Predictors of depression trajectories during the COVID-19 pandemic in adults with rheumatoid arthritis: Results from the Canadian Early Arthritis Cohort

Objectives Growing evidence points to mental health impacts of COVID-19. We explored trajectories of depressive symptoms in the year pre- and 2 years post-pandemic onset in adults with RA. Methods Data are from the Canadian Early Arthritis Cohort (CATCH), a prospective multicentre early RA cohort of Canadian adults treated by rheumatologists. Pre-pandemic, participants completed PROs and rheumatology exams in-person. After March 2020, PROs were collected at in-person and virtual visits. We used group-based trajectory modeling to explore longitudinal patterns of depressive symptoms prior to and throughout the COVID-19 pandemic and multinomial regression to identify factors associated with depression trajectory group. Results 989 participants had a mean (SD) age of 60 (14), RA for 6 (4) years and were mostly white (84%) women (73%), with some college education (60%). Most (77%) were in CDAI REM/LDA prior to pandemic. We identified 4 trajectories: Resilient (no symptoms throughout: 60%); Worsening (none→mild: 22%); Improving (mild→minimal 8%); and Persistent (moderate-severe throughout: 9%). Age, sex, race, education, pain, physical and social function, fibromyalgia and history of anxiety/depression were associated with different trajectories. Conclusion Although 60% had consistently affect during the first 2 years of the pandemic, mood worsened in > 1 in 5 suggesting a cumulative impact over time. Biological, psychological, and social factors and worse pre-pandemic symptoms and function were associated with a greater risk of depression during the pandemic. Identifying at-risk groups impacted by major stressors like the pandemic may offer new opportunities to personalize treatment, allocate resources, reduce disease flares, and improve outcomes.