Social isolation during COVID-19 impacts comorbidities, mental health

Isolation during the COVID-19 pandemic may lead to deterioration in comorbidities and mental health, according to two studies presented at the European Society of Endocrinology virtual conference (e-ECE 2021).

For the first study, Dr Liana Jashi from the Batumi Endocrinology Center, Batumi, Georgia, and co-investigators developed an online questionnaire which was distributed to 16 endocrinologists and 22 family and general practice physicians. These questionnaires were used to assess the impact of quarantine on health outcomes in patients with diabetes. 

Patient presentation at the clinics decreased by 79.9 percent, with 64.8 percent of patients communicating with their physicians via telephone or social media. [e-ECE 2021, abstract AEP170]

Hypoglycaemia was reported in 22 percent of patients. More than 11 percent of ambulatory patients initiated insulin therapy.

The incidence of stable angina pectoris attack increased by 35.5 percent. Hospitalization due to myocardial infarction was required in 41.5 percent of patients. About 88 percent of patients experienced elevations in blood pressure levels, which led to hospitalization in 50 percent of cases.

About 56 percent of patients experienced vision deterioration and 97.1 percent experienced weight gain. Cigarette use increased by 35.3 percent and alcohol consumption by 29.4 percent, while physical activity decreased by 29.8 percent.

Eighty-two percent of patients reported feelings of anxiety of fear.

Incidence of new diabetes occurred in 58.4 percent of patients.

“SARS-CoV-2 infection produces greater morbidity and mortality in people with cardiovascular disease, diabetes, and obesity,” said Jashi and co-investigators. “[While] quarantine and social distancing are necessary measures to prevent the virus from spreading, [they] also lead to elevated levels of loneliness and social isolation,” they said.

The survey showed that social isolation and quarantine in patients with diabetes reduced the availability of medical care and led to elevations in body weight, blood pressure, and cigarette and alcohol use, as well as deterioration in emotional health.

“This study highlights that people living with diabetes require greater support during pandemics to maintain exercise and protect their physical and mental health. National health services should use these data and future studies to implement better social care around supporting people with pre-existing conditions,” she said.

 

Quarantine resulted in poorer psychosocial health

Another study from Italy suggested that patients with hypocortisolism experienced negative psychosocial outcomes as a result of mass quarantine during the COVID-19 pandemic. [e-ECE 2021, abstract PEP14.7]

Dr Chiara Simeoli from the University of Naples Federico II, Naples, Italy, and colleagues analysed these outcomes in 478 patients with hypocortisolism who were adequately treated with glucocorticoids (363 with adrenal insufficiency [AI] and 115 congenital adrenal hyperplasia [CAH]) and compared them with 478 healthy controls. Questionnaires were distributed to participants at 12 centres during the last 3 weeks of the 2-month quarantine in Italy.

Compared with the control group, patients had significantly higher General Anxiety Disorder-7 and Patient Health Questionnaire-9 scores, indicating greater anxiety and depression, respectively (p<0.001 for both).

Patients had significantly lower Revised Ego Resiliency 89 Scale related to openness to life experience (ER89-R-OL) and Psychological Wellbeing (PWB)-self-acceptance scores compared with controls (p=0.003 and p=0.004, respectively). However, patients had higher PWB-environmental mastery scores than controls (p=0.043).

Among patients, Addison’s disease quality of life (AddiQoL) scores were lower among those with AI than CAH (p<0.001). Perceived Stress Scale (PSS) scores were higher in females with AI vs CAH (p=0.022), while ER89-R-OL scores were higher in males with AI vs CAH (p=0.035).

Sixty-four patients required an increase in glucocorticoid dose during quarantine which was more common among female than male patients (16.9 percent vs 8 percent; p=0.0057).

“[P]atients with hypocortisolism suffered increased anxiety and depression, associated with a dissatisfaction feeling of self and reduced resiliency, although [they reported] a higher sense of mastery in managing the environment [and] being able to choose contexts suitable to personal needs,” said Simeoli and colleagues.

“These findings confirmed that beyond the huge impact on physical health, COVID-19 epidemic, social isolation, and mass quarantine represent significant psychological stressors, causing severe effects on mental health, even more on people with pre-existing conditions. Psychological counselling for these vulnerable patients during COVID-19 should be considered by national healthcare services,” Simeoli concluded.