The effect of coronavirus disease 2019 on anxiety levels of children with cystic fibrosis and healthy peers

Introduction

Cystic fibrosis (CF) is a chronic, life-shortening disease causing recurrent respiratory tract infections and loss of lung function.¹ Previous meta-analyses and systematic reviews have shown that adults and children with chronic diseases have higher risk of depression and anxiety than the rest of the community.^2,3 A number of studies reported increased anxiety and depression in CF patients compared with healthy controls.^4–6 Facing a chronic disease such as CF on a daily basis causes a significant emotional burden, which can be attributed to a large number of treatments, hospitalizations, multiple diagnostic procedures, chronic respiratory symptoms, and a lower body mass index.⁶

Viral respiratory tract infections are more severe in patients with CF than in the general population. The influenza pandemic (H1N1 infection) in 2009 caused significant morbidity in patients with CF, and in a subgroup of patients with severe lung disease, H1N1 infection was associated with respiratory deterioration, intensive care admission and even death.^7,8 Coronavirus disease-19 (COVID-19) has emerged in China and has been spreading all over the world since December 2019. The first case of COVID-19 infection was confirmed in Turkey on March 11, 2020. In most of the pediatric cases (>90%) the disease is asymptomatic or presented with signs of upper respiratory tract infection symptoms. However, in a small number of children (0.6%), the infection may progress into critical disease causing respiratory insufficiency and death.⁹

During the COVID-19 pandemic people are likely to experience fear of falling sick, or dying, or feelings of helplessness, and a number of studies revealed a wide range of psychosocial impacts on people.⁴ In a study by Wang et al., which included 1,210 respondents, the psychological impact of the outbreak was rated as moderate or severe in 53.8%. Moderate to severe depression, anxiety symptoms, and stress were present in 16.5%, 28.8%, and 8.1% of the participants, respectively.¹⁰ Another cross-sectional study in 7,143 college students demonstrated that 21.3% had mild and 3.6% had moderate-to-severe anxiety symptoms, and economic effects on daily life and delays in academic activities were positively associated with anxiety symptoms.¹¹

Although children seem to be less vulnerable than adults to COVID-19, initial reports from China indicate that children and adolescents also have been impacted psychologically, manifesting...