Mental health intervention for scleroderma patients in COVID-19 lockdown sees mixed results
A virtual group program aimed at providing mental health coping strategies and reducing isolation during COVID-19 lockdowns in patients with scleroderma failed to significantly improve anxiety post-intervention, according to data.
However, the researchers added that the videoconference-based sessions did result in significantly lower anxiety and depression symptoms 6 weeks after the intervention.
“During COVID-19, many people with systemic sclerosis have reported being fearful that they could be infected and have severe complications or death, that they might not be able to access necessary health care, and that they might need to be isolated for long periods of time owing to their vulnerability,” Brett D. Thombs, PhD, of Jewish General Hospital, in Montreal, Canada, and colleagues wrote. “Anxiety symptoms measured early in the pandemic among people with systemic sclerosis increased dramatically compared with pre-COVID-19.”
Enter the Scleroderma Patient-centered Intervention Network COVID-19 Home-isolation Activities Together program, or SPIN-CHAT, a 4-week — with three sessions per week —video-based group intervention.
“The SPIN-CHAT Trial is important both broadly in COVID-19 and in the rheumatology community,” Thombs told Healio Rheumatology. “A recent systematic review identified SPIN-CHAT as one of only three well-conducted trials of scalable mental health interventions in any population in COVID-19. It showed that peer-led videoconference-based interventions can be effective. In rheumatology, it addressed the acute mental health needs of over 150 people with scleroderma who received the intervention via the trial or the waitlist.”
To analyze the impact of SPIN-CHAT on anxiety symptoms, and other mental health outcomes, in patients with systemic sclerosis during COVID-19 lockdowns, Thombs and colleagues conducted a pragmatic, two-arm, parallel, partially nested, randomized, controlled trial. The researchers used the international SPIN COVID-19 Cohort to recruit participants with systemic sclerosis who completed baseline measures, had at least mild anxiety symptoms, had not tested positive for COVID-19 and were not currently receiving mental health counseling.
Thombs and colleagues enrolled a total of 560 eligible participants, of whom 172 were randomly assigned 1:1 to either the SPIN-CHAT intervention or a waitlist. Each SPIN-CHAT group session included six to 10 participants, with each session lasting 90 minutes. Facilitators, who either had systemic sclerosis themselves or were part of a patient organization, encouraged participants to include coping skills into their daily lives, and led support segments.
Other parts of the sessions included leisure activities, provided by a recreational therapist; mental health coping strategy education and practice, provided by professionals; and group social support, facilitated by trained peer support group leaders.
Meanwhile, participants on the waitlist were provided only with reminders to complete trial measures. They later received the SPIN-CHAT program following the 6-week post-intervention outcome assessment.
The primary outcome in the intention-to-treat population was anxiety symptoms immediately following the SPIN-CHAT intervention, based on the PROMIS Anxiety 4a version 1.0 measure. Raw scores are converted into T scores standardized in the U.S. adult general population, with higher scores representing more anxiety. Secondary outcomes included anxiety symptoms, depression symptoms, fear, loneliness, boredom and physical activity 6 weeks post-intervention.
The researchers also assessed Client Satisfaction Questionnaire results among intervention participants immediately following the program.
According to the researchers, the SPIN-CHAT program failed to significantly reduce anxiety symptoms post-intervention (–1.57 points; 95% CI, –3.59 to 0.45), with a standardized mean difference (SMD) of –0.22 points. However, anxiety symptoms were significantly reduced 6 weeks later (–2.36 points; 95% CI, –4.56 to –0.16), with an SMD of –0.31. Depression symptoms were similarly lower 6 weeks post-intervention (–1.64 points; 95% CI –2.91 to –0.37; SMD 0·31), also an SMD of –0.31. No other secondary outcomes were significant, and the researchers reported no adverse events.
“A key takeaway from our trial is that this kind of ongoing collaborative group can move quickly and effectively to meet patient needs in real time,” Thombs said. “SPIN-CHAT went from an idea to a patient advisor meeting, a program, funding, ethics approval, and launch, all in a matter of several weeks. In terms of clinical significance, our trial showed that simple, multi-faceted strategies to address mental health, along with good peer support, can be used effectively by our vulnerable rheumatology patients to improve their mental health in COVID-19 and beyond.”