Assessment of mental health, knowledge, and attitude of patients with multiple sclerosis and neuromyelitis optica spectrum disorder in response to 2019 novel coronavirus

Change in Insomnia and Depressive Symptoms During COVID-19: A Prospective Longitudinal Study of Iranian Women with Multiple Sclerosis

BACKGROUND

There is some evidence that sleep patterns and psychological health have worsened in the general population as a result of the COVID-19-pandemic. Persons with multiple sclerosis (MS) represent a particularly vulnerable population for COVID-19 infections and effects of restrictions. The present study investigated whether insomnia and depressive symptoms, as well as other MS-related symptoms (i.e. fatigue and paresthesia), changed from before to during the COVID-19-pandemic among persons with diagnosed MS.

METHOD

A sample of 90 Iranian females with MS (mean age; 37.62 years; median EDSS score: 2.5) completed a series of self-rating scales at two time points: Nine months before the COVID-19 outbreak in May 2019 (baseline) and then again during the COVID-19 pandemic in May 2020 (study end). Self-rating questionnaires covered sociodemographic and disease-related information, insomnia, depressive symptoms, fatigue, and paresthesia.

RESULTS

Depressive symptoms increased over time with a significant p-value and medium effect size. Symptoms of insomnia increased over time (significant p-value, but small effect size), while no significant changes were observed in fatigue and paresthesia (very small effect sizes). The only predictor for insomnia during the COVID-19 pandemic was insomnia before the COVID-19 pandemic; the only predictor for depressive symptoms during the COVID-19 pandemic was insomnia before the COVID-19 pandemic.

CONCLUSIONS

Overall, the COVID-19 pandemic and its related social restrictions had significant effects on symptoms of depression and insomnia in this sample of Iranian women with MS, but had no effect on fatigue and paresthesia.

The impact of the COVID-19 pandemic on neuropsychiatric and sleep disorders, and quality of life in individuals with neurodegenerative and demyelinating diseases: a systematic review and meta-analysis of observational studies

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has affected the mental health, sleep and quality of life, especially in individuals with chronic disease. Therefore, the purpose of this systematic review and meta-analysis was to investigate the impact of the COVID-19 pandemic on neuropsychiatric disorders (depression, anxiety, stress), sleep disorders (sleep quality, insomnia) and quality of life in individuals with Parkinson's disease (PD), Multiple Sclerosis (MS) and Alzheimer's disease (AD) compared to healthy controls.

METHODS

Seven databases (Medline, Embase, ScienceDirect, Web of Science, The Cochrane Library, Scielo and Lilacs) were searched between March 2020 and December 2022. Observational studies (i.e., cross-sectional, case-control, cohort) were included. GRADE approach was used to assess the quality of evidence and strength of the recommendation. Effect size was calculated using standardized mean differences (SMD; random effects model). A customized Downs and Black checklist was used to assess the risk of bias.

RESULTS

Eighteen studies (PD = 7, MS = 11) were included. A total of 627 individuals with PD (healthy controls = 857) and 3923 individuals with MS (healthy controls = 2432) were analyzed. Twelve studies (PD = 4, MS = 8) were included in the meta-analysis. Individuals with PD had significantly elevated levels of depression (very low evidence, SMD = 0.40, p = 0.04) and stress (very low evidence, SMD = 0.60, p < 0.0001). There was no difference in anxiety (p = 0.08). Individuals with MS had significantly higher levels of depression (very low evidence, SMD = 0.73, p = 0.007) and stress (low evidence, SMD = 0.69, p = 0.03) and low quality of life (very low evidence, SMD = 0.77, p = 0.006). There was no difference in anxiety (p = 0.05) and sleep quality (p = 0.13). It was not possible to synthesize evidence in individuals with AD and sleep disorder (insomnia).

CONCLUSION

In general, the COVID-19 pandemic negatively impacted individuals with PD and MS. Individuals with PD showed significantly higher levels of depression and stress; and individuals with MS presented significantly higher depression and stress levels, as well as significantly lower quality of life when compared to healthy controls. Further studies are needed to investigate the impact of the COVID-19 pandemic in individuals with AD.

Assessment of Multiple Sclerosis Patients' Knowledge and Behavioral Practice Regarding COVID-19 in Saudi Arabia

Background Coronavirus disease 2019 (COVID-19) is caused by a coronavirus subtype called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is crucial to control the spread of coronavirus by understanding the disease and practicing the measures adopted during the COVID-19 pandemic. Multiple sclerosis (MS) is a central nervous system immune-mediated inflammatory demyelinating disease. COVID-19 infection may exacerbate the MS disease and its relapses. Therefore, MS patients are more susceptible to infection because of their immunosuppressive or immunomodulatory medications. Objective We aimed to evaluate the knowledge, attitude, and behaviors of patients with MS in Saudi Arabia regarding the COVID-19 pandemic. Method A quantitative observational cross-sectional study was conducted. MS patients in Saudi Arabia were included in the study population. Data were collected via an online self-reported questionnaire from 214 participants from November 2020 to June 2021. Results A total of 214 MS patients participated in this study. The gender distribution showed that the male participants represented 38.3% (n = 82), while female participants accounted for 61.7% (n = 132). Most MS patients understood the COVID-19 preventive measures. The mean knowledge score was 15.7 (SD = 2.34, range: 1-20), showing an appropriate level of knowledge. While the mean behaviors score was 6.1 (SD = 1.2, range: 2-9), showing good behaviors. The mean score for attitude was 5.4 (SD = 1.77, range: 1-8), showing optimistic attitudes. However, a closer analysis of the participants' answers showed that 74.3% of the patients agreed that the treatment plan should be discussed with their doctors during the pandemic. In addition, almost half of the participants (49.1%) agreed that being an MS patient means they are at higher risk of getting infected by the virus. Data also showed that 17% of patients continued to attend social events involving many people. Also, 28.0% of the patients reported being in crowded places. Conclusion MS patients' risk of COVID-19 might be linked to their knowledge, attitude, and behaviors. Our results suggest that although MS patients have a high knowledge and good attitude and behaviors, it is still essential to have health education programs among MS patients to reduce the risk of SARS-CoV-2 infection and the impact of the COVID-19 pandemic on MS patients' care. Knowledge, attitude, and behaviors toward the COVID-19 pandemic can highlight the importance of education programs and translate the findings into action to minimize the disease risk.

Impact of the covid-19 pandemic on the psychological status and cortisol level of multiple sclerosis patients

This study aimed to compare the changes in psychological status and cortisol level between multiple sclerosis (MS) patients and a healthy control group (HC). One hundred and fifty-five MS patients and 165 HC subjects had completed questionnaires consisting of 36-Item short health survey (SF-36), Hamilton Anxiety Rating Scale (HAM-A), Beck Depression Inventory-II (BDI-II), and fatigue severity score (FSS) before and after (one year from onset) COVID-19 pandemic. The salivary cortisol level was also measured again in 26 MS patients and 14 control individuals. MS patients had lower scores of mental and physical components of quality of life (MCS and PCS), but higher HAM-A, FSS, and BDII scores than HC Before and after COVID-19. There were significant changes in scores of MCS, BDI-II, HAM-A, and FSS after the COVID-19 outbreak in MS patients, but not in PCS score. In HC group, we observed significant changes in scores of MCS, BDI-II, and FSS, but not in scores of PCS and HAM-A. Compared to HC, the MS patients reported greater deterioration in the overall mental health component of their health-related quality of life, and their levels of anxiety and fatigue over the study period. The change of cortisol levels was non-significant with a small effect size.

Social isolation, loneliness and mental health sequelae of the Covid-19 pandemic in Parkinson's disease

People living with Parkinson Disease (PwP) have been at risk for the negative effects of loneliness even before the Coronavirus Disease 2019 (Covid-19) pandemic. Despite some similarities with previous outbreaks, the Covid-19 pandemic is significantly more wide-spread, long-lasting, and deadly, which likely means demonstrably more negative mental health issues. Although PwP are not any more likely to contract Covid-19 than those without, the indirect negative sequelae of isolation, loneliness, mental health issues, and worsening motor and non-motor features remains to be fully realized. Loneliness is not an isolated problem; the preliminary evidence indicates that loneliness associated with the Covid-19 restrictions has dramatically increased in nearly all countries around the world.

Psychological impacts of COVID-19 pandemic on individuals living with multiple sclerosis: A rapid systematic review

INTRODUCTION

The global spread of COVID-19 has raised concerns about its possible impact on mental health. People living with multiple sclerosis (PwMS) are considered potentially vulnerable to the mental health effects of the pandemic, as they may be subject to increased social isolation.

AIM

To systematically review the current evidence on the impact of the COVID-19 pandemic on mental health outcomes among PwMS.

METHOD

We searched four major databases (Medline, EMBASE, PsychInfo and Scopus) and the WHO Global Health COVID-19 research database. We included peer-reviewed primary research studies using validated health-related quality of life (HRQOL) and psychometric screening tools to evaluate mental health outcomes among PwMS during the COVID-19 pandemic. Studies reporting data on the prevalence of mental health disorders, severity of psychological symptoms and contributing demographic and clinical factors for PwMS during the COVID-19 pandemic were included.

RESULTS

Our initial search yielded 268 records; 19 studies (13 cross-sectional, 6 longitudinal) were included. Most were conducted during a peak in the pandemic in the host country via an online platform. The main mental health outcomes were depression, anxiety, stress, sleep quality and HRQOL. The included studies used a variety of outcome assessment tools and study designs. The prevalence of mental health issues such as depression, anxiety and stress were high among PwMS during the pandemic. In addition, compared to control populations, PwMS experienced more severe symptoms of depression and stress during the COVID-19 outbreak. However, results from longitudinal studies demonstrate that the severity of mental health symptoms among PwMS during the pandemic were not significantly different compared with the pre-pandemic period.

CONCLUSION

Although mental health issues such as anxiety and depression were common among PwMS during the pandemic, current evidence suggests that mental health among PwMS has not been significantly affected by pandemic-related restrictive measures. Instead, the observed differences may be the result of pre-pandemic differences in prevalence and severity. Where possible, future studies should seek to address the methodological issues identified in the included studies to ensure that data collected during the pandemic can be synthesized into recommendations for policy and practice.

Pet Ownership and Multiple Sclerosis during COVID-19

Background: Multiple sclerosis (MS) is associated with lower quality of life, reduced social participation, and decreased self-efficacy. The COVID-19 pandemic has had documented effects on the health and wellbeing of people with and without MS. Previous research has demonstrated the positive impact pets can have for people living with long-term conditions. Objectives: To explore the rates of pet ownership and pet attachment in people living with MS and pet ownership associations with quality of life, satisfaction with social roles, and self-efficacy scores; and to explore the effects of the COVID-19 outbreak on people’s perceived relationships with their pets. Materials and Methods: A postal questionnaire was distributed to members of a local MS Register and a control group of people without MS. The questionnaire assessed quality of life, satisfaction with social roles, self-efficacy, the perceived roles of pets, and pet-related concerns experienced during the COVID-19 pandemic. Results: No apparent difference in attachment to pets was found between the patient and control groups. Pet ownership and level of attachment were not associated with differences in quality of life or self-efficacy scores in people living with MS. Using multiple regression analysis, pet ownership was associated with a decrease in satisfaction with participation in social roles, but with the estimated effect being small compared to having a diagnosis of MS or being unemployed. Most participants reported that pets had positive roles during the pandemic, and the most reported pet-related concern was access to veterinary treatment. Conclusion: Pet owners both with and without MS reported subjective benefits to their wellbeing from pet ownership during COVID-19, although analysis suggested that pet ownership was associated with a reduction in satisfaction with social roles. The study had several limitations and suggestions are made for future work.

Attitude and Knowledge of Patients with Multiple Sclerosis (MS) About COVID-19 as Provided by Physicians

Background: Coronavirus disease 2019 (COVID-19) has become a pandemic, and patients receiving immunosuppressive agents could be at a higher risk of the infection. Patients’ knowledge and behavior play a major role in their health. Physicians should provide patients with enough information regarding medication use, prevention strategies, and treatment choices in case of infection. Objectives: This study aimed to evaluate the attitude and knowledge of Iranian patients with multiple sclerosis (MS) about COVID-19, as provided by physicians. Methods: A google form was designed, and the patients consented to fill out the survey. The participants’ basic characteristics were collected. Moreover, they were asked about COVID-19 transmission routes and prevention strategies, their concerns regarding MS-related checkups during the COVID-19 pandemic, COVID-19 infection tests, COVID-19 symptoms, and information they received from their physicians about what to do in case of COVID-19 infection. Results: Four hundred and ten forms were collected. The mean age of the patients and the mean duration of the disease were 34.5 ± 8 and 7.2 ± 5.7 years, respectively. Nearly 80% of the respondents believed that patients with MS were at a higher risk of COVID-19 infection, and 75% of them thought that wearing a face mask could prevent the infection transmission. Moreover, only 21% of 410 the physicians informed their patients of when to stop their medication if they were suspected to have COVID-19, and 22% of them informed their patients of where to refer in case of COVID-19 suspicion. Nearly half of all physicians prescribed immune-boosting supplements, such as selenium, zinc, and vitamin D. Conclusions: The results showed that Iranian MS patients had good knowledge regarding COVID-19 prevention strategies and transmission routes. However, they received less information from their physicians regarding medication use control, centers for admission, and physician consultation in case of COVID-19 infection.