Psychological distress after COVID-19 recovery and subsequent prolonged post-acute sequelae of COVID-19: A longitudinal study with 1-year follow-up in Japan

Abstract

BackgroundThis study investigated the longitudinal association between psychological distress in the post-acute phase and the subsequent prolonged post-acute sequelae of COVID-19 (PASC) among individuals with PASC.MethodsAn online longitudinal survey with 1-year interval was conducted from July to September 2021 (T1) and July to September 2022 (T2). Individuals who were 20-years-old or older, had a positive Polymerase Chain Reaction test, were one month post-infection, and did not select “Nothing” to a question regarding PASC presence were included. The primary outcome was the presence of PASC at T2. The presence of general, respiratory, muscular, neurological, gastrointestinal, dermatological, and cardiac symptoms at T2 was also used as an outcome among patients with relevant symptoms at time 1 (T1). Exposure was measured using the Kessler distress scale (K6) at T1, and those whose K6 was 13 or higher were identified as having psychological distress. Marginal structure models with robust standard errors were used to examine the association between psychological distress at T1 and any PASC symptoms at T2, and the associations between psychological distress and each symptom at T2 among participants with relevant symptoms at T1.ResultsA total of 1674 patients were analyzed; 17%had psychological distress. ; In total, 818 (48.9%), 523 (31.2%), and 672 (40.1%) patients reported general, respiratory, and neurological symptoms at T1, respectively. Individuals with psychological distress had higher odds of any symptoms at T2 (Odds Ratio [OR] =1.81, 95% Confidence Interval [CI]= 1.08 – 3.03) and general and respiratory symptoms at T2 among participants with relevant symptoms at T1 (OR = 1.95, 95% CI = 1.02 – 3.76; OR = 2.44, 95% CI = 1.03 – 5.80).ConclusionPsychological distress in the post-acute phase may lead to prolonged PASC symptoms, mainly general and respiratory symptoms, at the 1-year follow-up in individuals with PASC.Key MessagesPsychological distress before infection and during the acute phase predicts prolonged Post-Acute Sequelae of COVID-19 (PASC); however, in individuals with PASC, it is unclear whether psychological distress during the post-acute phase predicts prolonged PASC. This longitudinal survey indicated that psychological distress in the post-acute phase led to prolonged any levels of PASC, especially general and respiratory symptoms, at the 1-year follow-up. Therefore, mental health care for individuals with PASC may help to improve or mitigate prolonged PASC.