How Common is Post-Traumatic Stress Disorder in People with Marfan Syndrome During COVID-19?

What you need to know

• About 1 in 5 adults with Marfan syndrome showed signs of post-traumatic stress disorder (PTSD) during the COVID-19 pandemic
• Around 1 in 10 had moderate symptoms of depression, anxiety, or insomnia
• Anxiety was the strongest predictor of PTSD symptoms
• Older age, being unemployed/retired, and taking psychiatric medications were also associated with higher PTSD levels

What is Marfan syndrome?

Marfan syndrome is a genetic disorder that affects the body’s connective tissue. Connective tissue provides strength and flexibility to structures throughout the body. In Marfan syndrome, the connective tissue is weaker than normal, which can cause problems in many parts of the body, especially the heart, blood vessels, bones, joints, and eyes.

Some key features of Marfan syndrome include:

• Being tall and thin with long arms, legs, fingers, and toes
• A curved spine (scoliosis)
• An unusually shaped chest
• Flexible joints
• Flat feet
• Nearsightedness
• Heart problems, especially related to the aorta (the main blood vessel carrying blood from the heart)

Marfan syndrome is caused by a defect in the gene that tells the body how to make fibrillin-1, an important protein in connective tissue. It affects about 1 in 5,000 people. While there is no cure, treatments can help manage symptoms and prevent complications.

Why study mental health in people with Marfan syndrome during COVID-19?

The COVID-19 pandemic has been challenging for everyone’s mental health. But it may be especially difficult for people with chronic health conditions like Marfan syndrome. People with Marfan syndrome often require ongoing medical care and monitoring. The pandemic disrupted many healthcare services, which could increase stress and worry for these patients.

Additionally, people with Marfan syndrome may be at higher risk for severe COVID-19 due to potential heart and lung complications. This could lead to heightened anxiety about catching the virus.

While several studies have looked at mental health impacts of the pandemic in the general population, very little research has focused specifically on people with Marfan syndrome. Understanding their unique mental health needs and challenges can help healthcare providers offer better support.

About this study

This study aimed to assess rates of post-traumatic stress disorder (PTSD), depression, anxiety, and insomnia in Italian adults with Marfan syndrome during the third wave of the COVID-19 pandemic (February-April 2021).

The researchers recruited 112 adults with Marfan syndrome from a specialty clinic in northern Italy. Participants completed online questionnaires to assess their mental health symptoms.

The study looked at:

• Demographic information (age, sex, education level, employment status, etc.)
• Medical history related to Marfan syndrome
• PTSD symptoms using the Impact of Event Scale-Revised (IES-R)
• Depression symptoms using the Patient Health Questionnaire-9 (PHQ-9)
• Anxiety symptoms using the Generalized Anxiety Disorder-7 (GAD-7) scale
• Insomnia symptoms using the Insomnia Severity Index (ISI)

The researchers then analyzed the data to determine rates of these mental health conditions and what factors were associated with higher PTSD levels.

Key findings on mental health symptoms

Post-traumatic stress disorder (PTSD)

About 1 in 5 participants (20.5%) had IES-R scores indicating clinically significant PTSD symptoms related to the COVID-19 pandemic.

PTSD involves three main types of symptoms:

• Intrusion: Unwanted, distressing memories, nightmares, or flashbacks about the traumatic event
• Avoidance: Trying to avoid thoughts, feelings, or reminders related to the trauma
• Hyperarousal: Feeling “on edge,” irritable, having trouble sleeping or concentrating

The average total PTSD score was 13.96 out of 88 possible points. Scores above 24 indicate clinically significant symptoms.

Depression

Using the PHQ-9:

• 13.4% had moderate depression symptoms
• 10.7% had moderately severe depression symptoms

Anxiety

Using the GAD-7:

• 9.8% had moderate anxiety symptoms
• 8% had severe anxiety symptoms

Insomnia

Using the ISI:

• 10.7% had moderate insomnia symptoms
• 0.9% (1 person) had severe insomnia

Overall, about 1 in 10 participants showed moderate to severe symptoms across these mental health conditions. This suggests the pandemic took a significant toll on the mental wellbeing of many adults with Marfan syndrome.

Factors associated with PTSD symptoms

The researchers conducted statistical analyses to determine what factors were most strongly linked to higher levels of PTSD symptoms. The key findings were:

1. Anxiety was the strongest predictor of PTSD symptoms. Higher anxiety levels were associated with higher PTSD scores across all symptom types (intrusion, avoidance, hyperarousal).

2. Older age was associated with higher overall PTSD scores and more intrusion symptoms specifically.

3. Being unemployed or retired was linked to higher PTSD scores across all symptom types compared to being employed.

4. Taking psychiatric medications was associated with slightly lower overall PTSD scores. This may indicate that treatment was helping to some degree, though these individuals still had higher symptom levels overall.

5. Other factors like sex, education level, and physical health conditions related to Marfan syndrome were not significantly associated with PTSD scores in this study.

What do these findings mean?

This study provides important insights into the mental health impacts of the COVID-19 pandemic on adults with Marfan syndrome. The key takeaways are:

1. Mental health screening is crucial. About 1 in 5 participants showed signs of PTSD, and around 1 in 10 had moderate symptoms of depression, anxiety, or insomnia. Regular mental health check-ins should be part of routine care for people with Marfan syndrome, especially during times of heightened stress like a pandemic.

2. Anxiety may be a key risk factor for PTSD. Interventions to reduce anxiety could potentially help prevent or reduce PTSD symptoms. This might include cognitive-behavioral therapy, mindfulness practices, or anti-anxiety medications when appropriate.

3. Older adults and those who are unemployed/retired may need extra support. These groups showed higher levels of PTSD symptoms and may benefit from additional mental health resources and social support.

4. Psychiatric treatment may help, but symptoms can persist. While those on psychiatric medications had slightly lower PTSD scores, they still showed elevated symptoms overall. Ongoing monitoring and adjusting of treatment plans is important.

5. Physical health factors were not strongly linked to PTSD in this study. This suggests that the mental health impacts were more related to the stress and disruption of the pandemic itself rather than Marfan-specific health concerns.

Limitations to consider

While this study provides valuable information, there are some limitations to keep in mind:

• It only looked at one point in time during the pandemic. Mental health symptoms may have changed over the course of the pandemic.
• The study was conducted in one region of Italy. Findings may not generalize to all people with Marfan syndrome or other geographic areas.
• It relied on self-reported symptoms rather than clinical diagnoses.
• Other factors not measured in the study could influence mental health outcomes.

Conclusions

• Mental health screening and support should be a routine part of care for people with Marfan syndrome, especially during times of heightened stress like a pandemic.
• Interventions to reduce anxiety may help prevent or minimize PTSD symptoms in this population.
• Older adults and those who are unemployed or retired may need extra mental health support and resources.
• More research is needed on effective mental health interventions for people with Marfan syndrome.

This study highlights the importance of addressing mental health alongside physical health for people with chronic conditions like Marfan syndrome. By understanding and supporting their unique needs, healthcare providers can help improve overall wellbeing and quality of life for these patients.