# Depression, Anxiety, and Stress Symptoms in Women with Rheumatic Disease of Reproductive Age: Lessons from the COVID-19 Pandemic

## TL;DR

The study found that women with rheumatic diseases had mental health outcomes as good as or better than healthy controls during the pandemic.

## Contribution

This study explores mental health in women with rheumatic diseases during the pandemic and identifies access to care as a protective factor.

## Key findings

- Women with SARD reported lower stress and pandemic-related anxiety than healthy controls.
- Access to rheumatological care and recent disease activity were significant predictors of mental health outcomes in SARD patients.
- Mental health outcomes in SARD patients were equal to or better than controls despite pandemic stress.

## Abstract

Background: Women with systemic autoimmune rheumatic disease (SARD) are at higher risk of developing infection-related complications, anxiety, and depression. Using the example of the COVID-19 pandemic, we aimed to explore the impact of this external stressor on symptoms of depression, anxiety, and stress in a sample of women with SARD in a cross-sectional study design. Methods: Females aged 18–50 with SARD were enrolled from 04/2021 to 04/2022 at the Medical University of Vienna or through an online self-help group, while snowball sampling was used to recruit an age-matched healthy control group. Participants completed questionnaires including: (1) demographic information, medical history, and access to healthcare; (2) the Depression, Anxiety, and Stress Scale (DASS-21); and (3) the Coronavirus Anxiety Scale (CAS). Parameters were compared between groups using Chi-squared, Fisher’s exact, and Mann–Whitney U tests. Linear regression analysis was used to investigate which individual factors predicted the DASS-21 in women with SARD. Results: The study sample consisted of 226 women (n = 99 with SARD and n = 127 healthy controls). Women with SARD reported lower DASS-21 stress (p = 0.008) and CAS scores (p = 0.057) than the control group. There were no significant differences in DASS-21 anxiety or depression scores. Among women with SARD, a linear regression model identified the most important predictors of DASS-21 as access to rheumatological care (p = 0.002) and recent disease activity (p = 0.028). Conclusions: Despite the pandemic, women with SARD reported mental health outcomes equal to or better than those of the healthy control group. Continued access to rheumatological care may serve as an important protective factor for their mental health during large-scale crises like pandemics.