Mental health burden of patients with diabetes before and after the initial outbreak of COVID-19: predictors of mental health impairment

Background!#!The COVID-19 pandemic is affecting people's mental health worldwide. Patients with diabetes are at risk for a severe course of illness when infected with SARS-CoV-2. The present study aims to retrospectively examine mental health changes in patients with diabetes in Germany before and after the initial COVID-19 outbreak, and to furthermore explore potential predictors of such changes.!##!Methods!#!Over the course of eight weeks from April to June 2020, 253 individuals diagnosed with diabetes participated in an online cross-sectional study. Participants completed an anonymous survey including demographics, depression (PHQ-2) and generalized anxiety symptoms (GAD-2), distress (DT), and health status (EQ-5D-3L). In addition, all instruments used were modified to retrospectively ask participants to recall their mental health and health status before the outbreak had started. Additionally examined factors were COVID-19-related fear, trust in governmental actions to face the pandemic, and the subjective level of information about COVID-19.!##!Results!#!This study shows a significant increase in prevalence of depression symptoms, generalized anxiety symptoms and distress, as well as significantly decreased health statuses in diabetes patients after the initial COVID-19 outbreak. Increased depression symptoms, generalized anxiety symptoms and distress were predicted by COVID-19-related fear, whereas trust in governmental actions to face COVID-19 predicted higher depression symptoms.!##!Conclusions!#!The results indicate a negative impact of the initial COVID-19 outbreak on mental health and health status in patients with diabetes. In order to improve the efficacy of psychological support strategies for diabetes patients during the pandemic, possible predictors of mental health impairment such as the aforementioned should be examined more thoroughly and addressed more openly

Mental Health Burden of German Cancer Patients before and after the Outbreak of COVID-19: Predictors of Mental Health Impairment

The aim of this study was to analyze individual changes in cancer patients’ mental health before and after the COVID-19 outbreak, and to explore predictors of mental health impairment. Over a two-week period (16–30 March 2020), 150 cancer patients in Germany participated in this study. Validated instruments assessed demographic and medical data, depression and anxiety symptoms (PHQ-2, GAD-2), distress (DT), and health status (EQ-5D-3L). All instruments were adapted to measure the individual mental health before the COVID-19 outbreak. COVID-19-related fear, trust in governmental actions to face COVID-19, and the subjective level of information regarding COVID-19 were measured. Cancer patients showed a significant increase in depression and anxiety symptoms and distress, while health status deteriorated since the COVID-19 outbreak. Increased depression and generalized anxiety symptoms were predicted by COVID-19-related fear. Trust in governmental actions to face COVID-19 and COVID-19-related fear predicted increases in distress. Higher subjective levels of information predicted less increasing anxiety symptoms and distress. Present data suggests that cancer patients experienced a significant increase in mental health burden since the COVID-19 outbreak. Observed predictors of mental health impairment and protective factors should be addressed, and appropriate interventions established, to maintain mental health of cancer patients during the pandemic

Increased Safety Behavior and COVID-19-Related Fear in Adults with Cystic Fibrosis during the Pandemic

People with cystic fibrosis (pwCF) face great challenges during the ongoing COVID-19 pandemic. Recent research found equal levels of distress in pwCF and healthy controls (HC). The current study aimed to investigate the mental health burden and safety behavior in pwCF. Sixty-nine adult pwCF and sixty-nine propensity-score-matched HC participated in this study. Participants completed an anonymous online questionnaire assessing distress, generalized anxiety, depressive symptoms, COVID-19-related variables, self-reported adherent safety behavior (ASB), and dysfunctional safety behavior (DSB). PwCF showed equal amounts of distress (W = 2481.0, p = 0.669), depressive symptoms (W = 2632.5, p = 0.268), and generalized anxiety symptoms (W = 2515.5, p = 0.565) compared to the HC. COVID-19-related fear (W = 1872.0, p = 0.028), ASB (W = 1630.0, p = 0.001), and DSB (W = 1498.5, p < 0.001) were significantly elevated in pwCF. The pwCF estimated that the probability of suffering from symptoms (W = 954.5, p < 0.001), experiencing a severe course (W = 806.5, p < 0.001), or dying (W = 1079.0, p < 0.001) from COVID-19 is significantly higher than that of the HC. ASB was associated with a CF diagnosis, COVID-19-related fear, and a subjective level of information (R2 = 0.414, F(13, 124) = 6.936, p ≤ 0.001). DSB was associated with a diagnosis of CF and COVID-19-related fear (R2 = 0.196, F(13, 124) = 3.169, p ≤ 0.001). The data suggest that pwCF show functional and adequate behaviors towards the risk caused by the pandemic. Therefore, functional coping behaviors may provide advantages in addressing pandemic challenges

Veränderung der psychischen Belastung in der COVID-19-Pandemie in Deutschland: Ängste, individuelles Verhalten und die Relevanz von Information sowie Vertrauen in Behörden

Hintergrund: Auswirkungen der COVID-19- Pandemie auf die psychische Gesundheit zeigten sich bereits früh. Das Ausmaß der Auswirkungen, insbesondere kumulativ über die lang anhaltende Zeit der Pandemie, ist für Deutschland noch nicht umfassend untersucht worden. Ziel der Arbeit: Ziel der Studie war es, psychische Belastungen sowie COVID-19- bezogene Erlebens- und Verhaltensweisen zu erheben und deren Veränderung über die verschiedenen Phasen der Pandemie in Deutschland darzustellen. Material und Methoden: In die deutschlandweite onlinebasierte Querschnittsstudie (10.03.-27.07.2020) konnten 22.961 Menschen eingeschlossen werden (Convenience Sample). Erhoben wurden: generalisierte Angst (GAD-7), Depression (PHQ-2), psychischer Distress (DT) sowie COVID-19- bezogene Erlebens- und Verhaltensweisen wie COVID-19-bezogene Angst, Vertrauen in staatliche Maßnahmen, subjektives Informiertheitslevel, adhärentes Sicherheitsverhalten und persönliche Risikoeinschätzung für Ansteckung/Erkrankungsschwere. Die Pandemie wurde retrospektiv in 5 Phasen (Anfangs-, Krisen-, Lockdown-, Neuorientierungsphase und 'neue Normalität') eingeteilt. Ergebnisse: Es zeigten sich im Vergleich zu Prä-COVID-19-Referenzwerten anhaltend erhöhte Werte in GAD-7, PHQ-2 und DT. COVID-19-bezogene Angst, Informiertheitslevel, Vertrauen, Sicherheitsverhalten und die Einschätzung, an COVID-19 zu erkranken, zeigten nach initial starkem Anstieg einen Abfall bis z. T. unter den Ausgangswert. Ausnahme waren konstante Einschätzungen, einen schweren Verlauf von COVID-19 zu haben bzw. daran zu versterben. Diskussion: Die durch alle Pandemiephasen anhaltend erhöhten Werte psychischer Belastung verdeutlichen die Notwendigkeit nachhaltiger Unterstützungsangebote. Sinkende Werte in Bezug auf Vertrauen in staatliche Maßnahmen und das subjektive Informiertheitslevel unterstreichen das Gebot gezielter Aufklärung

Compartment-specific distribution of human intestinal innate lymphoid cells is altered in HIV patients under effective therapy

<div><p>Innate lymphocyte cells (ILCs), a novel family of innate immune cells are considered to function as key orchestrators of immune defences at mucosal surfaces and to be crucial for maintaining an intact intestinal barrier. Accordingly, first data suggest depletion of ILCs to be involved in human immunodeficiency virus (HIV)-associated damage of the intestinal mucosa and subsequent microbial translocation. However, although ILCs are preferentially localized at mucosal surfaces, only little is known regarding distribution and function of ILCs in the human gastrointestinal tract. Here, we show that in HIV(-) individuals composition and functional capacity of intestinal ILCs is compartment-specific with group 1 ILCs representing the major fraction in the upper gastrointestinal (GI) tract, whereas ILC3 are the predominant population in ileum and colon, respectively. In addition, we present first data indicating that local cytokine concentrations, especially that of IL-7, might modulate composition of gut ILCs. Distribution of intestinal ILCs was significantly altered in HIV patients, who displayed decreased frequency of total ILCs in ileum and colon owing to reduced numbers of both CD127(+)ILC1 and ILC3. Of note, frequency of colonic ILC3 was inversely correlated with serum levels of I-FABP and sCD14, surrogate markers for loss of gut barrier integrity and microbial translocation, respectively. Both expression of the IL-7 receptor CD127 on ILCs as well as mucosal IL-7 mRNA levels were decreased in HIV(+) patients, especially in those parts of the GI tract with reduced ILC frequencies, suggesting that impaired IL-7 responses of ILCs might contribute to incomplete reconstitution of ILCs under effective anti-retroviral therapy. This is the first report comparing distribution and function of ILCs along the intestinal mucosa of the entire human gastrointestinal tract in HIV(+) and HIV(-) individuals.</p></div

Association between plasma markers of gut epithelial damage/ microbial translocation and colon NCR(+)ILC3 frequency in HIV(+) individuals.

<p><b>(A)</b> Plasma serum levels of intestinal fatty acid binding protein (I-FABP; ng/ml), a marker for gut barrier defects, sCD14 (μg/ml), sCD163 (μg/ml), and LPS binding protein (LBP, μg/ml) were quantified by ELISA in HIV patients (red) and HIV(-) controls (blue) (* p≤0.05). Next, association between plasma levels of I-FABP (ng/ml) <b>(B)</b> and sCD14 (μg/ml) <b>(C)</b>, respectively, and frequency of colon NCR(+)ILC3 (left panel) or colon NCR(-)ILC3 (right panel) were examined. Pearson correlation coefficient was computed for analysing correlations.</p

Compartment-specific distribution and function of intestinal ILCs in HIV(-) individuals.

<p><b>(A)</b> Frequency of ILCs (black dots, left panel) and cNK cells (white dots; right panel) expressed as percentage of CD45(+) lymphocytes in the different parts of the human GI tract (ILCs: oesophagus, n = 10; stomach n = 15; duodenum, n = 21; ileum, n = 13; colon: n = 13; cNK: oesophagus, n = 12; stomach n = 15; duodenum, n = 21; ileum, n = 14; colon: n = 13; grey columns) in comparison to peripheral blood (n = 16; white columns). <b>(B)</b> Distribution of CD103(+)ILC1 (upper left panel), CD127(+)ILC1 (upper right panel), ILC2 (lower left panel), and ILC3 (lower right panel) in the human intestinal tract (black columns) and the circulating blood (white columns). <b>(C)</b> Composition of CD127(+)ILC1 (blue), intraepithelial ILC1 (red), ILC2 (green) and ILC3 (violet) in the peripheral blood and the different segments of the gastrointestinal tract. <b>(D)</b> Distribution of NCR(-) (left panel) and NCR(+) ILC3 (right panel) in the peripheral blood and the different segments of the gastrointestinal tract. <b>(E)</b> Percentage comparison between NCR(-) and NCR(+) ILC3 subsets in those compartments. For functional characterisation ILCs derived from PBMC or biopsy samples (oesophagus, stomach, duodenum, Ileum and colon) obtained from HIV(-) individuals, were stimulated with PMA/ionomycin and then tested for IFN-γ production in CD103(+)ILC1 <b>(F)</b>, CD127(+)ILC1 <b>(G)</b>,or IL-22 production in ILC3 <b>(H)</b>, respectively. * p≤0.05; ** p≤0.01; *** p≤0.001 (FDR-adjusted P values, parametric ANOVA).</p

Local IL-7 levels and segment-specific characteristics of intestinal ILCs in HIV(-) individuals.

<p><b>(A)</b> Relation between local IL-7 mRNA concentrations (green) and expression of RORγt in ILC3 (violet). Expression of RORγt is given as mean fluorescence intensity (MFI).oesophagus (n = 5), stomach (n = 7), duodenum (n = 6), ileum (n = 7), and colon (n = 6). <b>(B)</b> <i>In vitro</i> effect of increasing concentrations of recombinant IL-7 (0, 10, 50 ng/ml) expression on RORγt expression in tonsil ILC3. <b>(C)</b> Relation between local IL-7 mRNA concentrations (green) and expression of T-bet (MFI; blue) within intestinal CD127(+)ILC1. oesophagus (n = 5), stomach (n = 6), duodenum (n = 7), ileum (n = 7), and colon (n = 6)<b>(D)</b> Association between CD127 surface expression (MFI) on CD127(+)ILC1 (left panel; blue) and ILC3 (right panel; violet), respectively, and IL-7 mRNA concentrations (green). oesophagus (n = 6), stomach (n = 7), duodenum (n = 10), ileum (n = 9), and colon (n = 8) <b>(E)</b> <i>In vitro</i> effect of increasing concentrations of recombinant IL-7 (0, 10, 50 ng/ml) on surface expression of CD127. <b>(F)</b> CD127 surface expression (MFI) on ILC3 (violet;) compared to that of CD127(+)ILC1 (blue). oesophagus (n = 6), stomach (n = 7), duodenum (n = 10), ileum (n = 9), and colon (n = 8). Pearson correlation coefficient was computed for analysing correlations.</p