Rituximab, but not other antirheumatic therapies, is associated with impaired serological response to SARS- CoV-2 vaccination in patients with rheumatic diseases
Authors: Robert Spiera, Sarah Jinich, Deanna Jannat-Khah
Journal: Annals of the Rheumatic Diseases (2021)

<h3>ABSTRACT</h3> <h3>Background</h3> Unpaid carers who look after another member of their household (home-carers) have poorer mental health than the general population. The first COVID-19 national lockdown led to an increasing reliance on home-carers and we investigate the short and longer-term impact of lockdown on their mental health. <h3>Methods</h3> Data from 9,737 adult participants (aged 16+) from the UK Household Longitudinal Study (Understanding Society) were used to explore changes in 12-item General Health Questionnaire (GHQ-12) score between (a) pre-pandemic (2019) and early lockdown (April 2020) and (b) early and later (July 2020) lockdown. <h3>Results</h3> GHQ-12 scores among home-carers were higher pre-lockdown and increased more than for non-carers from 2019 to April 2020 with further increases for home-carers compared with non-carers between April and July. Compared with respondents caring for a spouse/partner, those caring for a child under 18 had a particularly marked increase in GHQ-12 score between 2019 and April, as did those caring for someone with learning difficulties. Home-carers of children under 18 improved from April to July while those caring for adult children saw a marked worsening of their mental health. Home-carers with greater care burden saw larger increases in GHQ-12 score from 2019 to April and from April to July, and increases through both periods were greater for home-carers who had formal help prior to lockdown but then lost it. <h3>Conclusions</h3> The mental health of home-carers deteriorated more during lockdown than non-carers. Policies that reinstate support for them and their care-recipients will benefit the health of both vulnerable groups. <h3>What is already known on this topic</h3> Carers have poorer mental health than the general population. Among carers who live with the care recipient (home-carers), some subgroups have poorer mental health than others: female versus male; those who provide more hours of care and have been caring for longer; spousal carers compared with those caring for children (including adult), parents, or other relationships; those caring for individuals whose impairment results in behavioural disturbances, than those who care for individuals with physical or long-term health conditions. <h3>What this study adds</h3> In a large representative UK survey, the decline in mental health during lockdown was greater among home-carers than for the general population, and stayed poorer through to July, even as the general population’s mental health recovered slightly. Compared with respondents who were caring for a spouse/partner, those caring for a child under 18 had a particularly marked increase in GHQ-12 score between 2019 and April while those caring for an adult child experienced a substantial decline in their mental health between the beginning and end of the first lockdown (April to July). The increase in GHQ-12 in April from 2019 was highest among those caring for someone with a learning disability and lowest for those caring for someone with a problem related to old age. Home-carers who had a greater care burden, in terms of hours of care provided, or lost formal support during lockdown, had poorer mental health.