Associations of Depression, Anxiety, Worry, Perceived Stress, and Loneliness Prior to Infection With Risk of Post–COVID-19 Conditions

Abstract

ImportanceFew risk factors for long-lasting (≥4 weeks) COVID-19 symptoms have been identified.ObjectiveTo 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 increased risk of developing post–COVID-19 conditions (sometimes called long COVID).Design, Setting, and ParticipantsThis prospective cohort study used data from 3 large ongoing, predominantly female cohorts: Nurses’ Health Study II, Nurses’ Health Study 3, and the Growing Up Today Study. Between April 2020 and November 2021, participants were followed up with periodic surveys. Participants were included if they reported no current or prior SARS-CoV-2 infection at the April 2020 baseline survey when distress was assessed and returned 1 or more follow-up questionnaires.ExposuresDepression, anxiety, worry about COVID-19, perceived stress, and loneliness were measured at study baseline early in the pandemic, before SARS-CoV-2 infection, using validated questionnaires.Main Outcomes and MeasuresSARS-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 daily life impairment due to these symptoms were self-reported on the final questionnaire, 1 year after baseline.ResultsOf 54 960 participants, 38.0% (n = 20 902) were active health care workers, and 96.6% (n = 53 107) were female; the mean (SD) age was 57.5 (13.8) years. Six percent (3193 participants) reported a positive SARS-CoV-2 test result during follow-up (1-47 weeks after baseline). Among these, probable depression (risk ratio [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 each associated with post–COVID-19 conditions (1403 cases) in generalized estimating equation models adjusted for sociodemographic factors, health behaviors, and comorbidities. Participants with 2 or more types of distress prior to infection were at nearly 50% increased risk for post–COVID-19 conditions (RR, 1.49; 95% CI, 1.23-1.80). All types of distress were associated with increased risk of daily life impairment (783 cases) among individuals with post–COVID-19 conditions (RR range, 1.15-1.51).Conclusions and RelevanceThe findings of this study suggest that preinfection psychological distress may be a risk factor for post–COVID-19 conditions in individuals with SARS-CoV-2 infection. Future work should examine the biobehavioral mechanism linking psychological distress with persistent postinfection symptoms.

Living alone is associated with a higher prevalence of psychiatric morbidity in a population-based cross-sectional study

“…Meanwhile, the relationship between living alone and lack of social support was also reported in COVID-19 related studies that resulted in higher risk of depression and anxiety (48,49). The addition of widowed and separated status was revealed to be related to depression and poor quality of life due to loneliness (50).…”

Psychological and Cognitive Effects of Long COVID: A Narrative Review Focusing on the Assessment and Rehabilitative Approach

“…Notably, Bellou et al have investigated the association of 91 unique prognostic factors, divided into seven different categories, including demographic and anthropometric individual characteristics, biomarkers, symptoms, clinical signs, medical history and comorbid diseases, and medications, thus facilitating the selection of candidate predictors for a prognostic model [ 79 ]. In this context, Wang et al found that psychological distress before the COVID-19 infection, including depression, anxiety, worry, perceived stress, and loneliness, was associated with a 32–46% increased risk of Long COVID [ 80 ]. For all these reasons, urgent in-person neuropsychological and neuropsychiatric assessments on Long COVID individuals are needed.…”

Psychophysiologic symptom relief therapy (PSRT) for post-acute sequelae of COVID-19: a non-randomized interventional study

“…In contrast to these reports, Sneller et al examined 186 adults at least 6 weeks after laboratory-confirmed COVID-19 infection and found no evidence of persistent viral infection, autoimmune reaction, or abnormal immune activation (6). They did note an association of anxiety with the development of PASC similar to a recent report by Wang et al (18). However, the concept that anxiety may be a driving factor thus implying that patients are in control of symptomatology may be dismissive and fails to explain some reported physiologic changes such as tachycardia or postural orthostatic hypotension (POTS).…”

“…We previously proposed and tested the hypothesis that some forms of chronic pain in which a specific physiological etiology for the pain is unclear, such as chronic back pain, represent a psychophysiological process (19,20). Our scientific premise, based on initial encounters with PASC patients without organ injury and an assessment of the literature (see discussion), is that patients with mild-moderate initial COVID-19 infections without identifiable organ injury could potentially be suffering from a psychophysiologic process developed during or shortly after acute infection (15)(16)(17)(18). Our psychophysiologic intervention in back pain patients significantly reduced back pain across multiple metrics; therefore, we hypothesized that a modified version of this intervention (Psychophysiologic Symptom Relief Therapy, PSRT) would attenuate symptoms in PASC patients across multiple health symptom domains.…”