Distress Prior To Covid-19 Infection May Predict Post-Covid Symptoms

A study published in this week’s JAMA Psychiatry reported on whether symptoms of anxiety, depression, worry and stress prior to suffering an acute Covid-19 infection might predict post-Covid-19 symptoms, commonly known as “Long Covid.” The authors, based at Harvard Medical School and the T.H. Chan School of Medicine at Harvard, used data from two Nurses’ Health Studies and the Growing Up Today study, whose cohorts were 96% female with an average age of 57 years. There were approximately 55,000 participants in the study, which dated back to April 2020, soon after the pandemic began.

Over one third of the participants were healthcare workers. Surveys were provided in April 2020 to those who had not yet sustained a SARS-CoV-2 (Covid-19) infection, and included questions regarding anxiety, depression, loneliness, stress, and worry. Of the participants, 6%, or 3200 individuals, developed a Covid-19 infection within the 19 months following the initial month of the study.

Those who reported evidence of Covid-19 infections were then assessed for any post-Covid symptoms longer than 4 weeks following onset of infection. These symptoms could include brain fog, fatigue, loss of sensations of taste or smell, and depression. Overall, those who reported symptoms of distress prior to Covid-19 infections had a 50% more likelihood of reporting post-Covid symptoms four or more weeks after illness.

Prior studies have shown that advanced age, obesity, and co-morbidities such as high blood pressure are associated with increased severity of acute infetions as well as post-Covid sequelae, but few large studies have identified psychological distress factors impacting disease outcomes.

The authors of the current study acknowledge that they are by no means implying that post-Covid-19 symptoms have any relationship to a psychosomatic illness nor fabrication of symptoms. Indeed, over 40% of those with post-Covid issues had no prior history of any notable stress, depression or loneliness. Perhaps more notably, the authors recognize that this is a very narrow representation of the general population in the United States. The majority of the participants were White female healthcare professionals in their mid to late 50’s. Moreover, symptoms were self-reported and not based on outside clinical evaluations.

While there are multiple limitations to this study, not to mention the ongoing stress on healthcare workers regarding risks of Covid-19 infections leading to continued worry and anxiety, it raises the important issue of the need to better identify risk factors for post-Covid issues, as well as the need to mitigate these stressors, due to Covid or otherwise.