(PS9-A5) What Drives COVID-19 Pandemic Anxiety in Individuals with Anxiety Disorders?

Introduction: The COVID-19 pandemic has increased population level anxiety, and those with pre-existing anxiety disorders are at greater risk of heightened anxiety in response to pandemic-related stressors. However, less is known about what factors drive COVID-related anxiety in anxiety disorder populations. This study examined the relative association of demographics, type of anxiety disorder, anxiety severity before the pandemic, concurrent anxiety severity, and whether or not previous treatment was received on COVID-related anxiety during the pandemic.

 

Methods: 321 adults with a primary anxiety disorder (generalized anxiety disorder (GAD) [64%], social anxiety disorder (SAD) [30%], panic disorder [5%], agoraphobia [2%], M_age=­34.8 years±14.5, 77% female) were randomized to a trial comparing 8 weeks of Mindfulness-Based Stress Reduction (MBSR) to escitalopram at 3 sites. 132 patients received treatment prior to the pandemic (treatment receivers sample; M_age=­­34.6 years±13.7, 80% female), and 189 sought treatment after the start of the pandemic (pre-treatment sample; M_age=­­34.9 years±15.1, 75% female). All participants completed the COVID-19 Concerns and Exposure Scale (CCES), which includes retrospective questions about anxiety before the pandemic and rates current COVID-related anxiety on a scale from 0 to 100 (i.e., what is your current level of anxiety and distress about the coronavirus and related changes?). All participants completed the CCES during the pandemic but treatment receivers had completed the study, whereas the pre-treatment sample completed it prior to randomization. Clinical raters assessed current anxiety severity with the Clinical Global Impression Scale (CGI), from the time point closest to administration of the CCES (treatment receivers: endpoint, pre-treatment: baseline).

 

Results: Three linear regressions, controlling for age, sex, and CGI, were conducted on COVID-related anxiety with 1) self-reported, retrospective pre-pandemic anxiety, 2) sample group (receiving vs. not receiving treatment), and 3) diagnosis as predictors.  1) Pre-pandemic anxiety was not significantly associated with COVID-related anxiety (p=.482), but CGI did predict COVID-related anxiety (b(SE)=4.94(1.25), p< .001). 2) The pre-treatment sample reported significantly higher COVID-related anxiety (58.9±25.6 vs. 49.9±24.9; t(319)=3.15, p< .005) than treatment receivers in a t-test. However, in a regression, sample group did not predict COVID-related anxiety (p=.11), but again CGI did significantly predict COVID-related anxiety (b(SE)=3.86(1.42), p=.007). 3) In the subsample with GAD and SAD, diagnosis was not predictive of COVID-related anxiety (p=.144), but CGI was (b(SE)=4.78(1.28), p< .001).



Conclusion: The only factor accounting for the level of COVID-related anxiety in response to the pandemic was overall anxiety severity closest in time to report of COVID-related anxiety, when considering demographics, pre-pandemic anxiety levels, previous treatment, diagnosis, and current overall anxiety severity. Future studies should consider if there are specific treatment elements or types of response to interventions that did support resilience to the development of COVID-related anxiety.