5. DISCUSSION
At the beginning of the COVID-19 crisis in Italy, rates of depression
and anxiety were highly elevated in pwCF (71%) and parents (57%
depression, 79% anxiety), with a large proportion scoring in the
moderate to severe range. Ratings of stress were also highly elevated
during this crisis. Importantly, these rates of psychological
symptomatology were much higher during the COVID lockdown, than those
obtained during routine CF care prior to COVID [12,27-28]. Twice the
number of pwCF scored in the elevated range at baseline assessment in
this study than prior published data [12].
Overall, the results of this Telehealth Psychological Support
Intervention demonstrated positive effects, significantly reducing
symptoms of stress and depression for both pwCF and caregivers.
Decreases in ratings of stress and symptoms of depression and anxiety
were substantial. For pwCF, 38% reported decreases in depression and
25% in anxiety, leading to a change in severity; for parents 21.4% and
28.6% reported less depression and anxiety, respectively. Two parents
made a dramatic improvement, reporting severe symptoms at pre and mild
symptoms at post, thus, improving by two categories of severity. This
intervention may also have served to prevent a worsening of
psychological symptoms. Although substantial decreases in symptomatology
were observed, the majority of pwCF and caregivers remained stable
within a particular category, with few showing a pattern of increased
symptoms.
In considering how many participants achieved a clinically meaningful
change in symptomatology, 17-37% of pwCF and 7-13% of parents,
respectively. Although the overall results of this telehealth
intervention were highly positive, decreases in anxiety did not meet the
statistical threshold for significance for either pwCF or parents.
Several possible reasons may account for this. First, COVID-19 is a
novel coronavirus and there was no information about how this new virus
might affect pwCF. Given that CF is a very serious, underlying pulmonary
condition, there was considerable fear that pwCF would be more
negatively affected than others, and the CF healthcare community did not
know if pwCF were uniquely vulnerable. Second, during and after the
intervention, people were still living with this crisis every day.
Triggers for anxiety were ubiquitous (e.g., news, mortality rates) and
the extreme social isolation in Italy may have also raised levels of
anxiety. Finally, many people lost their jobs because all services and
businesses were closed, and children and adolescents were not able to go
to school. The pandemic caused a major economic recession in Italy, as
in other parts of the world, and this might have limited reductions in
anxiety.
The psychological support intervention was very brief, only 4 sessions,
but was highly effective. It utilized basic skills derived from CBT,
including relaxation training, cognitive reframing, exercises to
increase positive emotions (e.g., music), good sleep hygiene, and
physical exercises for home. It was delivered via telehealth with a
clinical psychologist, which enabled pwCF and parents to access the
intervention easily and efficiently. There were no technical
difficulties because it utilized simple technology (videocall) and if
necessary, could be conducted by phone.