{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T16:20:20Z","timestamp":1772986820534,"version":"3.50.1"},"reference-count":48,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T00:00:00Z","timestamp":1747872000000},"content-version":"vor","delay-in-days":141,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003107","name":"Bundesministerium f\u00fcr Gesundheit","doi-asserted-by":"publisher","award":["ZMI1-2519FSB501"],"award-info":[{"award-number":["ZMI1-2519FSB501"]}],"id":[{"id":"10.13039\/501100003107","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Depression and Anxiety"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    People living with a rare disease are a vulnerable patient group and experience challenges in participation and healthcare. Due to changes in healthcare and threat of the infection during coronavirus disease 2019 (COVID\u201019) pandemic, people living with rare diseases have been particularly affected. Therefore, this study aimed to investigate depressive symptoms and symptoms of anxiety during the COVID\u201019 pandemic and identify factors associated with symptom levels.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    One\u2010hundred and seventy\u2010two people living with a rare disease were recruited from centers for rare diseases and patient organizations in Germany from January 2021 to January 2022. In addition to descriptive analyses and group comparisons, we applied multiple linear regression models to identify factors associated with outcome variables of interest (depressive and anxiety symptoms, assessed by the Hospital Anxiety and Depression Scale [HADS]).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    For the depressive symptoms, 14% of the participants reached the cutoff for moderate and 14.5% for a high level of depressive symptoms. Concerning anxiety symptoms, 22% reported moderate levels of anxiety and 13.4% reported high levels of anxiety. Higher depressive symptoms were significantly associated with older age, lower socioeconomic status, having severe or varying symptoms compared to low symptom severity, lower treatment satisfaction, lower social support, and more unmet needs. Higher anxiety levels were associated with more unmet needs and more intense COVID\u201019\u2010related concerns.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    The findings indicate red flags of high symptoms that should be considered during routine care of patients with rare diseases. Healthcare providers should be sensitized for the need for psychosocial support and use a quick assessment to assign patients in need to specific support programs.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Trial Registration:<\/jats:bold>\n                    German Clinical Trials Registry: DRKS00020488\n                  <\/jats:p>","DOI":"10.1155\/da\/9002779","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T01:04:23Z","timestamp":1747962263000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors Associated With Depression and Anxiety in People With Rare Diseases During COVID\u201019: A Cross\u2010Sectional Study"],"prefix":"10.1155","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2513-7954","authenticated-orcid":false,"given":"Laura","family":"Inhestern","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alba","family":"Schwab de la O","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Zybarth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maja","family":"Brandt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramona","family":"Otto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"H\u00e4rter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Corinna","family":"Bergelt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,5,22]]},"reference":[{"key":"e_1_2_14_1_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41431-019-0508-0"},{"key":"e_1_2_14_2_2","unstructured":"What Is a Rare Disease? EURORDIS Retrieved September 21 2022https:\/\/www.eurordis.org\/information-support\/what-is-a-rare-disease\/."},{"key":"e_1_2_14_3_2","doi-asserted-by":"publisher","DOI":"10.1037\/hea0000840"},{"key":"e_1_2_14_4_2","first-page":"605","article-title":"Bridging the Gap Between Health and Social Care for Rare Diseases: Key Issues and Innovative Solutions","volume":"1031","author":"Castro R.","year":"2017","journal-title":"Yeast Membrane Transport"},{"key":"e_1_2_14_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/mgg3.315"},{"key":"e_1_2_14_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13023-017-0730-1"},{"key":"e_1_2_14_7_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291721003792"},{"key":"e_1_2_14_8_2","unstructured":"EURORDIS Juggling Care and Daily Life: The Balancing Act of the Rare Disease Community 2017 Retrieved June 30 2022http:\/\/download2.eurordis.org.s3.amazonaws.com\/rbv\/2017_05_09_Social%20survey%20leaflet%20final.pdf."},{"key":"e_1_2_14_9_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0211343"},{"key":"e_1_2_14_10_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18010014"},{"key":"e_1_2_14_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdab037"},{"key":"e_1_2_14_12_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18147661"},{"key":"e_1_2_14_13_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13023-023-02771-w"},{"key":"e_1_2_14_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00103-023-03719-y"},{"key":"e_1_2_14_15_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-040470"},{"key":"e_1_2_14_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7525-1-29"},{"key":"e_1_2_14_17_2","volume-title":"HADS-D: Hospital Anxiety and Depression Scale: Deutsche Version","author":"Herrmann-Lingen C.","year":"2011"},{"key":"e_1_2_14_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0022-3999(01)00296-3"},{"key":"e_1_2_14_19_2","unstructured":"WinklerJ.andStolzenbergH. 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