Impacto de la pandemia COVID-19 en la salud física y mental de pacientes con enfermedades crónicas

Résumé

Objective The objective of this doctoral thesis is to analyse the prevalence and current levels of anxiety, distress, stress and depression as well as related factors in patients with chronic conditions during the COVID-19 pandemic. Also, this thesis aims to analyse the clinical parameters of the usual follow-up of these patients in Primary Care health Centres of the Andalusian Health Service. Methodology The first two studies about the levels and prevalence of anxiety, distress, stress and depression were based on two systematic reviews and meta-analyses. For the third study, a prospective longitudinal study was carried out in primary care centres of the Andalusian Health Service. The data was recorded before the pandemic (T1), during the declaration of the state of emergency (T2) and in the transition phase (T3). Results In the study carried out in diabetic patients, the prevalence of anxiety was 23% (95% CI = 19–28) for patients with DM1 and 20% (95% CI = 6–40) in patients with DM2. For distress it was 41% (95% CI = 24–60) in DM1 and for patients with DM2 it was 36% (95% CI = 2–84). For stress, the prevalence was 79% (95% CI = 49–98) in patients with DM1. The second study analysed depression, finding a prevalence for diabetic patients of 17% (95% CI = 7–31) to 33% (95% CI = 16–51), in patients with obesity of 48% (95% CI = 26). –71), and in patients with hypertension of 18% (95% CI = 13–24). The factors related to depression were female sex, being single, altered clinical parameters of diabetes, changes in self-care behaviours, reduction in physical activity and sleep time, as well as fear of contagion. The third article, after analysing routine follow-up clinical variables, reported that during the declaration of the state of emergency as well as in the successive waves of contagion, there were significant improvements in BMI, total cholesterol and HDL levels during the beginning of the pandemic. The Barthel and Pfeiffer index, blood pressure, triglycerides and LDL worsened in T2 and the negative effects were maintained in T3. Compared to pre-pandemic values, HbA1c levels improved in T3 but HDL levels worsened. Conclusions The systematic reviews and meta-analyses done in this doctoral thesis showed that patients with chronic diseases have seen their mental health diminished, since a significant increase in levels of anxiety, distress and stress was observed in diabetic patients. On the other hand, it was observed that the prevalence of depression in diabetic, obese and hypertensive patients increased. The studies reviewed showed that factors associated with a higher level of depression include female sex, being single, altered clinical parameters of diabetes, changes in self-care behaviours, reduction in physical activity and sleep time, as well as fear of contagion. On the other hand, based on the results obtained in the empirical study at the primary care level in chronic patients, greater difficulty was found in carrying out activities of daily living as well as a worsening in their cognitive evaluation. Furthermore, in the short term during confinement and the different waves, only reductions in BMI, total cholesterol and HDL levels were evident, so the changes were positive. However, blood pressure, triglycerides and LDL worsened, maintaining the negative effects during the transition phase. Compared to pre-pandemic values, HbA1c levels improved in the long term during the transition phase, but HDL levels worsened.