Patients who report depression, anxiety, stress, and loneliness before contracting COVID-19 may be at increased risk of experiencing persistent signs and symptoms of COVID-19 (also known as long COVID), according to a study published yesterday in JAMA Psychiatry.
“Post–COVID-19 conditions remain poorly understood, with no definitive etiology, prevention, or treatment,” wrote Siwen Wang, M.D., of the Harvard T.H. Chan School of Public Health and colleagues.
To examine the relationship between psychological distress and post–COVID-19 conditions, Wang and colleagues used data from three ongoing studies: the Nurses’ Health Study II, Nurses’ Health Study 3, and the Growing Up Today Study. Participants in these studies included active health care workers and other adults; those who reported past COVID-19 infections at baseline were excluded from the study. Participants were invited to complete an online COVID-19 questionnaire from April to September 2020, after which participants completed additional surveys every three months until November 3, 2021.
The authors measured participants’ depression, anxiety, perceived stress, loneliness, and worry about COVID-19 at baseline. Depressive and anxiety symptoms in the past two weeks were assessed with the four-item Patient Health Questionnaire. Worry about COVID-19 was assessed with the question, “How worried are you about COVID-19?” The authors also measured perceived stress and loneliness among participants who were not active health care workers using the four-item Perceived Stress Scale and the three-item UCLA Loneliness Scale.
Participants reported COVID-19 test results on all questionnaires. Post-COVID-19 conditions (defined as signs and symptoms consistent with COVID-19 that extend beyond four weeks from the onset of infection) were assessed on the final questionnaire. Participants were asked whether they were experiencing persistent symptoms such as fatigue, confusion or brain fog, shortness of breath, or difficulty breathing.
Most of the 54,960 participants included in the analysis (mean age 57 years) were White (96.5%) and female (96.6%); 38% of them were active health care workers. In total, 3,193 participants reported positive COVID-19 tests during the study period, 43.9% of whom reported post-COVID-19 symptoms. The most common symptoms were fatigue, smell or taste problems, shortness of breath, confusion or brain fog, and memory issues.
All types of distress prior to the participants’ COVID-19 infections were significantly associated with increased risk of post-COVID-19 symptoms. The greatest risk was among participants who experienced anxiety or had the highest rates of perceived stress. These participants had a 1.5-fold increased risk of post-COVID-19 symptoms. Participants with high levels of two or more types of distress were at an even greater risk of post-COVID-19 symptoms compared with those who did not experience high levels of distress. The authors noted that these increased risks remained significant after adjusting for other health-related factors.
“Further research should investigate whether interventions that reduce distress help prevent or treat post–COVID-19 conditions,” the authors concluded. “Identification and treatment of biological pathways linking distress with long-term COVID-19 symptoms may benefit individuals with post–COVID-19 conditions or other chronic postinfection syndromes.”
For related information, see the Psychiatric News article “Psychiatry Patients With Long COVID-19 Need Team-Based, Coordinated Care.”
(Image: iStock/BlackJack3D)
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