BRAIN. Broad Research in Artificial Intelligence and Neuroscience ISSN: 2068-0473 | e-ISSN: 2067-3957 Covered in: Web of Science (WOS); PubMed.gov; IndexCopernicus; The Linguist List; Google Academic; Ulrichs; getCITED; Genamics JournalSeek; J-Gate; SHERPA/RoMEO; Dayang Journal System; Public Knowledge Project; BIUM; NewJour; ArticleReach Direct; Link+; CSB; CiteSeerX; Socolar; KVK; WorldCat; CrossRef; Ideas RePeC; Econpapers; Socionet. 2021, Volume 12, Issue 2, pages: 342-348 | https://doi.org/10.18662/brain/12.2/212 The Evolution of Mental Health in Patients with Psoriasis during the COVID-19 Pandemic Roxana-Cristina OLTENACU¹, Alexandru Bogdan CIUBARA2, Alexandru NECHIFOR3, Stefan Lucian BURLEA4, Anamaria CIUBARA5 1 Dunarea de Jos University of Galati, Romania, rcoltenacu@gmail.com 2 Dunarea de Jos University of Galati, Romania, bogdan.ciubara@ugal.ro 3 Dunarea de Jos University of Galati, Romania, alexandrunechiformed@yahoo.com, corresponding author 4 University of Medicine and Pharmacy “Grigore T. Popa” Iasi, Romania, lucianburlea@yahoo.com 5 Dunarea de Jos University of Galati, Romania, anamburlea@yahoo.com Abstract: Introduction: The aim of this study was to assess the impact of the Covid-19 pandemic on mental health on a sample of 37 patients with psoriasis in Brăila County. Methods: A cross- sectional study on a sample of 37 patients with psoriasis was conducted by questionnaires e-mailed to patients. The study was conducted between November 20th, 2020 - January 15th, 2021. Mental health was measured using the Hamilton Anxiety Assessment Scale (HAS). Data collected on predictors included, but were not limited to, sex, age, background, marital status, level of education, smoking, alcohol consumption, comorbidities, period of self-isolation, severity of psoriasis, and type of treatment for psoriasis. Results: There were 37 participants included. Factors associated with poor mental health were: place of origin (54% from urban areas), sex (62.1% women), age (67.5% between 65 and 80 years old), period of self-isolation (81% in self-isolation for more than 14 days), comorbidities (75.6% with multiple comorbidities) and form of treatment for psoriasis (48.6% are systemically administered treatment for psoriasis). Conclusions: In this sample of patients with psoriasis from Brăila County who isolate or socially distance themselves, urban patients, women, elderly, those with comorbidities and those who are systemically administered treatment for psoriasis were associated with a high score on the Hamilton anxiety assessment scale. However, we have to admit that our research has some limitations. First, the number of participants included in the study was small. Secondly, we used an online way to conduct the study. Thirdly, we used a self- assessment scale to assess the anxiety symptoms of psoriasis patients, which might have some deviation from the outcome. Looking beyond the current situation, it is essential to evaluate and restructure the way we think about patient’s care. Keywords: anxiety, psoriasis, pandemic, COVID-19. How to cite: Oltenacu, R.-C., Ciubara, A.B., Nechifor, A., Burlea, S.L., & Ciubara, A. (2021). The Evolution of Mental Health in Patients with Psoriasis during the COVID-19 Pandemic. BRAIN. Broad Research in Artificial Intelligence and Neuroscience, 12(2), 342-348. https://doi.org/10.18662/brain/12.2/212 https://doi.org/10.18662/brain/12.2/212 mailto:rcoltenacu@gmail.com mailto:bogdan.ciubara@ugal.ro mailto:alexandrunechiformed@yahoo.com mailto:lucianburlea@yahoo.com mailto:anamburlea@yahoo.com https://doi.org/10.18662/brain/12.2/212 BRAIN. Broad Research in June, 2021 Artificial Intelligence and Neuroscience Volume 12, Issue 2 343 1. Introduction Psoriasis is a major socio-medical problem that affects approximately 125 million people worldwide (Karam et al., 2017, Parisi et al., 2013). Most often, psoriasis is associated with anxiety, depression and sleep disorders (Fleming et al., 2017; Koo et al., 2017; Jensen et al., 2018; Ljosaa et al., 2010). COVID-19 is an infectious disease caused by the recently discovered coronavirus SARS-CoV-2. The number of COVID -19 cases in Romania from the beginning of the pandemic until the end of March 2021 is 952,803 infected people (Worldometer, March, 2021). The current situation has changed the approach regarding patients who require direct contact during the medical visit, including dermatological consultations. The health system was overwhelmed, and many hospitals could not cope with the large number of patients (Sandu & Damian 1018). Psoriasis patients having limited access to necessary medical services. Home isolation and quarantine orders issued by authorities to limit the spread of the infection were another reason why many patients avoided outpatient services. The Covid-19 pandemic continues to affect millions of people worldwide (Sandu, 2020a; 2020b). While the immediate health consequences are the main goal, the indirect impact of the virus remains unseen (Sandu, 2020c; 2020d; Sandu & Nistor 2020). 2. Material and methods This cross-sectional study was conducted between November 20, 2020 - January 15, 2021. The purpose of this study was to assess, at some point during the pandemic, the mental health of psoriasis patients in Brăila County. The inclusion criteria were: 1) age over 18 years; 2) cooperative; 3) under topical or systemic treatment for psoriasis; 4) with internet access; 5) agreed to participate in the study. The exclusion criteria were: 1) age under 18; 2) uncooperative; 3) no treatment for psoriasis; 4) no internet access; 5) did not agree with the inclusion in the study. Finally, 37 patients with psoriasis were included in the study. Mental health was measured using the Hamilton Anxiety Assessment Scale (HAS) (Hamilton, 1959) sent by e-mail or telephone to patients. Data collected on the variables included sex, age, background, level of education, alcohol consumption, comorbidities, period of self-isolation / quarantine, severity of psoriasis and type of treatment for psoriasis. The Evolution of Mental Health in Patients with Psoriasis during the … Roxana-Cristina OLTENACU, et al. 344 The score obtained after completing the Hamilton Anxiety Assessment Scale was the one that divided the patients into four categories: a total score between 0-4 ranks patients as normal patients, a total score between 5-10 ranks patients as being patients with mild anxiety, a total score between 11-16 rates patients as patients with moderate anxiety and a total score above 17 rates patients as patients with severe anxiety. 3. Results 3.1. Gender of patients Of the 37 patients included in the study, 23 were female and 14 were male. Of the group of female patients, following the completion of the Hamilton Anxiety Assessment Scale, 12 are normal, 7 have mild anxiety, 3 have moderate anxiety and one patient has severe anxiety. Of the male patients, 8 are normal, 4 have mild anxiety and 2 have moderate anxiety. 3.2. Age The patients were divided into three age categories: the age category under 45 years, the age category between 45 years and 65 years and the age category between 65 years and 80 years. In the age group under 45, which includes 4 patients, 3 patients are normal, and one patient has mild anxiety. In the age category 45 years - 65 years, which includes 8 patients, 4 are normal, 3 have mild anxiety and one patient has moderate anxiety. In the age category between 65 and 80 years, which includes 25 patients, 13 are normal, 7 have mild anxiety, 4 patients have moderate anxiety, and 1 patient has severe anxiety. 3.3. Marital status Of the 34 married patients included in the study, 17 are normal, 11 have mild anxiety, 5 have moderate anxiety and 1 patient has severe anxiety. All 3 unmarried patients are normal. 3.4. Background From the total of 20 urban patients included in the study, 11 are normal, 6 have mild anxiety, 2 have moderate anxiety and 1 patient has severe anxiety. Of the 17 patients in rural areas, 9 patients with psoriasis are normal, 5 patients have mild anxiety, and 3 patients have moderate anxiety. BRAIN. Broad Research in June, 2021 Artificial Intelligence and Neuroscience Volume 12, Issue 2 345 3.5. Alcohol consumption 27 patients stated that they did not consume alcohol. Of the group of psoriasis patients who do not consume alcohol, 15 are normal, 6 have mild anxiety and 3 patients have moderate anxiety. Of the 10 patients who consume alcohol, 5 are normal, 2 have mild anxiety, 2 have moderate anxiety and 1 patient has severe anxiety. 3.6. Smoking There are 8 patients in the category of smoking patients. 7 are normal and 1 patient has mild anxiety. Of the 29 non-smokers included in the study, 13 are normal, 10 have mild anxiety, 5 have moderate anxiety and 1 patient has severe anxiety. 3.7. The severity of psoriasis The severity of psoriasis was determined using the Psoriasis area and Severity Index (PASI) criteria (Naldi & Gambini, 2007), who specified that a PASI score < 10 defines the mild form, between 10 - 20 the moderate form and > 20 the severe form. Thus, patients were divided into three categories, namely, patients with mild form psoriasis, patients with moderate form psoriasis and patients with severe form psoriasis. Of the 14 patients with a mild form of psoriasis, 10 are normal and 4 have mild anxiety. Of the 17 patients with moderate psoriasis, 8 are normal, 5 have mild anxiety, 3 have moderate anxiety and 1 patient has severe anxiety. 6 patients have severe psoriasis, of these, 2 are normal, 2 have mild anxiety and 2 have moderate anxiety. 3.8. Comorbidities 28 patients included in the study have multiple comorbidities, of these, 13 are normal, 9 have mild anxiety, 3 have moderate anxiety and 1 patient has severe anxiety. 9 patients do not have comorbidities, of these, 7 are normal and 2 have mild anxiety. 3.9. Psoriasis treatment administration Within the group of those who systemically administer their psoriasis treatment, there are 21 patients, of whom 11 are normal, 6 have mild anxiety, 3 have moderate anxiety and one patient has severe anxiety. 16 patients are receiving topical treatment for psoriasis, of whom 9 are normal, 5 have mild anxiety and 2 have moderate anxiety. The Evolution of Mental Health in Patients with Psoriasis during the … Roxana-Cristina OLTENACU, et al. 346 3.10. Self-isolation and quarantine Out of a total of 37 patients included in the study, 30 stayed in self- isolation and quarantine for more than 14 days. This is due, in particular, to the orders imposed by the authorities. Of these, 16 are normal, 9 have mild anxiety, 3 moderate anxiety and 1 patient has severe anxiety. Of the 7 patients who were in self-isolation and quarantine for 14 days or less, 4 are normal, 2 have mild anxiety and 1 patient has moderate anxiety. 4. Discussions In this study we assessed the impact of the pandemic on the psychic of patients with psoriasis. The current situation has forced us to choose an online way to conduct the study. Following this study, we obtained the following conclusions: prone to developing anxiety during the pandemic are: women, patients over the age of 65, those in urban areas, alcohol users, non- smokers, those with moderate forms of psoriasis, those with multiple morbidities, those who systemically administer their treatment for psoriasis and those who have been in isolation or quarantine for more than 14 days. We must however admit that our research has some limitations. Firstly, the sample size of patients included in the study was small and has, therefore, reduced the credibility of the study. Secondly, we used an online way to conduct the study, so that, those in urban areas, those who are retired or who do not have a job, were able to respond affirmatively to our invitation to participate in the study. Thirdly, we used a self-assessment scale to assess the anxiety symptoms of psoriasis patients, which might have some deviation from the outcome. One of the questions asked to patients was whether they were infected with Covid-19 during this pandemic, and most refused to answer, which is why the degree of infection with Covid-19 could not be included in the list of variables. 5. Conclusions Most patients with psoriasis will not develop significant mental health problems during the pandemic, even those who have a severe form of the disease, but the widespread impact could be considerable. 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