Psychological Fragility in an Italian Cohort of Systemic Sclerosis Patients During COVID-19 Pandemic Category: Short Communication

Figures & data

Table 1 Generalized Anxiety Disorder Scale-7 (GAD-7) Questionnaire.

Over the Last 2 Weeks, How Often Have You Been Bothered by the Following Problems?	Not at All	Several Days	More Than Half the Days	Nearly Every Day
1) Feeling nervous, anxious or on edge	0	1	2	3
2) Not being able to stop or control worrying	0	1	2	3
3) Worrying too much about different things	0	1	2	3
4) Trouble relaxing	0	1	2	3
5) Being so restless that it is hard to sit still	0	1	2	3
6) Becoming easily annoyed or irritable	0	1	2	3
7) Feeling afraid as if something awful might happen	0	1	2	3

Note: A score ≥8 is a reasonable cut-off for needing further identifying evaluation to determine presence and type of anxiety disorder. GAD-7 score obtained by adding score for each question (total points).

Table 2 10-Item COVID-19 Fears Questionnaire for Chronic Medical Conditions (COVID-19 Fears), Validated on Population of Patients with Systemic Sclerosis

	Not at All	Slightly	Moderately	Very	Extremely
1) I will become infected when I have to leave the house to get supplies or when supplies are brought to me
2) I will not be able to access health care that I need for my condition
3) I will need to be isolated for longer than others because of my condition
4)I will be infected and experience more severe complications because of my condition
5) I will be infected and will not receive the medical treatment I need
6)I will be infected and healthcare professionals will not be familiar with the needs of a person with my condition
7) People close to me (eg, family, close friends) will be infected and become ill
8) I will not be able to access medications I need for my condition due to shortages
9) I will not be able to obtain basic supplies (eg, food, other household necessities)
10) I will be infected with the virus

Notes: This table contains a list of statements that are related to COVID-19 and possible fears you may have about its consequences. Please select the response that reflects how much each statement describes your experience on a typical day in the last week. You may choose among not at all, slightly, moderately, very, extremely. Please do not skip any questions. Because of the COVID-19 pandemic outbreak, I am afraid that. COVID-19 Fears Questionnaire for Chronic Medical Conditions reprinted from Journal of Psychosomatic Research, Vol 139, Authors: Yin Wu, Linda Kwakkenbos, Richard S. Henry, Lydia Tao, SamiHarb, Angelica Bourgeault, Marie-Eve Carrier, Brooke Levis, YingSun, Parash Mani Bhandari, Andrea Carboni-Jiménez, MariaGagarine, Chen He, Ankur Krishnan, Zelalem F. Negeri, DipikaNeupane, Luc Mouthon et al. Validation of the COVID-19 Fears Questionnaires for Chronic Medical Conditions: A Scleroderma Patient-centered Intervention Network COVID-19 Cohort study. page 110271, Copyright (2020), with permission from Elsevier, license number 5315350257568.¹²

Table 3 Characteristics of Study Population

	Patients Who Missed Scheduled Appointment	Patients Who Regularly Performed Follow-Up
Female:Male ratio	28:1	78:8
Mean age ± SD	63 ± 12.3	60 ± 13
Current job, n (%)	11 (39.3)	30 (34.8)
No cohabitant, n (%)	6 (21.4)	15 (17)
Worsening of SSc symptoms, n (%)	3 (10.7)	26* (30.3)
Taking medications for anxiety/depression, n (%)	8 (28.6)	16 (18.6)
Median GAD-7 score [quartiles]	10.5 [8.25;14]**	4 [0;7]
GAD-7 score ≥8, n (%)	22 (78.6)***	16 (18.6)
Median COVID-19 Fears score [quartiles]	31.5 [26.25;37.25]****	20 [13.75;28]

Notes: *p=0.0039; **p<0.0001; ***p<0.0001; ****p<0.0001.

Abbreviations: SSc, systemic sclerosis; SD, standard deviation; GAD-7, Generalized Anxiety Disorder Scale-7; COVID-19 Fears, COVID-19 Fears Questionnaire for Chronic Medical Conditions.

Table 4 Multivariate Analysis Performed on 28 Patients Who Missed Scheduled Appointments Considering GAD-7 Score as the Dependent Variable

Variable	OR	SE	95% CI	P-value
Current job	−0.3100	0.1406	−0.5881 to −0.03634	0.0275*
Disease reported as “active”	0.1014	0.1736	−0.2493 to 0.4326	0.5591
No cohabitant	−0.08060	0.1441	−0.3705 to 0.1953	0.5760
Age	0.002937	0.005284	−0.007311 to 0.01341	0.5783
Therapy for anxiety/depression	0.2903	0.1235	0.04553 to 0.5302	0.0188*

Note: *p<0.05.

Abbreviations: OR, odds ratio; SE, standard error; CI, confidence interval.

Table 5 Multivariate Analysis Performed on 28 Patients Who Missed Scheduled Appointments Considering COVID-19 Fears Score as the Dependent Variable

Variable	OR	SE	95% CI	P-value
Current job	−0.2615	0.08282	−0.4245 to −0.09976	0.0016*
Disease reported as “active”	0.06232	0.1078	−0.1530 to 0.2697	0.5631
No cohabitant	−0.1367	0.08776	−0.3116 to 0.03263	0.1192
Age	0.002224	0.003170	−0.003949 to 0.008479	0.4829
Therapy for anxiety/depression	0.1943	0.07531	0.04560 to 0.3409	0.0099*

Note: *p<0.05.

Abbreviations: OR, odds ratio; SE, standard error; CI, confidence interval.

Wu Y, Kwakkenbos L, Henry RS, et al. Validation of the COVID-19 fears questionnaires for chronic medical conditions: a scleroderma patient-centered intervention network COVID-19 cohort study. J Psychosom Res. 2020;139:110271. PMID: 33096402; PMCID: PMC7543945. doi:10.1016/j.jpsychores.2020.110271

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