Introduction
Cystic fibrosis (CF) is a chronic, life-shortening disease causing recurrent respiratory tract infections and loss of lung functions [1]. Previous meta-analyses and systematic reviews have shown that adults and children with chronic diseases have higher risk of depression and anxiety compared to community [2,3]. A number of studies reported increased anxiety and depression in CF pateints compared to healthy controls [4-6]. Facing a chronic disease such as CF on a daily basis cause significant emotional burden which can be attributed to large number of treatments, hospitalizations, multiple diagnostic procedures, chronic respiratory symptoms, a lower body mass index [6].
Viral respiratory tract infections are more severe in patients with CF compared to general population. Influenza pandemic in 2009, caused significant morbidity in patients with CF and in a subgroup of patients with severe lung disease, H1N1 infection was associated with respiratory deterioration, intensive care admission and even death [7,8]. Coronavirus disease-19 (COVID-19) has emerged in China and been spreading all over the world since December 2019. The first case of COVID-19 infection has been confirmed in Turkey as of March 11, 2020. Although in most of the pediatric cases (>90%) the disease is asymptomatic or presented with signs of upper respiratory tract infection symptoms, in a small number of children (%0.6), the infection may progress into critical disease causing respiratory insufficiency and death [9].
During COVID-19 pandemic people are likely to experience fear of falling sick, dying or feelings of helplessness and a number of studies revealed a wide range of psychosocial impacts on people [4]. In a study by Wang et al, included 1210 respondents, psychological impact of the outbreak was present in 53.8%. Moderate to severe depression, anxiety symptoms and stress levels were present in 16.5%, 28.8% and 8.1% of the participants respectively [10]. Another cross-sectional study in 7143 college students demonstrated that 21.3% had mild and 3.6% had moderate-to-severe anxiety symptoms where economic effects on daily life and delays in academic activities were positively associated with anxiety symptoms [11].
Although children seem to be less vulnerable than adults to COVID-19, initial reports from China indicate that children and adolescents also have been impacted psychologically, manifesting behavioral problem. Previous studies suggested that when children are out of school (eg, weekends and summer holidays), they are physically less active, have longer screen time, irregular sleep patterns, and less favourable feeding habits, resulting in weight gain and a loss of cardiorespiratory fitness [12,13].
Shuang-Jiang Zhou et al conducted a cross-sectional study including 8079 students aged 12–18 years during the COVID-19 pandemic period. The prevalence of depressive symptoms, anxiety symptoms, and a combination of depressive and anxiety symptoms was found 43.7%, 37.4%, and 31.3%, respectively [14]. Home confinement during pandemic appears to be another factor in increasing stress levels in children. In 2013, Sprang et al has been found that the post-traumatic stress scores of quarantined children was four times higher than those who were not quarantined [15].
Although the mortality of COVID-19 infection was found higher in patients with underlying diseases, until now, there is no evidence suggesting that the course of COVID-19 is more severe in CF patients compared to general population [16]. Clinical features of COVID-19 including dry cough, myalgia, and fever are quite distinct from the symptoms of CF and recognisable. However it is possible that mild disease might be labelled as within the normal spectrum of symptoms for that individual. However, COVID-19 infection still might cause more stress and anxiety in CF patients. To our knowledge there is only one study evaluating anxiety of CF patients during COVID-19 pandemic. Senkalfa et al compared the anxiety of 45 CF patients with 90 healthy control group and revealed that healthy children, aged 13–18 years had higher state anxiety scores than age-matched children with CF [17].
In this study, our aim was to evaluate the effect of COVID-19 pandemic on family environment and relations, self-care practises and peer relations, psychological reactions including anxiety and coping of CF patients and compare with healthy controls.