For immediate release: September 7, 2022
Boston, MA – Psychological distress, including depression, anxiety, worry, perceived stress and loneliness, before COVID-19 infection was associated with an increased risk of long-term COVID, according to Harvard TH Chan School of Public Health researchers. The increased risk was independent of smoking, asthma and other health-related behaviors or physical health problems.
“We were surprised to see how much psychological distress before COVID-19 infection was associated with an increased risk of long-term COVID,” said Siwen Wang, a researcher in the Harvard Chan School Department of Nutrition who led the study. ‘study. “Distress was more strongly associated with the development of long COVID than physical health risk factors such as obesity, asthma, and hypertension.”
The study was published online in JAMA Psychiatry on September 7, 2022.
According to the US Centers for Disease Control, approximately 20% of US adults who have had COVID-19 have developed long COVID, which is defined as having symptoms related to COVID-19, such as fatigue, fog cerebral or respiratory, cardiac, neurological or digestive symptoms for more than four weeks after infection. Severe COVID-19 illness increases the risk of long COVID, although people with milder COVID-19 cases can also develop long COVID. Symptoms, which can be debilitating, can last for months or years, and little is known about the traits linked to the development of long COVID.
Mental health is known to affect outcomes for certain illnesses. Depression and other mental illnesses have been associated with an increased risk of more severe COVID-19, including the risk of hospitalization, which is a risk factor for long COVID. In other acute respiratory infections, such as the flu or the common cold, mental health problems are associated with greater severity and longer duration of symptoms. Previous studies have also suggested that distress is associated with chronic symptoms following Lyme disease and chronic fatigue syndrome and fibromyalgia, which have symptoms similar to those of long COVID.
To determine the effects of psychological distress prior to COVID-19 infection on the development of long COVID, Wang and colleagues recruited over 54,000 people in April 2020. At the start of the study, the researchers asked participants about their psychological distress. Over the next year, more than 3,000 participants contracted COVID-19, and researchers asked participants about their COVID-19 symptoms and duration of symptoms.
After analyzing responses and comparing those who developed long COVID to those who did not, researchers determined that distress prior to COVID-19 infection, including depression, anxiety, l worry, perceived stress and loneliness, was associated with a 32%-46% increased risk of prolonged COVID. These types of psychological distress were also associated with a 15-51% increased risk of impaired daily living due to long duration of COVID.
“To the best of our knowledge, this is the first prospective study to show that a wide range of social and psychological factors are risk factors for long COVID and impaired daily life due to long COVID” , said Andrea Roberts, senior researcher in the Department of Environmental Health at Harvard Chan School and lead author of the JAMA Psychiatry article. “We need to consider psychological health in addition to physical health as risk factors for a long COVID-19. These findings also reinforce the need to increase public awareness of the importance of mental health and to obtain mental health care for those who need it, including increasing the number of mental health clinicians and improving access to care.
Other Harvard Chan School co-authors include Luwei Quan, Jorge Chavarro, Natalie Slopen, Laura Kubzansky, Karestan Koenen, and Marc Weisskopf.
This research was supported by the National Institutes of Health (3R01HD094725-02S1, U01HL145386, R24ES028521, U01 CA176726, R01 CA67262, and R01 HD057368); the Dean’s Fund for Scientific Advancement Acceleration Award from the Harvard TH Chan School of Public Health; and the Massachusetts Consortium on Pathogen Readiness Evergrande COVID-19 Response Fund Award, and the Veterans Administration (IIR 20-076, INV 20-099, IIR 20-101).
“Associations of pre-infection depression, anxiety, worry, perceived stress, and loneliness with risk for post-COVID-19 conditions”, Siwen Wang, Luwei Quan, Jorge Chavarro, Natalie Slopen, Laura Kubzansky, Karestan Koenen, Jae Hee Kang, Marc Weisskopf, Westyn Branch-Eliman, Andrea Roberts, JAMA Psychiatry, online September 7, 2022, doi: 10.1001/jamapsychiatry.2022.2640.
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Harvard TH Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and generate powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators and students, we work together to bring innovative ideas from the lab to people’s lives, not only achieving scientific breakthroughs, but also working to change the individual behaviors, public policies and health care practices. Each year, more than 400 Harvard Chan School faculty members teach more than 1,000 full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the school is recognized as America’s oldest professional public health training program.