Pre-COVID psychological distress associated with long COVID

JAMAScott Cunningham MD PhD, et al. | September 13, 2022



It is well-known that psychological distress increases the severity and duration of symptoms in patients with upper respiratory infections.

Similarly, the current study showed the psychological distress prior to infection with SARS-CoV-2 increased the risk of long COVID.

Data were used from the Nurse’s Health Study II, Nurse’s Health Study 3, and the Growing Up Today Study.

Eligible participants did not have a current or prior SARS-CoV-2 infection at the time of enrollment (baseline questionnaire) and were given periodic surveys thereafter. Infection with SARS-CoV-2 was self-reported monthly for 6 months, then quarterly for 6 months.

The final questionnaire (1 year after the baseline questionnaire) queried long COVID symptoms (> 4 weeks) and daily life impairment.

Of 54,960 study participants, 3193 (6%) had a positive SARS-CoV-2 test during the study period (April 2020 and November 2021).

All of the following types of psychological distress (pre-infection) were associated with long COVID symptoms: probable depression (RR=1.42); worry about COVID (RR=1.37); perceived stress (RR=1.46); and loneliness (RR=1.32). Participants who had > 2 types of psychological distress prior to infection were at increased risk for long COVID (RR=1.49).

All types of psychological distress prior to infection with SARS-CoV-2 were associated with daily life impairment (RR=1.15-1.51).