THE COVID-19 PANDEMIC REDUCED STRESS DIFFERENTLY IN PEOPLE WITH LUPUS BY POVERTY AND SOCIAL ISOLATION

PV177 / #114 Poster Topic: AS19 - Patient-Reported Outcome Measures Background/Purpose Many people with systemic lupus erythematosus (SLE), particularly from communities of color in the U.S., suffer from substantial psychosocial and socioeconomic stressors. The COVID-19 pandemic had a significant impact on mental health. We evaluated the effect of the pandemic in PWL on stress by social isolation (SI) and poverty. Methods Georgians Organized Against Lupus (GOAL) is a Centers for Disease Control and Prevention (CDC)-supported population-based cohort of validated SLE patients in Atlanta who completed annual surveys across multiple domains from surveys in 4 periods: pre-pandemic or baseline (8/20/2017-1/31/2020), early-pandemic (2/1/2020-9/18/2021), late-pandemic (9/19/2021-5/11/2023), and post-pandemic (5/12/2023-10/15/2024). The early and late pandemic periods coincide with the U.S. COVID-19 Public Health Emergency declaration divided in half. At baseline, we analyzed sociodemographics and validated measures of lupus characteristics and physical and psychological parameters, including poverty and PROMIS SI (see Table). A mixed model for repeated measures was used to characterize time trends for the outcome (Perceived Stress Scale, PSS). The model was expanded through stratification to examine the possible effect modification of poverty and SI at baseline on longitudinal PSS trends across the periods (see Figures). Table. Descriptive characteristics at baseline (before the pandemic) Figures. Perceived stress across pandemic periods by baseline social isolation and poverty Results At baseline, out of 953 participants, most identified as female (94%) and Black (81.3%) and had a mean age of 47.5 years. Over 62% lived at or below 200% of the Federal Poverty Level (high poverty), and 29.5% (281 out of 953) had some SI (PROMIS score > 50). High-poverty individuals were mainly Black, younger, had no or government insurance (Medicare and/or Medicaid), and had higher disease activity and damage. Socially isolated individuals were mostly younger, poorer, and had higher disease activity and damage. Baseline stress was higher in those with SI and high poverty. From the pre- to early-pandemic period in the moderate-severe SI group, the mean PSS score declined by 2.67 (95% CI: 2.81-5.55) for those in the high-poverty group compared to 2.17 (95% CI: 0.21-4.12) in the low poverty group. The PSS scores do not, over time, return to prepandemic levels. Those without SI had no significant changes in stress over time. When stratified by poverty level, there is a suggestion of different stress trajectories by the degree of SI, though again, not reaching prepandemic levels. Conclusions Though this may be unexpected, improvement in stress with the pandemic in those with SLE may have indicated how severe stress had been for these individuals before the pandemic. The impact of SI on stress may be mediated through stigmatization and poor functional status. The pandemic may have reduced these factors by bringing people with SLE closer to the general population as the public isolated themselves, wore masks, and implemented occupational and other financial support measures. Improvement in stress was seen most in those with higher levels of SI and poverty, which may be subgroups to study further and target interventions. Additional research is needed into other related causal pathways, mitigating factors, biological mechanisms, and whether these improvements are durable. Acknowledgments: This work was supported by the CDC grant U01DP006698.

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