Study explores long-lasting psychological implications of long COVID

In a recent study posted to the medRxiv* preprint server, researchers evaluated the long-standing psychological manifestations of long coronavirus disease (long COVID).

Study: Long-term psychological consequences of long Covid: a propensity score matching analysis comparing trajectories of depression and anxiety symptoms before and after contracting long Covid vs short Covid. Image Credit: Starocean/Shutterstock
Study: Long-term psychological consequences of long Covid: a propensity score matching analysis comparing trajectories of depression and anxiety symptoms before and after contracting long Covid vs short Covid. Image Credit: Starocean/Shutterstock

Background

The persistence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) symptoms developed during or following acute COVID 2019 (COVID-19) that cannot be explained by alternative diagnoses is known as long COVID. Nearly 10% of SARS-CoV-2 patients are estimated to be affected by long COVID following 12 weeks of initial infection, with a large percentage of people experiencing symptoms for up to six months. 

The psychological implications of long-term COVID-19, such as anxiety, depression, poor sleep, and stress, are becoming more widely recognized, as evidenced by accumulating research data. The development and long-term dynamics of psychological conditions after SARS-CoV-2 infection, on the other hand, remain unknown.

About the study

In the present study, the scientists examined the timing of the first episode of psychological symptoms following COVID-19 and protracted patterns of psychological symptoms between short and long COVID groups. The team evaluated longitudinal data from University College London (UCL) SARS-CoV-2 social study that was conducted between March 2020 and November 2021.

The present research encompassed details on 3,115 individuals above 18 years residing in England who had COVID-19 during November 2021. The study volunteers were enlisted through targeted recruitment of vulnerable/underrepresented groups and convenient sampling.

People with long COVID were matched to individuals with short COVID utilizing propensity score matching (PSM) various health, socioeconomic, and demographic covariates. Depressive symptoms and anxiety symptoms were quantified using patient health questionnaire 9 (PHQ-9) and generalized anxiety disorder 7 (GAD-7) assessment, respectively.

Post-COVID-19 experiences from typical mental health problems during the SARS-CoV-2 pandemic were distinguished using growth curve modeling. The growth curve modeling accounted for impacts of social restrictions like lockdowns and time of the year on mental health via monitoring people 10 months before their SARS-CoV-2 infection and up to the 22-month follow-up period.

Results and discussions

The study results showed that out of the 3,115 COVID-19 patients in England during November 2021, 495 had long COVID which were matched to 962 subjects with short COVID, and provided 13,324 observations.

The depression and anxiety symptoms heightened immediately after the onset of the SARS-CoV-2 infection in short and long COVID cohorts. The peak in both anxiety and depressive symptoms happened within one week of their reported SARS-CoV-2 infection. This inference indicates that rapid psychobiological mechanisms were involved in the etiology of SARS-CoV-2-related mental distress in both short and long COVID. 

Short and long COVID patients were matched on psychiatric and physical comorbidities before 10 months of SARS-CoV-2 infection and COVID-19 symptom severity. The short and long COVID cohorts demonstrated equivalent trajectories of depressive and anxiety symptoms 10 months before the SARS-CoV-2 infection. Yet, upon the onset of the SARS-CoV-2 infection, depression levels in the long COVID cohort were considerably greater than those in the short COVID group. However, anxiety levels were not markedly different among the two cohorts. This strengthens prior theories that the elevation in depression symptoms in the long COVID cohort was biologically stimulated by SARS-CoV-2 and was not due to the higher predisposition of emotional distress during the infection. 

A similar pattern of improvement in the COVID-related depression symptoms with time was observed in the short and long COVID groups. Yet, the depressive symptom levels were higher in the long COVID group during the 22-month follow-up period than in the short COVID cohort and 10-month earlier data. In contrast, the depressive symptom levels in the short COVID group became lower than the baseline within four months. Anxiety symptom levels also did not improve in the long COVID cohort during the 22-month follow-up period, unlike in the short COVID group. This indicates that there were widening disparities in mental distress among the two cohorts.

Conclusions

According to the authors, the current study was among the longest and largest investigations on the psychological experiences of long COVID patients so far.

The study findings demonstrated that anxiety and depressive symptoms hiked shortly after  SARS-CoV-2 infection onset in both short and long COVID cohorts. However, the long COVID cohort exhibited a drastically higher initial hike in depressive symptoms and elevated levels upon follow-up at 22 months. On the contrary, the initial elevation in anxiety was not substantially distinct among the two groups. Yet, a substantial reduction in anxiety symptoms in the 22-month follow-up was only observed in the short COVID cohort compared to the long COVID group. This led to a prominent gap between the long and short COVID groups.

In summary, the present study provides information on the psychobiological processes that play a role in the emergence of psychological symptoms associated with long COVID. This work suggests that initial psychological experiences following SARS-CoV-2 infection might be a possible predictor of long COVID. The current findings emphasize the need for integrating mental health monitoring and proper psychological support with the treatment and diagnosis of the physical effects of long COVID.

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
Shanet Susan Alex

Written by

Shanet Susan Alex

Shanet Susan Alex, a medical writer, based in Kerala, India, is a Doctor of Pharmacy graduate from Kerala University of Health Sciences. Her academic background is in clinical pharmacy and research, and she is passionate about medical writing. Shanet has published papers in the International Journal of Medical Science and Current Research (IJMSCR), the International Journal of Pharmacy (IJP), and the International Journal of Medical Science and Applied Research (IJMSAR). Apart from work, she enjoys listening to music and watching movies.

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