Signs of the malady can include breathing problems, brain fog, chronic coughing, changes in taste and smell, overwhelming fatigue, difficulties in performing daily life functions, and disruptions in sleep that can last months, even years, after the infection has cleared the body.
People who self-identified as having anxiety, depression or loneliness, or who felt extremely stressed or worried frequently about the coronavirus were more likely to experience long Covid-19, according to the study published this month in JAMA Psychiatry.
“We found participants with two or more types of psychological distress before infection had a 50% higher risk of getting long Covid,” said study coauthor Dr. Siwen Wang, a research fellow in the department of nutrition at the Harvard T.H. Chan School of Public Health in Boston.
“Having higher levels of psychological distress prior to a Covid infection also increased the risk of getting long Covid by 50%,” Wang said. “Those people also reported more symptoms seen in long Covid.”
It’s possible that some could use the study’s findings to support a hypothesis that post-Covid illness is psychosomatic, a prevalent belief in the early days of the pandemic, said Dr. Wesley Ely, a professor of medicine and critical care at Vanderbilt University Medical Center in Nashville, Tennessee. He was not involved in the study.
Instead, the study’s message should be that people with existing psychological distress are closer to the “disaster” of long Covid, said Ely, codirector of Vanderbilt’s Critical Illness, Brain Dysfunction and Survivorship Center.
“Imagine 10 people are running a race, and you give five people a head start,” Ely said. “Those are the people who already had a mental health issue — they are just closer to the unfortunate finish line of getting long Covid.”
The mind-body connection
The idea that mental distress can affect the body in negative ways isn’t new. It’s also a two-way lane: Having a chronic illness is strongly associated with the development of depression and other psychological disorders.
With common noninfectious disorders such as heart disease, “depression/anxiety/emotional distress do appear to play a role,” said Dr. Joseph Bienvenu, a professor in the department of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine in Baltimore, in an email. He was not involved in the study.
People with major depression can develop blood pressure issues and may be more likely to have a heart attack. Chronic depression, stress and anxiety have been linked to insomnia, and a lack of quality sleep is a major culprit in the development of obesity, type 2 diabetes and other disorders.
And psychological distress has been shown to weaken the immune system, said study coauthor Dr. Angela Roberts, an associate professor of pulmonary and critical care medicine at Stanford University in California.
“Your brain and your immune system are very tightly interconnected,” Roberts said. “Studies have shown when you’re depressed or anxious, your immune system doesn’t work as well against targets like viruses and bacteria.”
Some patients continue to suffer
To do the new study, researchers worked with nearly 55,000 people with no history of Covid-19 who were enrolled in three major longitudinal studies: the Nurses’ Health Study II, the Nurses’ Health Study 3 and the Growing Up Today Study. Participants in those studies tend to be predominantly female and White, which can limit how much the results can be generalized to a wider population, the study said.
Participants were asked about their mental health in April 2020, quite early in the pandemic. They continued to fill out mental health surveys each month for six months, then quarterly. At the end of a year, researchers narrowed the pool of subjects to nearly 3,200 people who had developed Covid-19 and met study requirements.
“This study is particularly nice in that participants’ baseline characteristics were assessed independently in time from their later Covid symptoms,” Johns Hopkins’ Bienvenu said.
Compared with people not having mental distress, those with depression and loneliness had a 1.32 times greater chance of developing long Covid symptoms. Participants who worried a good deal about the coronavirus — predominantly people of color, women and asthma sufferers — were 1.37 times more likely to develop long Covid, the study found.
Anxiety was associated with a greater risk — 1.42 times more likely — but people with higher levels of perceived stress were nearly 50% more likely to develop post-Covid symptoms, said Wang, the study coauthor.
All the associations between psychological distress and long Covid remained significant, even after researchers adjusted for demographics, body weight, smoking status and a history of asthma, cancer, diabetes, and high blood pressure or cholesterol.
In addition, all types of psychological distress except loneliness were linked to a higher risk of being unable to complete the actions of daily life due to ongoing long Covid symptoms.
While many cases of long Covid are mild and resolve within a few months, other patients continue to suffer for an extended time. Some still haven’t recovered their quality of life more than two years into the pandemic, according to Dr. Aaron Friedberg, a clinical assistant professor of internal medicine who works in the Post-Covid Recovery Program at Ohio State University’s Wexner Medical Center in Columbus.
“They can’t think, they can’t breathe. I have one person whose disease is so severe, they basically can’t get out of bed,” Friedberg told CNN in an earlier interview. “I saw a person recently who is still not working because of Covid symptoms two years later.”