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.