Persistent somatic symptoms are key to individual illness perception at one year after COVID-19

Abstract

Background: Sequelae of Coronavirus disease 2019 (COVID-19) were investigated by both patient-initiated and academic initiatives. Patient's subjective illness perceptions might differ from physician's clinical assessment results. Herein, we explored factors influencing patient's perception during COVID-19 recovery. Methods: Participants of the prospective observation CovILD study with persistent somatic symptoms or cardiopulmonary findings at the clinical follow-up one year after COVID-19 were analyzed (n = 74). Explanatory variables included baseline demographic and comorbidity data, COVID-19 course and one-year follow-up data of persistent somatic symptoms, physical performance, lung function testing (LFT), chest computed tomography (CT) and trans-thoracic echocardiography (TTE). Factors affecting illness perception (Brief Illness Perception Questionnaire, BIPQ) were identified by penalized multi-parameter regression and unsupervised clustering. Results: In modeling, 47% of overall illness perception variance at one year after COVID-19 was attributed to fatigue intensity, reduced physical performance, hair loss and baseline respiratory comorbidity. Overall illness perception was independent of LFT results, pulmonary lesions in CT or heart abnormality in TTE. As identified by clustering, persistent somatic symptom count, fatigue, diminished physical performance, dyspnea, hair loss and sleep problems at the one-year follow-up and severe acute COVID-19 were associated with the BIPQ domains of concern, emotional representation, complaints, disease timeline and consequences. Conclusion: Persistent somatic symptoms rather than clinical assessment results, revealing lung and heart abnormalities, impact on severity and quality of illness perception at one year after COVID-19 and may foster unhelpful coping mechanisms. Besides COVID-19 severity, individual illness perception should be taken into account when allocating rehabilitation and psychological therapy resources. Study registration: ClinicalTrials.gov: NCT04416100.

Two‐year trajectories of COVID‐19 symptoms and their association with illness perception: A prospective cohort study in Amsterdam, the Netherlands

“…Symptom trajectories were also highly congruent with illness perception when adjusting for age, sex, initial COVID-19 severity and timing of infection. These findings are in line with a previous longitudinal study that found higher B-IPQ scores at 1 year after COVID-19 among individuals with a greater number of long COVID symptoms, reduced physical performance and higher fatigue score 21. Whilst we cannot proclaim a causal relationship, this association observed has two important implications.…”

“…These findings are in line with a previous longitudinal study that found higher B‐IPQ scores at 1 year after COVID‐19 among individuals with a greater number of long COVID symptoms, reduced physical performance and higher fatigue score. 21 Whilst we cannot proclaim a causal relationship, this association observed has two important implications. Firstly, in clinical practice, our findings imply that the B‐IPQ—a rapid assessment tool—could be used to quantify long COVID severity in real‐time, monitor individuals' progression over time or screen individuals for risk of developing more severe long COVID, as suggested by the association between the M1 B‐IPQ and belonging to a 24‐month trajectory with a greater number of symptoms.…”