Effects of isolation during the covid-19 pandemic on teenagers with sickle cell disease in italy: The experience of a dedicated telephone service for psychological support
Authors: M. Perdibon, E. Maran, V. Munaretto, G. Reggiani, C. Marin, A. Biffi, R. Colombatti, L. Sainati
Journal: HemaSphere (2021)

Background: In the past year the COVID19 Pandemic and the repeated lockdown measures have disrupted people's life. Teenagers with chronic illness, such as Sickle Cell Disease (SCD) present special health care and educational needs during the delicate phase of transition to adulthood compared to their peers. The Veneto Region, in North East Italy, was one of the first red zones areas in Europe since February 26th 2020 with Phase 1 of strict lockdown until April 30th 2020;Phase 2 with progressive reopening of activities during the summer;Phase 3 since September 2020 with initial high school opening but successive implementation of risk zones across the country with regional limitation of movements, economical activities, social life and education according to the diffusion of COVID19 in the area. Since November 2020 high school students were forced to stay at home and perform virtual classes;only individual sports were allowed. Aims: We analyzed the psychological impact of the restrictions and isolation measures on teenagers and young adults with SCD in the Veneto Region of Northern Italy during the 3 different phases of lockdown while offering a dedicated telephone service of psychological support. Methods: A dedicated telephone service was organized since March 2020 by a Psychologist of the SCD Team to contact families and offer support. Adolescents and young adults were contacted directly. Telephone calls occurred during Phase 1 (strict isolation), phase 2 (progressive reopening) and the current phase 3 (alternation of openings and closures) and were characterized by a set of standardized questions tailored to the phase followed by an open dialogue. A qualitative description is presented. Results: 28 adolescents responded to the phone calls and agreed to be called again. Psychological experiences differed according to the phase of the lockdown. In phase 1, in which the limits to personal freedom were high, they felt equal to the general population and felt confident that this painful period would soon end. In phase 2, due to loosen restrictions, greater concerns and anxiety emerged: the need to coexist with the virus and the continuous changing of the rules generated a greater perception that a sudden painful event could break into their life at any time, increasing personal discomfort and undermining the quality of life. Phase 3 showed further different responses. 23/28 stated that they resumed school or work activities, although in different ways (virtual classes or smart working). All reported feeling accustomed to, and therefore less anxious, about covid-19. All claimed to respect the rules, to know them well, and to apply them. 20/28 patients reported spending most of their time at home, were not interested in going out and didn't have social interactions. 6/28 teenagers requested specific psychological support in the form of weekly phone calls or zoom calls with the SCD psychologist, which is still ongoing. Most of them are girls who asked for help in managing their anxiety and the fear that they won't be able to realize their expectation in professional or family life. Summary/Conclusion: The dedicated telephone service for psychological support was well received by teenagers with SCD with a subgroup requesting a repeated intervention. The qualitative results of our experience demonstrate the need for psychological support during the pandemic in patients with chronic disease;remote support has proven to be an effective tool.