Key points Is psychological distress before SARS-CoV-2 infection associated with the risk of COVID-19-related symptoms lasting 4 weeks or longer, known as post-COVID-19 conditions? Findings This cohort study found that among participants who did not report SARS-CoV-2 infection at baseline (April 2020) and reported a positive SARS-CoV-2 test result during 1 year of follow-up (N = 3193) , depression, anxiety, perceived stress, loneliness, and worry about COVID-19 were prospectively associated with a 1.3 to 1.5 times higher risk of self-reported post-COVID-19 conditions, as well as an increased risk of deterioration of daily life related to post-COVID-19. COVID-19 conditions. Meaning In this study, pre-infection psychological distress was associated with the risk of post-COVID-19 conditions and impairment of daily life in those with post-COVID-19 conditions. |
Importance
Few risk factors have been identified for long-term (≥4 weeks) COVID-19 symptoms.
Aim
To determine whether high levels of psychological distress before SARS-CoV-2 infection, characterized by depression, anxiety, worry, perceived stress, and loneliness, are prospectively associated with an increased risk of developing post-COVID-19 conditions (a sometimes called long COVID conditions).
Design, environment and participants
This prospective cohort study used data from 3 large, ongoing, predominantly female cohorts: Nurses’ Health Study II, Nurses’ Health Study 3, and Growing Up Today Study.
Between April 2020 and November 2021, participants were followed with periodic surveys. Participants were included if they did not report a current or previous SARS-CoV-2 infection in the April 2020 baseline survey when distress was assessed and answered 1 or more follow-up questionnaires.
Exhibitions
Depression, anxiety, worry about COVID-19, perceived stress, and loneliness were measured at baseline at the beginning of the pandemic, before SARS-CoV-2 infection, using validated questionnaires.
Main results and measures
SARS-CoV-2 infection was self-reported during each of 6 monthly and then quarterly follow-up questionnaires.
COVID-19-related symptoms lasting 4 weeks or longer and impairment of daily life due to these symptoms were self-reported in the final questionnaire, 1 year after onset.
Results
Of 54,960 participants, 38.0% (n = 20,902) were active healthcare workers and 96.6% (n = 53,107) were women; the mean (SD) age was 57.5 (13.8) years.
Six percent (3,193 participants) reported a positive SARS-CoV-2 test result during follow-up (1 to 47 weeks after baseline). Among these, probable depression (relative risk [RR], 1.32; 95% CI = 1.12-1.55), probable 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 COVID-19 conditions (1403 cases) in factor-adjusted generalized estimating equation models. sociodemographics, health behaviors and comorbidities.
Participants with 2 or more types of distress before infection had almost a 50% increased risk of post-COVID-19 conditions (RR, 1.49; 95% CI, 1.23-1.80) . All types of distress were associated with an increased risk of daily life impairment (783 cases) among people with post-COVID-19 conditions (RR range, 1.15-1.51).
Symptoms of post-COVID-19 conditions that do not occur due to space limitations include intermittent fever; rash, blisters, or hives anywhere on the body; and ulcers in the mouth or tongue. Values do not add up to 100% because the mean levels of the variables (i.e., subclinical depressive and anxious symptoms, some worry, and loneliness less than some of the time) are not shown due to space limitations. Perceived stress and loneliness were queried only in participants who were not active healthcare workers.
Conclusions and relevance
- The findings of this study suggest that pre-infection psychological distress may be a risk factor for post-COVID-19 conditions in people with SARS-CoV-2 infection.
- Future work should examine the biobehavioral mechanism linking psychological distress to persistent postinfection symptoms.
