Objectives: Growing evidence points to mental health impacts of coronavirus disease 2019 (COVID-19). We explored trajectories of depressive symptoms in the year pre- and 2 years post-pandemic onset in adults with RA.
Methods: Data are from the Canadian Early Arthritis Cohort (CATCH), a prospective, multicentre, early RA cohort of Canadian adults treated by rheumatologists. Pre-pandemic, participants completed patient-reported outcome measures and rheumatology exams in person. After March 2020, patient-reported outcomes were collected at in-person and virtual visits. We used group-based trajectory modelling to explore longitudinal patterns of depressive symptoms prior to and throughout the COVID-19 pandemic and multinomial regression to identify factors associated with depression trajectory group.
Results: A total of 989 participants had a mean age of 60 years (s.d. 14), RA for 6 years (s.d. 4) and were mostly white (84%) and female (73%) with some college education (60%). Most (77%) were in Clinical Disease Activity Index remission/low disease activity prior to the pandemic. We identified four trajectories: resilient (no symptoms throughout: 60%), worsening (none-mild: 22%), improving (mild-minimal: 8%) and persistent (moderate-severe throughout: 9%). Age, sex, race, education, pain, physical and social functioning, fibromyalgia and history of anxiety/depression were associated with different trajectories.
Conclusion: Although 60% had a consistent affect during the first 2 years of the pandemic, mood worsened in greater than one in five, suggesting a cumulative impact over time. Biological, psychological and social factors and worse pre-pandemic symptoms and function were associated with a greater risk of depression during the pandemic. Identifying at-risk groups impacted by major stressors like the pandemic may offer new opportunities to personalize treatment, allocate resources, reduce disease flares and improve outcomes.