Preventive Behaviors and Mental Health-Related Symptoms Among Immunocompromised Adults During the COVID-19 Pandemic: An Analysis of the COVID Impact Survey

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Abstract
Background: The COVID-19 pandemic has disrupted the continuity of care of U.S. adults living with chronic diseases, including immunocompromised adults. Disruption in care may be a barrier to identifying COVID-19 associated sequelae, such as mental health symptoms, among the immunocompromised. Our objectives were (1) to evaluate COVID-19-related preventive behaviors, with a focus on canceling doctor’s appointments as a proxy for continuity of care, and (2) to compare COVID-19-related mental health symptoms among the immunocompromised with the general population. Methods: We used nationally-representative data of 10,760 U.S. adults from the publicly-available COVID-19 Household Impact Survey. We defined immunocompromised as adults with a self-reported diagnosis of “a compromised immune system” (n=854,7.6%). We compared adherence to self-reported COVID-19 preventive behaviors among immunocompromised adults compared to others using χ2-tests. We focused on continuity of care and estimated determinants of canceling doctor’s appointments among the immunocompromised using multivariable Poisson regression to estimate adjusted prevalence ratios (aPR) with 95% confidence intervals (95% CI). We evaluated associations of mental health symptoms with being immunocompromised using multinomial logistic regression. Results: Immunocompromised adults were more likely to adhere to recommended COVID-19 preventive behaviors including washing or sanitizing hands (96.3% vs. 89.8%,χ2<0.001), maintaining social distance (91.9% vs. 83.7%,χ2<0.001), and canceling a doctor’s appointment (47.1% vs. 29.7%,χ2<0.001). Hispanic adults (aPR:1.47,95% CI:1.12-1.92) and immunocompromised women (aPR:1.25,95% CI:1.00-1.56) were more likely to cancel doctor’s appointments compared to NH-White adults and men, respectively. Immunocompromised adults reported higher odds of feeling nervous/anxious/on edge (cOR:1.89,95% CI: 1.44-2.51), depressed (cOR: 2.81,95% CI: 2.17-3.64), lonely (cOR: 2.28,95% CI: 1.74-2.98), and hopeless (cOR: 2.86,95% CI: 2.21-3.69) 3-7 days in the last week. Conclusion: Immunocompromised adults were more likely to cancel their doctor’s appointments and report COVID19-related mental health symptoms. The continuity of care of immunocompromised adults should be prioritized via alternative interventions, such as telehealth.

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