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\title{Impact of anxiety, stress and depression related to COVID-19 pandemic on
the course of hereditary angioedema with C1 inhibitor deficiency}



\author[1]{Deniz Eyice Karabacak}%
\author[2]{semra demir}%
\author[1]{Osman Ozan Yeğit}%
\author[1]{Ali Can}%
\author[3]{Kadriye Terzioğlu}%
\author[2]{Derya Erdoğdu}%
\author[4]{Muge Olgac}%
\author[5]{raif coskun}%
\author[1]{Bahauddin Çolakoğlu}%
\author[2]{Suna Büyüköztürk}%
\author[1]{Aslı Gelincik}%
\affil[1]{Istanbul University Istanbul Faculty of Medicine}%
\affil[2]{Istanbul University, Istanbul Faculty of Medicine}%
\affil[3]{Kartal Dr Lütfi Kırdar Education and Research Hospital}%
\affil[4]{Şişli Hamidiye Etfal Education and Research Hospital}%
\affil[5]{Prof Dr Cemil Taşçıoğlu City Hospital}%


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  \date{May 19, 2024}


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\begin{abstract}
Background: Hereditary angioedema (HAE) attacks can be provoked with
psychological factors. The aim of this study was to assess the effects
of anxiety, depression and stress related to COVID-19 pandemic on
disease activity of HAE patients during the quarantine period (QP) and
the return to normal period (RTNP). Methods: This prospective study was
conducted between March 2020 and September 2020 in four allergy centres.
Demographic, clinical features and mental health status were evaluated
in QP (from March to the beginning of June) and RTNP (from June to the
beginning of September) was applied by the government. The 10-point
visual analogue scale (VAS10) was used to define the severity of HAE
attacks. Depression-Anxiety- Stress Scale-21 (DASS-21) and Fear of
Covid-19 (FC-19) scales were performed to assess mental health status.
Results: 139 HAE patients were included in the study. In QP, median
attack numbers and median VAS10 scores were 5 (min-max: 0-45) and 6
(min-max: 0-10), respectively. HAE attack numbers, DASS-21 stress,
anxiety, depression and total DASS-21 scores, as well as FC-19 scores
were higher in QP than RTNP (p= 0.001, p \textless{}0,001, p = 0,001, p
\textless{}0,001, p \textless{}0.001, p\textless{}0.001, respectively).
However, there was no difference in attack severity scores between the
two periods (p\textgreater{}0.05). Conclusions: This study revealed that
the restriction measures during Covid-19 outbreak causes an increase in
the number of HAE attacks in relation to anxiety, depression, stress and
fear of Covid-19 pandemic. Therefore, it is important to provide
psychological support to HAE patients during the pandemic.%
\end{abstract}%



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