Keywords: COVID-19, depression, anxiety, cognitive behavioral therapy, telehealth intervention
1. INTRODUCTION
In December 2019, a novel coronavirus, SARS-CoV-2 (i.e., COVID-19), spread in Hubei, China. The virus caused a variety of symptoms, ranging from asymptomatic/mild symptoms to serious impairments and death [1]. The spread of COVID-19 has led to significant morbidity and mortality worldwide [2], causing high levels of stress, fear and anxiety about this extremely contagious, rapidly spreading virus [3]. Anxiety was related to fears of being infected, infecting others, and concerns its associated comorbidities and high mortality rate. Loss of normal routines (e.g., attending work, school), reduction of activities (e.g., restaurants), and a severe economic recession contributed to increasing stress and worsening mental health (e.g., depression, anxiety). A previous systematic review on large-scale disasters revealed increased depression, anxiety, PTSD, substance misuse, domestic violence [4]. The SARS epidemic was also associated with increased psychological distress in patients and clinicians [5].
The first study in China on the impact of COVID-19 found elevated depression and anxiety in a large sample of 1210 individuals: 17% reported moderate-severe depression and 29% moderate-severe anxiety [6]. A study in Hong Kong screened 500 adults using well-validated screening tools (i.e., PHQ-9, GAD-7), reporting high levels of depression (19%) and anxiety (14%). Further, 25% of the sample reported a worsening of mental health due to the pandemic [7]. Adolescents in China also reported high levels of depression (43.7%) and anxiety (37.4%) using PHQ-9 and GAD-7 [8]. Similar elevations in psychological distress have been documented across the world, with rates of depression and anxiety ranging from 7-20% and 10-19%, respectively [9-11].
As the pandemic spread throughout Italy and Europe, new mental health concerns were raised by people with cystic fibrosis (pwCF) and parent caregivers, who are already at increased risk for depression and anxiety [12,13, 14]. Psychological symptoms in pwCF have been associated with worse adherence, more frequent hospitalizations, and earlier mortality [15,16]. Havermans et al. (2020) characterized pwCF as at-risk for psychological symptomatology, reporting feelings of sadness, helplessness and difficulties adhering to prescribed treatments. Increased stress, negative thoughts, and trouble sleeping were also reported, combined with a sense of fear and worry. Parents of children with CF reported high levels of anxiety and disturbances in sleep [17,18].
As Italy became a COVID “hot spot,” concerns about the psychological functioning of pwCF and caregivers increased. To address these concerns, psychologists on the CF team at Bambino Gesù Children’s Hospital developed a Telehealth Psychological Support Intervention. It targeted adolescents/young adults with CF and caregivers, providing them with cognitive behavioral strategies to cope with the stress and emotional challenges of the lockdown in March. The lockdown was highly restrictive: schools and universities were closed, people were told to work from home, and individuals could go out only for essential tasks (e.g., supermarket, pharmacy). Access to routine healthcare also changed for pwCF and many were afraid of coming to the CF Center; in-person appointments were reserved for those with serious health problems. The purpose of this study was to evaluate the effectiveness of a cognitive behavioral telehealth intervention to reduce symptoms of stress, depression and anxiety in pwCF and parents during the lockdown. This 4-session telehealth intervention was delivered via internet and was aimed at reducing psychological symptomatology and improving disease management. Feasibility and satisfaction were assessed.