Psychological distress was widespread among people with asthma during COVID-19
Research shows the pandemic increased anxiety, depression and PTSD in people with asthma
When the COVID-19 pandemic broke out in 2020, authorities, including the UK government, reduced the freedom of movement for everyone. Groups such as those with non-communicable diseases, like asthma, were categorised as having an increased risk of severe COVID-19 and were asked to ‘shield’. A paper published recently in the journal ‘Psychology & Health’ outlines the results from a study carried out by members of the Asthma UK Centre for Applied Research.
The multidisciplinary research team included health psychologists, primary care clinicians, pharmacists and Patient and Public Involvement representatives. The team created a survey to find out whether people with asthma experienced symptoms of anxiety, depression, distress and how the pandemic had impacted their wellbeing. Additionally, the team interviewed people with asthma to explore asthma management, current concerns and coping, and health communication.
849 people with asthma completed the survey. 26 people of those were interviewed. The interviewees included a wide range of participants from location, age, gender, when they received their asthma diagnosis, and whether they were asked to shield during the pandemic. There were various themes that arose during these interviews.
Most survey respondents got their health information from mainstream media, websites or a healthcare professional. Almost 60% felt that they had not been given adequate health information about COVID-19, and some felt that there were mixed messages from the UK Government.
Online and social media played an important role in feeling connected, but also made many participants limit their use of the internet to preserve their mental health.
Interaction with healthcare
Participants were able to speak to a healthcare professional, and some were able to have remote consultations (video call, telephone call, email, and text). Some preferred the convenience of an online appointment rather than travelling to a general practice.
COVID-19 related concerns
Contracting COVID-19 was a worry for all interview participants. However, having lived with asthma before COVID-19, they had to rely on their understanding of their own condition, their past experiences and trust their instincts when determining which condition was causing their symptoms.
Vaccines were viewed as important for creating a safe way out of lockdown, as participants acknowledged that COVID-19 was not going to disappear, and they needed ways for living with the disease.
Impact on mental health
The average levels of anxiety was moderate with a quarter of those surveyed reporting severe anxiety. Similarly, the average level of depression among the group was moderate, with 13% in the severe depression category. PTSD was a clinical concern in over 60% of the participants.
The participants developed a wide range of coping strategies to care for mental health, including being outside in a garden where possible, keeping up-to-date with information, limiting social media and following guidelines.
Death was a topic that was discussed by the participants, with some mentioning wills and resuscitation instructions in case they died from COVID-19. There was also a sense of grieving for the time lost while spent in lockdown by missing important life events, or socialising with friends and family.
Over 66% of participants felt that the pandemic had changed the way they managed their asthma day-to-day. Some mentioned an improvement in their asthma symptoms, and some were more vigilant in monitoring their symptoms to ensure their asthma was as well managed as possible.
Most participants were following government public health guidelines strictly and were frustrated at others breaking the rules. Participants were experiencing guilt when deliberating whether they should follow the guidance or engage in an activity which had positive implications for their mental or physical health, but may be against official public health guidance.
People living with asthma during COVID-19
Overall, this research shows that people with asthma had higher levels of anxiety and depression, and PTSD during the pandemic than the general population.
The researchers recommend that clear and transparent information should be provided, and particularly for those with asthma. This should include asthma self-management strategies, like asthma action plans.
The study team suggest future research in the areas of addressing how mental health consequences for vulnerable people can be mitigated under pandemic conditions, and how these groups could reintegrate after shielding.
This study follows on from research that many of the team produced in 2021, reviewing online COVID-19 information for people with asthma.
Dr Tracy Jackson, lead author on the publication said:
The COVID19 pandemic brought unprecedented challenges and was a time of unpredictability. We listened to our PPI members who were highly concerned of the impact of COVID19 on those living with asthma and other respiratory conditions. We worked together to create and undertake this research and are delighted that it has been published. Many thanks to all of our participants who kindly shared their experiences of living with asthma during the pandemic.
Noelle Morgan, one of the Centre's Patient and Public Involvement members was a co-author on this publication. She said:
During the COVID-19 pandemic, it was a frightening period for everyone, especially those with asthma and respiratory conditions. Health information was insufficient, shielding guidance was ambiguous, and the mental health impact was significant. Being part of this project from the beginning was invaluable, as it provided a platform for the voices of people with asthma and allowed them to be heard openly, at a time when everything else felt constrained
Read the paper
Tracy Jackson, Kirstie McClatchey, Amy Hai Yan Chan, Noelle Morgan, Emma Kinley & Hilary Pinnock (2023) Psychological impact of the COVID-19 pandemic on people with asthma: a co-produced mixed-methods study, Psychology & Health, DOI: 10.1080/08870446.2023.2256784