Correlation Between Stress, Anxiety, and Depression Related to COVID-19 Pandemic among Patients with Rheumatoid Arthritis and Non-compliance to Treatment: A Cross-Sectional Study

Background: The prevalence of anxiety and depression is high in rheumatoid arthritis (RA) patients. As RA patients tend to be immunodeficient, they are at greater risk of coronavirus disease 2019 (COVID-19) infection due to their scheduled hospital appointments. Therefore, they have become more anxious and worried during COVID-19 pandemic, and some patients recently have canceled or postponed their treatment. Objectives: This study aimed to assess the effect of stress, anxiety, and depression due to COVID-19 outbreak on non-compliance to treatment among RA patients. Methods: In this cross-sectional study, we included 149 RA patients (male/female = 12: 137). Four questionnaires, including the 21-item Depression, Anxiety, and Stress Scale (DASS-21), 14-item Perceived Stress Scale (PSS-14), 18-item Health Anxiety Inventory (HAI-18), and 8-item Morisky Medication Adherence Scale (MMAS-8) were employed. The questionnaires were filled by the researchers on behalf of the participants using telephone interviews due to social distancing protocol. Results: There was a significant negative correlation between stress (P = 0.001), anxiety (P < 0.001), health anxiety (P = 0.014), and depression (P = 0.001) and compliance to treatment among RA patients. However, anxiety was the only predictor for non-compliance to treatment. Conclusions: Therapists should be aware of the symptoms of stress, anxiety, and depression among their RA patients, especially during stressful life events, and carefully monitor their compliance to treatment to prevent exacerbation of RA.