SPIN-CHAT Program Reduces Anxiety and Depression Symptoms for Patients With Rheumatic Disease

Anxiety and depression symptoms were significantly lower after 6 weeks in patients following the Scleroderma Patient-centered Intervention Network COVID-19 Home-isolation Activities Together (SPIN-CHAT) Program, according to a study published in The Lancet.¹ The results may indicate effectiveness of programs designed to aid in mental health needs in this population group during the COVID-19 pandemic.

“For both anxiety and depression symptoms, there was a sharp drop in symptoms from baseline to immediately post-intervention in both groups. Thereafter, symptoms continued to drop substantively among intervention participants but not waitlist controls,” explained investigators. “One potential explanation might relate to the nature of the intervention, which was designed to provide education and skills practice for coping with mental health challenges and foster ongoing social support to address isolation and loneliness.”

Patients with pre-existing medical conditions, such as those with rheumatic diseases, are not only more at risk of COVID-19 complications, but they are also more likely to suffer from poor mental health including anxiety and depression. Patients with systemic sclerosis (or scleroderma) may have substantial lung involvement, use immunosuppressant drugs, and are generally frailer. The COVID-19 pandemic has dramatically increased symptoms of anxiety in this patient population, as they fear severe complications or death. Isolation and uncertain access to health care add to these worries.

The SPIN-CHAT Program (NCT04335279) was developed by investigators in order to help participants deal with isolation and learn better mental health coping mechanisms. It was a 2-arm, parallel, randomized, controlled trial that lasted 4-weeks (meeting 3 times per week, 90-minute sessions) in a virtually-based group setting. Patients were diagnosed with systemic sclerosis, recruited from the International SPIN COVID-19 Cohort, and exhibited symptoms of anxiety with a PROMIS Anxiety 4a version 1.0 T-score of at least 55 (mild symptoms).

Baseline measures were taken between April 9, 2020, and April 27, 2020 and participants were placed in groups of 6-10. Anxiety symptoms were analyzed immediately post-intervention. In total, 560 patients were eligible, with 172 patients assigned to either the SPIN-CHAT Program (n=86) or the waitlist (n=86). The mean age of patients was 55 years, 94% were women, and 79% were White.

Using the 4-item PROMIS Anxiety 4a version 1.0, post-intervention analysis did not show a significant reduction in anxiety symptoms (−1·57 points, 95% CI −3·59 to 0·45; standardized mean difference [SMD] −0·22 points). However, symptoms reduced 6 weeks later (−2·36 points, 95% CI −4·56 to −0·16; SMD −0·31). Additionally, depression symptoms were significantly lower 6 weeks post-intervention (−1·64 points, 95% CI −2·91 to −0·37; SMD −0·31).

These results may be due to the ongoing nature of learning how to manage anxiety and depression. The program informed participants about the importance of physical activity, activity engagement, and coping skills. They set personalized goals and practiced new skills each week, continuing to implement strategies that worked best for each individual.

The SPIN-CHAT Program was created by a group of experts and patients with systemic sclerosis early in the pandemic in order to address mental health symptoms of this vulnerable population. It was, however, limited by including participants with undiagnosed systemic sclerosis and the symptoms of anxiety and depression were relatively low at the start of the trial. Investigators would like to do further research and reassess these symptoms, but the fast-moving COVID-19 pandemic hinders that ability. Additionally, investigators are not sure how generalizable the results would be to other patient populations, as the SPIN-CHAT Program was geared towards a specific patient group.

“Additional trials should test effects of multifaceted mental health coping interventions similar to SPIN-CHAT. However, in the midst of the COVID-19 pandemic, policymakers must make decisions with less evidence than would preferably be available,” concluded investigators. “As the length of the pandemic extends, the mental health needs of the public and how to address them is an increasingly important challenge… Multifaceted programs similar to SPIN-CHAT might be attractive options because they represent a relatively low-resource option that provides skills and support to up to 10 people at a time.”

Reference:

Thombs BD, Kwakkenbos L, Levis B, et al. Effects of a multi-faceted education and support programme on anxiety symptoms among people with systemic sclerosis and