Along with illness and death, the COVID-19 pandemic has devastated the economy, strained the health care system, upended social life, interrupted education and day care, and imposed conditions of long-term isolation for many. Providing much-needed mental health services has been a challenge in Canada and around the world.
A study led by Dr. Brett Thombs from the Lady Davis Institute (LDI) at the Jewish General Hospital, and published in Lancet Rheumatology, undertook an evaluation of a unique intervention developed with and for people with the rare disease scleroderma to help alleviate anxiety during the pandemic. Thombs and his team randomized 172 patients from 12 countries to videoconference-based education and support groups, led jointly by health professionals and trained patient group leaders, or to a waitlist control. They found that anxiety and depressive symptoms were reduced somewhat, although not significantly, at the end of the 4-week program but that six weeks later, they were significantly better among those who received the intervention.
“Long before COVID-19 made tele-health common, we established the Scleroderma Patient-centred Intervention Network (SPIN) to create an international support system for people with scleroderma,” said Dr. Thombs, a Senior Investigator at the LDI, Professor in the Department of Psychiatry at McGill University, and Canada Research Chair. “It was natural for us to build upon this platform to address mental health in the pandemic with our COVID-19 Home-isolation Activities Together (SPIN-CHAT) Program. We worked with patient partners to develop the right approach. Then, patients who previously underwent support group leader training with us facilitated the groups along with health care professionals. It really was a case of patients coming together to help patients.”
People with scleroderma are among those most vulnerable to COVID-19 because many experience significant lung symptoms, are frail, and take immunosuppressant therapies. As a result, their level of social isolation has been among the most extreme.
Violet Konrad, from Sherbrooke, Quebec, who has lived with scleroderma for 9 years, led two of the intervention groups. “The program gave many people with scleroderma the will and the means to keep going during the pandemic,” she said. “During a time of great isolation, we were, together, able to create an international community where life was good.”
Louise Vidricaire, of Baie-St-Paul, Quebec, who participated in the program, added, “Fear gave way to a thirst to learn more and more.”
The study found that mental health outcomes continued to improve after the program finished, potentially capturing the time it took for new skills and social support to take effect. Thus, the researchers concluded, multi-faceted interventions like SPIN-CHAT have potential to address mental health needs in vulnerable groups during COVID-19, even though some uncertainty remains about their effectiveness.
“Our findings are consistent with the fact that acquiring and successfully using mental health coping skills is an ongoing process that occurs over time,” said Dr. Thombs. “An intervention like SPIN-CHAT gives participants tools to successfully cope with the challenges they face during the pandemic. We are hoping that our approach will prove adaptable and helpful to other vulnerable groups contending with enhanced isolation and anxiety as they try to protect their physical health by minimizing risk of exposure to COVID-19.”
The SPIN-CHAT Program is four weeks long and involves twelve sessions. Participants are educated about, and participate in, exercises that include staying connected, managing worry and stress, relaxation, physical activity, and social support. Although developed for people with scleroderma, the core program elements are applicable to other vulnerable populations coping with stress and isolation brought on by COVID-19.
Thombs noted, “There is still some uncertainty about the level of clinical importance of the symptom reductions that SPIN-CHAT achieved, but, in the midst of the current crisis, decisions about support services to provide must be made with less evidence than would otherwise be ideal.”
“As the length of the pandemic extends with no end in sight, the mental health needs of the public and how to address them is an increasingly important challenge. The mental health of vulnerable individuals, including those with medical conditions, is of particular concern. Multi-faceted programs similar to SPIN-CHAT may be attractive options because they represent a relatively low-resource option that provides skills and support to up to 10 people at a time,” argued the study’s authors.
