Prevalence of Anxiety and Depression Among Patients in a Palliative Care Setting During the COVID-19 Pandemic: A Mixed-Methods Cross-Sectional Study.

Abstract

Background: COVID-19 is a new disease with high transmission and mortality rates and can cause or exacerbate a myriad of psychological sequelae, particularly in patients with underlying serious illness. Palliative care patients' experiences have been widely studied, but research on their experiences during COVID-19 pandemic is scanty.

Aim: To determine the prevalence of and factors associated with anxiety and depression among palliative care patients and explore palliative care patients' experiences during the COVID-19 pandemic.

Materials and methods: This cross-sectional mixed-methods study used the Hospital Anxiety and Depression Scale (HADS) and face-to-face audio-recorded interviews to collect data from participants between April and May, 2022. Quantitative data were analysed using STATA v.17. Chi-square test and multivariate logistic regression were performed to examine factors associated with depression and anxiety. Qualitative data were analysed using thematic analysis.

Results: Of the 96 participants, 74% (n=71) were female. Patients who earned ≥100,000 Ugandan shillings (OR=0.18, p=0.026, CI 0.040-0.818) had lower odds of depression compared to patients who earned less, while patients who missed clinic appointment sometimes (OR=26.02, P=0.025, CI 1.503-450.226) and those who reported change in sleep pattern (OR=15.91, p=001, CI 3.030-83.567) had higher odds of depression. Male participants had lower odds of anxiety (OR=7.93, p=0.003, CI 2.004-31.370) while those who missed medicines very often (OR=6.79, p=0.024, CI 1.288-35.852) and those who reported change in sleep pattern (OR=10.21, p=0.000, CI 2.790-37.393) showed higher odds of anxiety. Three main themes emerged from the qualitative interviews: (1) Navigating multidimensional suffering before and during a pandemic, (2) the healthcare system as a precipitant of suffering, and (3) finding hope and meaning amidst uncertainty and suffering.

Conclusion: Mental health morbidities were great in this cohort, occurring in a multifaceted manner, with disruptions to the psychological, social, financial, and physical dimensions of patients' quality of life. Palliative care continuity and mental health, psychosocial and spiritual support services should be integrated into humanitarian emergency health care package in future outbreaks.