ECE2021 Presented Eposters Presented ePosters 14: COVID-19 (8 abstracts)
Psychological distress in patients with hypocortisolism during mass quarantine for Covid-19 epidemic in Italy
Chiara Simeoli 1 , Mattia Barbot 2 , Marta Franco 3 , Marianna Martino 4 , Valentina Morelli 5 , Francesco Ferraù 6 , Rosa Maria Paragliola 7 , Valeria Hasenmajer 8 , Valentina Guarnotta 9 , Giuseppina De Filpo 10 , Roberta Giordano 11 , Guido Di Dalmazi 12 , Chiara Sabbadin 2 , Alessandro Veresani 3 , Andrea M. Isidori 8 , Giovanna Mantovani 5 , 13 , Giorgio Arnaldi 4 , Mara Boschetti 14 , Carla Scaroni 2 , Annamaria Colao 1 , Felice Iasevoli 15 & Rosario Pivonello 1
1Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Naples, Italy; 2Endocrinology Unit, Department of Medicine, DIME University-Hospital of Padova, Padua, Italy; 3Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy; 4Clinica di Endocrinologia e Malattie del Metabolismo, Dipartimento di Scienze Cliniche e Molecolari (DISCLIMO), Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy; 5Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 6Endocrine Unit, University Hospital ’G. Martino’, Department of Human Pathology of Adulthood and Childhood ’G. Barresi’DETEV, University of Messina, Messina, Italy; 7Unit of Endocrinology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Fondazione Policlinico “Gemelli” IRCCS, Rome, Italy; 8Department of Experimental Medicine, Policlinico Umberto I, COVID Hospital, Sapienza University of Rome, Rome, Italy; 9Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, UOC di Malattie endocrine, del Ricambio e della Nutrizione, Università degli studi di Palermo, Palermo, Italy; 10Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy; 11Division of Endocrinology, Department of Clinical and Biological Sciences, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy; 12Endocrinology and Diabetes Prevention and Care Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; 13Department of Medical Sciences and Community Health, University of Milan, Milan, Italy; 14Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy; 15Department of Neuroscience, University of Naples Federico II, Naples, Italy
Beyond the huge impact on physical health, coronavirus disease-19 (COVID-19) epidemic represents a significant psychological stressor, causing effects on mental health. The psychological distress of the epidemic and consequent mass quarantine on patients with hypocortisolism, particularly frail and vulnerable to infections and stress, is unknown. The current multicentre, web-survey-based, case-control study evaluated the psychological impact of COVID-19 quarantine in a large cohort of patients with hypocortisolism. The study was performed on 478 patients with hypocortisolism adequately treated with glucocorticoids, of which 363 with adrenal insufficiency (AI)(215F, 148M, 47.61 ± 12.44 years) and 115 with congenital adrenal hyperplasia (CAH)(75F, 40M, 38.84 ± 13.23 years), matched with 478 Italian healthy controls. Major disabilities, ongoing/recent hospitalization, psychiatric illnesses/medications, COVID-19 infection/suspicion represented exclusion criteria. All patients with hypocortisolism were informed on required glucocorticoid dose adjustments in case of intercurrent illnesses and stress conditions. AddiQoL, General Anxiety Disorder-7 (GAD-7), Perceived Stress Scale (PSS), Patient Health Questionnaire-9 (PHQ-9), Specific Psychotic Experiences (SPEQ), Ego-Resiliency Revised Scale (ER89-R), and 18-items Psychological Well-Being (PWB) questionnaires were telematically and anonymously administered to participants during the last 3-weeks of quarantine, lasted 2 months in Italy; higher scores of GAD-7, PSS, PHQ-9 and SPEQ indicated higher anxiety, perceived stress, depression, and psychosis, whereas lower scores in AddiQoL, ER89-R and PWB indicated lower QoL, resiliency and psychological well-being. In the whole cohort of patients, GAD-7 (P <0.001), PHQ-9 (P <0.001) and PWB-environmental mastery (P = 0.043) scores appeared significantly higher, whereas ER89-R related to openness to life experience (ER89-R-OL) (P = 0.003) and PWB-self-acceptance (P = 0.004) scores significantly lower in patients than in controls. AI patients reported significantly lower AddiQoL (P <0.001) scores than CAH patients, with significantly higher PSS (P = 0.022) scores in AI than CAH females, and higher ER89-R-OL (P = 0.035) scores in AI than CAH males. During quarantine, 64 (13.4%) patients, 53 (14.6%) AI and 11 (9.6%) CAH patients required glucocorticoid dose increase, with females reporting a significantly higher prevalence of glucocorticoid dose increase than males (16.9% vs 8%, P = 0.0057). In conclusion, patients with hypocortisolism suffered increased anxiety and depression, associated with a dissatisfaction feeling of self and a reduced resiliency, although reporting a higher sense of mastery in managing the environment, being able to choose contexts suitable to personal needs. Moreover, AI patients reported a worst QoL than CAH patients, with higher perceived stress in females, and higher resiliency in males. Therefore, an empowerment of psychological counseling for these vulnerable patients during COVID-19 should be considered by national health-care services.
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Endocrine Abstracts
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