Distress before COVID-19 infection raises the chance of long COVID by 45%

Psychological, not physical, factors are linked to long COVID.

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It is believed that individuals with severe COVID-19 tend to develop long COVID. But that’s not necessary: even people with milder COVID-19 cases can also develop long COVID. Its symptoms can last for several months to years. However, it remains unclear which traits are associated with long COVID.

A new study by the researchers at Harvard T.H. Chan School of Public Health sheds light on this. It suggests that psychological distress, including depression, anxiety, worry, perceived stress, and loneliness, before COVID-19 infection was associated with an increased risk of long COVID. The increased risk was independent of smoking, asthma, and other health behaviors or physical health conditions.

Researchers were surprised to know how strongly psychological distress before a COVID-19 infection was associated with an increased risk of long COVID. They also found that distress was more strongly linked to developing long COVID than physical health risk factors such as obesity, asthma, and hypertension.

Some diseases’ prognoses are known to be influenced by mental health. An increased chance of more severe COVID-19, including the risk of hospitalization, a risk factor for extended COVID, has been linked to depression and other mental diseases. Mental health disorders are related to more severe symptoms and last longer than other acute respiratory tract diseases like the flu or the common cold.

Previous research has also revealed a link between distress and long-lasting symptoms of COVID, chronic Lyme disease symptoms, and symptoms of chronic fatigue syndrome, and fibromyalgia.

For this study, scientists enrolled more than 54,000 people in April 2020. Participants were asked about their psychological distress at the initial stage of the study. Over the following year, more than 3,000 participants contracted COVID-19, and the researchers asked participants about their COVID-19 symptoms and symptom duration.

After examining the responses and contrasting those who experienced long COVID with those who did not, the researchers concluded that distress before COVID-19 infection, including depression, anxiety, worry, perceived stress, and loneliness, was linked to a 32 percent to 46 percent higher risk of long COVID. The probability of daily life impairment from long COVID was also increased by 15% to 51% for these categories of psychological distress.

Andrea Roberts, a senior research scientist in the Department of Environmental Health at Harvard Chan School and senior author of the JAMA Psychiatry paper, said“To the best of our knowledge, this is the first prospective study to show that a wide range of social and psychological factors are risk factors for long COVID and daily life impairment due to long COVID.”

“We need to consider psychological health and physical health as risk factors of long COVID-19. These results also reinforce the need to increase public awareness of the importance of mental health and to get mental health care for people who need it, including increasing the supply of mental health clinicians and improving access to care.”

Journal Reference:

  1. When Wang et al. Associations of Depression, Anxiety, Worry, Perceived Stress, and Loneliness Prior to Infection With Risk of Post–COVID-19 Conditions. JAMA Psychiatry. Published online September 7, 2022. DOI: 10.1001/jamapsychiatry.2022.2640