“We were surprised by how strongly psychological distress before a COVID-19 infection was associated with an increased risk of long COVID,” said the lead author, Siwen Wang, MD, a researcher in the department of nutrition at Harvard T.H. Chan School of Public Health, in a statement. “Distress was more strongly associated with developing long COVID than physical health risk factors such as obesity, asthma, and hypertension.” Out of nearly 55,000 participants who enrolled in the study in April 2020, 6 percent (3,193) contracted the coronavirus over the following year. The average age of those who tested positive was 55 — almost all were white (96.8 percent) and women (96.4 percent). Almost half were active healthcare workers. Of those who tested positive for the virus, about 44 percent had long COVID symptoms, and among these, about 87 percent had symptoms lasting two months or longer, and nearly 56 percent reported at least occasional daily life impairment related to post-COVID conditions. Based on participant responses about their symptoms and their duration, Wang and her team determined that mental distress before COVID-19 infection — including depression, anxiety, worry, perceived stress, and loneliness — was associated with a 32 to 46 percent increased risk of long COVID, which in this investigation was defined as symptoms lasting four weeks or longer. Participants with two or more types of distress prior to infection were nearly 50 percent more likely to experience post-COVID conditions. Wang and colleagues noted that those who had probable depression or anxiety were younger, more likely to be active healthcare workers, and had a higher prevalence of asthma. Psychological disturbances were also linked with a 15 to 51 percent greater risk of daily life impairment due to long COVID. Nearly one in five American adults who have had COVID-19 have developed long COVID, according to the Centers for Disease Control and Prevention (CDC). The most common long COVID symptoms reported by these participants were fatigue (56 percent), smell or taste problems (44.6 percent), shortness of breath (25.5 percent), confusion/disorientation/brain fog (24.5 percent), and memory issues (21.8 percent). The research results back up prior investigations that associated psychological distress with greater severity and longer duration of acute respiratory tract infections, and a study published in January 2022 in Neurology in which mental health problems appeared to increase this risk of post-COVID health problems in individuals with multiple sclerosis. Previous studies have also suggested that distress is associated with chronic symptoms after Lyme disease and in chronic fatigue syndrome and fibromyalgia, which have symptoms similar to those of long COVID. “We need to consider psychological health in addition to physical health as risk factors of long COVID-19,” said the senior author Andrea Roberts, PhD, a senior research scientist in the department of environmental health at the T.H. Chan School. “We need to consider psychological health in addition to physical health as risk factors of long COVID-19. These results also reinforce the need to increase public awareness of the importance of mental health and to get mental health care for people who need it, including increasing the supply of mental health clinicians and improving access to care.”
