Psychological distress is often associated with physical issues. This might also be true for COVID-19: Anxiety, depression or pandemic concerns could lead to long-lasting symptoms after an infection, a study suggests.
At least 10 % of all COVID-19 patients will later suffer from post-COVID. Long and post-COVID both describe a set of diverse symptoms consistent with COVID-19 that extend beyond 4 weeks after the infection. Yet, the long-term effects of a SARS-CoV-2 infection are not well understood – with no etiology, prevention or treatment. One of many remaining questions is: Which people are at high risk of developing post-COVID?
Scientists tried to answer that question by taking a closer look at COVID-19 patients who suffered from mental stress or illness. Psychological distress is already associated with greater severity and longer duration of acute respiratory tract infections. The study, recently published in JAMA Psychology, shows that people who have been exposed to higher levels of psychological distress prior to their COVID-19 infection are at greater risk of developing post-COVID symptoms and suffering from related life impairments.
Scientists have now looked into whether psychological distress – including depression, anxiety, loneliness, perceived stress and worry about COVID-19 – before infection were associated with an increased likelihood of developing post-COVID in the early days of the pandemic.
Among nearly 55,000 participants, 3,193 participants (6 %) self-reported a positive SARS-CoV-2 test result during the over one-year follow-up. Reports happened monthly for the span of six months and were accompanied by quarterly questionnaires. Among these, self-reported depression (risk ratio [RR], 1.32; 95 % CI = 1.12–1.55), anxiety (RR = 1.42; 95 % CI, 1.23–1.65), worry about COVID-19 (RR, 1.37; 95 % CI, 1.17–1.61), perceived stress (highest vs lowest quartile: RR, 1.46; 95 % CI, 1.18–1.81) and loneliness (RR, 1.32; 95 % CI, 1.08–1.61) were associated with a post-COVID condition (1,403 cases). Especially participants with two or more of these distress conditions were at a nearly 50 % increased risk for developing post-COVID (RR, 1.49; 95 % CI, 1.23–1.80).
According to the results, the type of distress among individuals with post-COVID condition did not matter – all of them, except loneliness, were significantly associated with an increased risk of daily life impairments (RR range, 1.15–1.51). The most common symptoms were fatigue (56.0 %), smell or taste problems (44.6 %), shortness of breath (25.5 %), confusion/disorientation/brain fog (24.5 %) and memory issues (21.8 %). Long lasting COVID-19 related symptoms, as well as life impairments, were also self-reported until one year after baseline.
These results are very similar to the design and findings of a different study published in Nature Communications. “In this study too, we found a similar increase in odds of developing the condition if individuals had prior anxiety and depression symptoms, or, in electronic health records, diagnoses,“ said Prof. Claire Steves, Professor of Ageing at Health at King’s College London, UK. The recent US study replicates those previous findings, she concludes.
However, the study has several limitations, such as its observational design or participants (predominantly female healthcare workers). There was also no statistical adjustment for the latter. Certain healthcare workers might have had a greater cause to worry about Covid than others, presumes Prof. Kevin McConvway, Emeritus professor of Applied Statistics at the Open University, UK. “In that case, the aspect of work might be the real cause of the observed association, rather than the psychological distress itself.”
On top of that, all signs for psychological distress and life impairments due to post-COVID were self-reported – the results did not come from clinical diagnoses. Due to the prospective character of the study, it’s hard to establish any cause and effect to the correlation.
These findings don’t give any clues about why – or if at all – these psychological factors are potential risk factors to develop post-COVID. However, the results remind us to keep people’s mental state in mind while looking at their physical state.
“Whilst persisting symptoms tend to be attributed to the ‘seed’ of an acute event such as an infection or injury, the ‘soil’ of the individual’s vulnerability to developing persistent illness is also important,” says Michael Sharpe, Professor of Psychological Medicine at the University of Oxford, UK. Psychological interventions could play a role to prevent this vulnerability of developing prolonged symptoms after an acute infection such as COVID-19, he suggests.
Although no causal relationship has been established, current research shows how important one’s mental health can be in various diseases. Further research can now help to establish preventive measures against long-term consequences that can arise from COVID-19.
Image source: Aarón Blanco Tejedor, Unsplash