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.