Prevalence of covid-19 related concerns and the association with participant characteristics among adults with heart disease engaged in telebehavioral therapy during the pandemic

Kashine, N.; Greenberger, H. M.; Andreopoulos, E.; Pande, R. L.

Introduction: Individuals with cardiac conditions may be at increased risk for behavioral health issues, as well as for adverse COVID-19 outcomes. The purpose of this study was to examine the prevalence and types of COVID-19 related concerns, and associated characteristics, among U.S. adults with heart disease engaged in a telebehavioral therapy program during the COVID-19 pandemic. Methods: The analytic sample comprised de-identified data from a consecutive cohort of 480 adults with heart disease (62% female, 27% non-white race/ethnicity, mean age 70.9 ± 12.6 years) that completed an initial consultation for an evidence-based telebehavioral therapy program between March 23-April 11, 2020. Baseline characteristics including age, sex, race/ethnicity, U.S. region, marital status, living alone, employment status, self-rated health (from the 36-Item Short Form Health Survey), and psychological symptom severity (Depression Anxiety Stress Scales 21) were obtained through standardized assessment conducted by a licensed therapist. COVID-19 related concerns were abstracted from clinical notes and characterized using qualitative research methods. Associations between participant characteristics and the presence of a COVID-19 concern were evaluated using chi-square statistics and logistic regression. Results: Forty percent of participants (191/480) reported at least one COVID-19 related concern at their initial consultation. The three most prevalent concerns were anxious feelings associated with the pandemic (14.2%), isolation (11.9%), and health-related concerns (e.g., contracting COVID-19;11.9%). Depression (39.9%), anxiety (40.1%), and stress (26.3%) symptoms were prevalent among participants. There were no significant associations between having a COVID-19 concern and age>=65 years, U.S. region, unmarried/unpartnered status, living alone, unemployed status, poor/fairself-rated health (p>.05). Female vs. male sex (45% vs. 32%;p=.006) and white vs. non-whiterace/ethnicity (43% vs. 30%;p=.006) were each associated with higher odds of having a COVID-19related concern;after multivariate adjustment these associations remained significant (OR femalesex = 1.8, 95%CI 1.2-2.7;OR white race/ethnicity = 1.9, 95%CI = 1.2-3.0). Conclusion: COVID-19 related concerns were common among adults with heart disease engagedin telebehavioral health care during the COVID-19 pandemic, and more common among female and white participants.