Psychological discomfort already present raises the possibility of long-COVID

In a recent study, researchers examined the relationship between psychological distress prior to coronavirus disease 2019 (COVID-19) and the risk of post-acute sequelae of COVID-19. The report was published in the Journal of the American Medical Association (JAMA) Psychiatry (PASC).

PASC, also referred to as extended COVID, is described as the persistence of COVID-19 signs and symptoms after four weeks have passed after the disease’s original onset. Long COVID is frequently accompanied by symptoms like exhaustion, dyspnea, cognitive fog, loss of taste and smell, depression, and digestive problems. Lower quality of life and an inability to resume employment are linked to PASC.

According to systematic reviews, 54% to 73% of COVID-19 patients who are hospitalised may develop extended COVID. Only three studies have looked at psychological distress as a risk factor for post-COVID-19 syndrome. It associated with increased clinical severity and longer durations of acute respiratory tract infections.

Concerning the study
Researchers examined whether pre-infection psychological distress, such as anxiety, sadness, loneliness, worry, and perceived stress, was linked to a higher chance of acquiring PASC in the current study. Three large ongoing longitudinal studies’ participants were asked to respond to an online survey on COVID-19.

Following that, respondents received monthly surveys. Quarterly surveys were conducted between August 2020 and November 3, 2021. A four-item patient health questionnaire was used to assess the frequency of anxiety and depressed symptoms over the previous two weeks (PHQ-4). This included a two-item depression scale and a two-item generalised anxiety disorder scale (GAD-2) (PHQ-2).

Concern with COVID-19 was also investigated. Additionally, two more categories of discomfort were examined in people who weren’t active healthcare workers (HCWs). The PSS-4, a four-item scale, measured the frequency of stress during the previous month. The three-item loneliness scale measured how often people felt alone, excluded, or lonely. Hospitalization, COVID-19 symptoms, and test findings for SARS-CoV-2 were all self-reported.

336 days following the baseline survey, PASC was evaluated. Participants who reacted to PASC items and those who did not were compared in terms of sociodemographic characteristics, baseline distress kinds, and COVID-19 severity risk factors. Using a generalised estimating equation, relative risks (RRs) and 95% confidence intervals (CIs) for PASC were calculated.

With a mean age of 57.5 years, the 54,960 participants were mostly White (96.5%), females (96.6%), and active HCWs (38%). Over a 19-month period of follow-up, 3193 subjects had positive SARS-CoV-2 test results. At baseline, respondents were younger, more likely to be active HCWs, and more likely to have asthma than those who did not have probable anxiety (GAD-2 score of 3) or depression (PHQ-2 score of 3).

Women, people with asthma, and members of racial and ethnic minorities were more likely to be concerned about COVID-19 than were other demographics. Participants with a body mass index (BMI) of 35 were more likely to have these conditions than those with probable sadness, anxiety, loneliness, worry about COVID-19, or high felt stress levels. A positive SARS-CoV-2 test result was reported by 44% of patients who had PASC. 86.9% of them had symptoms that lasted longer than two months.

Fatigue (56%), altered taste or smell (44.6%), dyspnea (25.5%), confusion/brain fog/disorientation (24.5%), and memory issues (21.8%) were common symptoms. The risk of PASC was considerably increased for all forms of psychological distress. Participants who experienced numerous forms of distress at baseline were more likely to develop PASC. Additionally, when subjects reported PASC, researchers looked into how pre-infection distress related to symptoms and disability.

Except for impaired taste/odor and a prolonged cough, all COVID-19 symptoms were more common in people who were in distress than in people who weren’t. Participants who reported discomfort at baseline exhibited higher long COVID symptoms. A 25% to 51% increased likelihood of experiencing symptoms that interfered with activities was linked to symptoms of anxiety, depression, perceived stress, and fear about COVID-19.

The risk of PASC was found to be strongly correlated with pre-COVID-19 psychological distress. Individuals with at least one distress had an average of one more PASC symptom than those without distress at baseline. A higher likelihood of PASC-related impairment of daily life was linked to all categories of distress, with the exception of loneliness.

Because 40% of respondents who reported PASC had no psychological distress at baseline, the authors advised against interpreting the data that PASC is psychosomatic. Furthermore, over 50% of PASC individuals reported relapses brought on by physical exercise, which, in contrast, is protective against mental disease relapse. Furthermore, symptoms of PASC differ significantly from symptoms of mental illness.

It should be noted that the study population was predominately White, female, and HCW, which restricted the generalizability of the findings. In conclusion, the results indicate that psychological anguish from the past increases the likelihood of acquiring PASC. Future research should look into whether interventions that lessen distress can assist treat or prevent PASC.



Journal reference:
Wang S, Quan L, Chavarro JE, et al. Associations of Depression, Anxiety, Worry, Perceived Stress, and Loneliness Prior to Infection with Risk of Post–COVID-19 Conditions. JAMA Psychiatry, 2022. DOI: 10.1001/jamapsychiatry.2022.2640,

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