NMSD

t
pdtpdtpd







Table 2
Summary of regression analysis with chronic disease, hope for the future and their product as predictors of
anxiety as a criterion variable

BSDB t p
   0.2  
     
     
Note. BSDB
error of B, tB, ppt.

Table 3
Summary of regression analysis with chronic disease, hope for the future and their product as predictors of
depression as a criterion variable
Depression
BSDB t p
   0.22  .02
     
     
Note. BSDB
error of B, tB, ppt.
Table 4
Summary of regression analysis with chronic disease, hope for the future and their product as predictors of
stress as a criterion variable
Stress
BSDB t p
     
     
     
Note. BSDB
error of B, tB, ppt.

FpR2Fp
R2FpR2


Figure 1
Relationship of hope for the future with anxiety, depression, and stress
depending on the existence of a chronic health condition

  




Discussion










  
     


 






         


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










Conclusions





diseases.
References
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
society. The Lancet
International Statistical Review, 78
doi.org

The Lancet.


     
sionals. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 14



and depression. Journal of Internal Medicine, 287

      The Journal of Educational Re-
search, 111
Psy-
chological Medicine
Childhood and Society. Triad Paladin.
The Oxford handbook of hope


Rehabilitation Psychology, 53.

   
Health Psychol-
ogy, 29
  
    Epidemiology and health, 38. 
org


The Lancet Psychiatry

     
diction of life satisfaction after spinal cord injury. Rehabilitation Psychology, 55

British
Journal of Health Psychology. 

Comprehensive Psychiatry, 87,

  
         Nephrology, 19  

       
Palliative & Supportive Care, 18


Behaviour
Research and Therapy, 33

Social Work, 65

BMJ:
British Medical Journal, 368. 

 Generativity and Adult Development: How and Why We Care for the Next Generation

British Medical Jour-
nal, 368. 

 Ethiopian Journal of Health Sciences, 29 

   
Jama, 323
         
          
      Cadernos de Saude Publica, 36  doi.

 
Diseases of the Colon & Rectum




Zbirka psihologijskih skala i upitnika, svezak 6,


    
 Health Psychology, 24 

             
      American Journal of Hypertension, 31


Intensive Care Medicine


            
     Psychiatria Danubina   


Archives of Internal Medi-
cine, 159

Archives of Internal Medi-
cine, 159
 
  Frontiers in Psychology, 7, 2022. 

     
   Journal of Research in Personality, 30  

     
   Journal of Research in Personality, 30  



Psychiatry and Clinical Neurosciences, 74

Open Journal of Therapy and Rehabil-
itation, 4

Zbirka psihologijskih skala i upitnika: svezak 5

Društve-
na istraživanja, 20


Explore, 7
   

   

             
International Journal of Infectious Diseases  

   Asian Journal of
Psychiatry, 51. 
          

 Clinical Microbiology and Infection. 

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COVID‐19: Concerns and behaviours in Croatia
Article
Full-text available
Objectives The COVID‐19 pandemic has created uncertainty that has heightened fear and worry worldwide, thus elevating the potential for a growth in anxiety. This study aims to examine changes in levels of COVID‐19 concern and safety behaviours among persons living in Croatia during the period in which the first COVID‐19 case was identified and when the country recorded its first fatality. These changes were examined with respect to gender and family circumstances. Design The repeated cross‐sectional data were conducted over two time points over the 3 weeks (N1 = 888; N2 = 966). Methods Participants completed online questionnaire regarding various COVID‐19 concerns and safety behaviours aimed at disease prevention. Results Findings demonstrate dramatic increase in concern and safety behaviours among participants during the 3 weeks between the first identified case and the first fatality. The results suggest that parents, and mothers especially, represent the most concerned group, regardless of age. People with chronic health conditions also expressed greater concern and safety behaviour than healthy participants, but with small effect size. Conclusion These findings highlight the importance of developing clear guidelines for alleviating the negative effects on mental health through effective communication strategies that minimize fear and emphasize positive behavioural change. Statement of contribution What is already known on this subject? • In times of pandemic, people react with elevated levels of anxiety and some will adjust their behaviours in order to protect themselves as well as their family and friends. • Some of the measures introduced to protect the spread of the COVID‐19 disease have induced an atmosphere of fear, which in turn can lead to an increase in maladaptive anxiety and a greater burden on mental health. What does this study add? • By conducting the research in two waves representing two critical time points in the developing COVID‐19 situation in Croatia, we were able to trace a large increase in anxiety levels and safety behaviours among the general population. • There is a discordance between those who are at most risk from serious consequences of the disease and those who are at greatest risk for maladaptive anxiety. Parents, and mothers in particular, represent the most concerned group, regardless of age. • Lockdown measures have allowed us to ensure the safety of those vulnerable for serious COVID‐19 illness. Now, we must focus on preserving the mental health of our whole community.
PTSD as the second tsunami of the SARS-Cov2 pandemic
Article
Full-text available
  • Apr 2020
Since the first cases, the coronavirus disease (COVID-19) rapidly spread around the world, with hundred-thousand cases and thousands of deaths. Post-traumatic stress disorder (PTSD) is a common consequence of major disasters. Exceptional epidemic situations also promoted PTSD in the past. Considering that humanity is undergoing the most severe pandemic since Spanish Influenza, the actual pandemic of COVID-19 is very likely to promote PTSD. Moreover, COVID-19 was renamed severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2). With a poor understanding of viruses and spreading mechanisms, the evocation of SARS is generating a great anxiety contributing to promote PTSD. Quarantine of infected patients evolved to quarantine of 'infected' towns or popular districts, and then of entire countries. In the families of cases, the brutal death of family members involved a spread of fear and a loss of certainty, promoting PTSD. In the context of disaster medicine with a lack of human and technical resources, healthcare workers could also develop acute stress disorders, potentially degenerating into chronic PTSD. Globally, WHO estimates 30-50% of the population affected by a disaster suffered from diverse psychological distress. PTSD individuals are more at-risk of suicidal ideation, suicide attempt, and deaths by suicide - considering that healthcare workers are already at-risk occupations. We draw attention towards PTSD as a secondary effect of the SARS-Cov-2 pandemic, both for general population, patients, and healthcare workers. Healthcare policies need to take into account preventive strategy of PTSD, and the related risk of suicide, in forthcoming months.
Mental Health Outcomes of Adults with Comorbidity and Chronic Diseases during the COVID-19 Pandemic: A Matched Case-Control Study
Article
Background: Individuals with certain pre-existing chronic health conditions have been identified as a high-risk group for fatalities of COVID-19. Therefore, it is likely that individuals with chronic diseases may worry during this pandemic to the detriment of their mental health. This study compares the mental health of Bangladeshi adults affected by chronic disease to a healthy, matched control group during the COVID-19 pandemic. Subjects and methods: A matched case-control analysis was performed with data collected from 395 respondents with chronic diseases and 395 controls matched for age, gender, and residence. Inclusion criteria for cases were respondents who self-reported having asthma, cardiovascular disease symptoms and/or diabetes. Respondents were recruited using an online survey, which included the DASS-21 measure to assess symptoms of stress, anxiety, and depression. Chi-square test, t-test, Fisher’s exact test and a conditional logistic regression were performed to examine associations among variables. Results: The prevalence of anxiety symptoms and depression symptoms and the level of stress were significantly higher among cases (59%; 71.6%; 73.7%, respectively) than among controls (25.6%; 31.1%; 43.3%, respectively). Chi-square and t-test showed significant associations and differences between having chronic diseases and mental health outcomes. A conditional logistic regression showed that respondents with asthma, diabetes, cardiovascular disease symptoms, or any combination of these diseases had higher odds of exhibiting symptoms of stress, anxiety, and depression than healthy individuals. Conclusion: These results underscore a subpopulation vulnerable to mental health consequences during this pandemic and indicate the need for additional mental health resources to be available to those with chronic diseases.
Mental Health in Chronic Disease Patients during the COVID-19 Quarantine in Greece
Article
  • Jun 2020
Objective: To investigate the effect of the time spent on quarantine on distress, anxiety, depression, and somatization of chronic disease patients during the COVID-19 quarantine in Greece and the differences in these parameters between healthy individuals and chronic disease patients. Method: The sample consisted of 943 healthy individuals and 163 patients (respiratory, autoimmune, cardiovascular, endocrine, patients with other diseases, and patients with more than one disease) completing sociodemographic assessments as well as the 4-Dimensional Symptom Questionnaire (4DSQ) during March 30, 2020 to May 3, 2020. Pearson's correlation was used to search for the association between time spent on quarantine and the 4DSQ subscales (distress, anxiety, depression, and somatization). Independent sample T-test and Glass's Δ were used for differences between healthy individuals and chronic disease patients in these subscales, an analysis also carried out between healthy individuals and all patient subgroups. Results: No statistically significant correlations were noted between the 4DSQ subscales and the quarantine duration, both for the patient and the healthy individuals' group. Chronic disease patients had significantly higher levels of distress (p = 0.001, Δ = 0.28) and somatization (p = 0.000, Δ = 0.47), but not there were no significant differences in anxiety (p = 0.098, Δ = 0.14) and depression (p = 0.052, Δ = 0.19). Concerning head-to-head comparisons between the healthy individuals' group and each patient group, significantly higher scores in distress were found only for patients with respiratory diseases (p = 0.028, Δ = 0.42). Regarding somatization, significantly higher scores were noted for the healthy individuals' group compared with patients with autoimmune diseases (p = 0.010, Δ = 0.62), respiratory diseases (p = 0.027, Δ = 0.42), other diseases (p = 0.003, Δ = 0.55), and more than one disease (p = 0.012, Δ = 0.60). No statistically significant differences were found in anxiety and depression. Significance of results: The results of this study indicate that interventional programs for chronic disease patients during quarantine should focus on distress and somatization, not on anxiety and depression. Respiratory patients might have more supportive care needs compared with patients with other diseases.
Impact of COVID-19 on routine care for chronic diseases: A global survey of views from healthcare professionals
Article
  • Jun 2020
Routine care for chronic disease is an ongoing major challenge. We aimed to evaluate the global impact of COVID-19 on routine care for chronic diseases. An online survey was posted 31 March to 23 April 2020 targeted at healthcare professionals. 202 from 47 countries responded. Most reported change in routine care to virtual communication. Diabetes, chronic obstructive pulmonary disease, and hypertension were the most impacted conditions due to reduction in access to care. 80% reported the mental health of their patients worsened during COVID-19. It is important routine care continues in spite of the pandemic, to avoid a rise in non-COVID-19-related morbidity and mortality.
Stress, anxiety, and depression levels in the initial stage of the COVID-19 outbreak in a population sample in the northern Spain
Article
  • Apr 2020
The SARS-CoV-2 virus reached Spain in March 2020, and a nationwide state of alert was declared on March 14th, leading to the confinement of the entire population. The current study was conducted in the Basque Autonomous Community in northern Spain. The authors analyzed stress, anxiety, and depression with the arrival of the virus and the levels of symptoms according to age, comorbidity, and confinement. Levels of anxiety, stress, and depression were measured in a sample of 976 adults, using the DASS scale (Depression Anxiety, and Stress Scale). Although levels of symptoms were generally low at the start of the alert, younger individuals with chronic diseases reported more symptoms than the rest of the population. The study also detected higher levels of symptoms after the stay-at-home order was issued. Such symptoms are predicted to increase as the confinement continues. The authors propose psychological interventions for prevention and treatment in order to mitigate the pandemic’s psychological impacts.
Risk factors for disease severity, unimprovement, and mortality of COVID-19 patients in Wuhan, China
Article
  • Apr 2020
Objective Since December 2019, coronavirus disease (COVID-19) emerged in Wuhan. However, the characteristics and risk factors associated with disease severity, unimprovement and mortality are unclear. Methods All consecutive patients diagnosed with COVID-19 admitted to the Renmin Hospital of Wuhan University from January 11 to February 6, 2020 were enrolled in this retrospective cohort study. Results A total of 663 COVID-19 patients were included in this study. Among those, 247 (37.3%) had at least one kind of chronic disease. A total of 0.5% (n=3) of patients were diagnosed with mild COVID-19, while 37.8% (251/663), 47.5% (315/663), and 14.2% (94/663) were in moderate, severe, and critical condition, respectively. In our hospital during follow-up, 251 of 663 (37.9%) patients were improved and 25 patients died, leading to a mortality rate of 3.77%. Older patients (>60 years old) and those with chronic diseases were prone to have severe and critical COVID-19 conditions, show unimprovement, and die (P < 0.001, < 0.001). Multivariate logistic regression analysis identified being male (OR = 0.486, 95% CI 0.311-0.758; P = 0.001), having severe COVID-19 conditions (OR = 0.129, 95% CI 0.082-0.201; P < 0.001), expectoration (OR = 1.796, 95% CI 1.062-3.036; P = 0.029), muscle ache (OR = 0.309, 95% CI 0.153-0.626; P = 0.001), and decreased albumin (OR = 1.929, 95% CI 1.199-3.104; P = 0.007) were associated with unimprovement in COVID-19 patients. Conclusion Being male, in severe COVID-19 conditions, expectoration, muscle ache, and decreased albumin were independent risk factors which influence the improvement of COVID-19 patients.
How COVID-19 Outbreak Is Impacting Colorectal Cancer Patients in Italy: A Long Shadow Beyond Infection
Article
  • Mar 2020
Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy
Article
  • Mar 2020
Trauma and Suicide Risk in College Students: Does Lack of Agency, Lack of Pathways, or Both Add to Further Risk?
Article
  • Mar 2020
The present study sought to examine trauma history and hope as predictors of suicide risk in a sample of 561 college students. Furthermore, authors aimed to understand whether the lack of hope agency and hope pathways contributed to further risk for suicide, above and beyond trauma history. Results suggested that trauma history and hope agency were significant and unique predictors of suicide risk among college students. More specifically, hope agency accounted for additional variance in the prediction model of suicide risk, beyond that accounted for by trauma history. Some implications of the present findings for social work practice are discussed.