Anxiety due to COVID-19 more prevalent in MG patients vs. public
German study finds greatest fear is consequences of infection on health
Anxiety related to COVID-19 is more prevalent among people with myasthenia gravis (MG) than among the general population, a study in Germany shows.
For individuals with MG, the most pronounced cause of such anxiety was the fear patients experienced about the consequences of a COVID-19 infection on their health. This fear was particularly associated with MG symptom exacerbation, or worsening, in the case of an infection, as well as a higher risk of infection due to immunosuppressive treatments.
“In this study, we show that COVID-19-related anxiety in MG patients was frequent, with the most pronounced fear being the risk for their own health,” the researchers wrote, noting that people with the neuromuscular disease were “particularly vulnerable during the COVID-19 pandemic.”
According to the team, such fears “[make] an ongoing psychological and emotional impact of the COVID-19 pandemic among MG patients likely and [highlight] the need for a screening for depression and anxiety in this population in clinical practice.”
The study “Anxiety in Myasthenia Gravis Patients Throughout the COVID-19 Pandemic — Prevalence, Risk Factors, and Association With Vaccination Status,” was published in the journal Brain and Behavior.
MG is caused by self-reactive antibodies that attack proteins at the neuromuscular junction — the region where nerve and muscle cells communicate to coordinate voluntary movements. This leads to symptoms of muscle weakness and fatigue.
Researchers conducted 3-part online survey of MG patients
During the COVID-19 pandemic, people with MG were more vulnerable than most individuals because they require treatment with immunosuppressing medications that increase the risk of infections. Additionally, acute respiratory infections can trigger MG exacerbations and crises.
This study aimed to assess the prevalence of COVID-19-related anxiety in MG patients in Germany. The researchers conducted a three-part online survey between May 2020 and February 2022 that involved 648 adults with MG. The participants had a mean age of 53.5, and two-thirds were women.
More than half of the patients (58.1%) had antibodies targeting acetylcholine receptors, the most common type of self-reactive antibodies found in people with MG. Meanwhile, 22.7% had no detectable autoantibodies. Antibodies targeting muscle-specific tyrosine kinase were present in 6% of the patients, and those targeting low-density lipoprotein receptor-related protein 4 in 2.7%.
Most patients (69.9%) were treated with immunosuppressive medications. Slightly more than half (52.9%) underwent a thymectomy, a surgical procedure to remove the thymus gland; that gland is believed to be involved in the production of the self-reactive antibodies that drive MG.
From the first to the third survey, the percentage of patients knowing someone who had been infected with COVID-19 increased continuously from 34.8% to 87%. At the last survey, 8.4% of MG patients had contracted COVID-19, and 1.8% had been hospitalized due to the condition.
More COVID-19 anxiety seen among MG patients than general population
COVID-19-related anxiety was frequent, with patients most commonly reporting fear for their own health (83.9%), followed by fear for the health of others (75.6%), fear of an infection (61.2%), and fear of social consequences (61.2%).
Anxiety was influenced by the MG diagnosis (75.1%), especially by the fear of symptom exacerbation and a higher risk of infection due to the use of immunosuppressive therapies.
Further analysis indicated that being a woman and receiving immunosuppressive medications, including rituximab, were associated with an increased concern for a patient’s own health.
Most patients (92%) were vaccinated for COVID-19 once vaccines became available. The main factor associated with patients’ vaccination status was their fear of COVID-19 consequences on their health.
Overall, these findings suggest that anxiety during the COVID-19 pandemic was more prevalent among MG patients than in the general population and was mainly driven by the fear of the potential consequences of the infection for their own health.
The team noted that these findings are in contrast with a study using a similar methodology in people from the general population. In that study, “COVID-19-related fears were less prevalent, and … concerned mostly the health of others.”
The researchers say these results show an impact beyond just the COVID-19 pandemic.
“Our data also underscores the importance of addressing mental health challenges in MG patients during future pandemics or other public health crises,” the researchers wrote.
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