Long-COVID symptoms worsened by stressful events

A recently published study, Journal of Neurological Sciences reported that life stressors affect post-acute symptoms and long-term outcomes after hospitalization for coronavirus disease 2019 (COVID-19).

Post-acute sequelae of COVID-19 (PASC) have been observed in 25% to 69% of non-hospitalized patients and 33% to 90% of hospitalized patients. Variable prevalence may be due to differences in study design, symptoms, and timing of assessment. Despite numerous studies reporting the prevalence of post-COVID-19 sequelae, limited data are available on predictors of long-term quality of life and cognitive and functional outcomes.

Study: Life stressors significantly influence long-term outcomes and post-acute symptoms 12 months after hospitalization with COVID-19.  Image Credit: / ShutterstockStudy: Life stressors significantly influence long-term outcomes and post-acute symptoms 12 months after hospitalization with COVID-19. Image Credit: / Shutterstock

about the study

In this study, the researchers prospectively examined the impact of demographics, hospital clinical variables, pre-COVID-19 comorbid conditions, and life stressors on outcome measures at six months and one year post-COVID-19 hospitalization. This observational study was conducted on patients hospitalized for COVID-19 between 10 March and 20 May 2022.

Follow-up interviews were conducted six months and one year after the initial COVID-19 diagnosis. Subjects aged 18 years or older who were hospitalized with a positive SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) test and were approved for a follow-up interview were considered eligible. Persons evaluated in the emergency room or outpatient setting were excluded.

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Data on demographic information, medical/neurological history, new in-hospital neurologic or other complications, and medications used during acute COVID-19 were recorded. Disease severity was graded according to ventilation requirement and sequential organ failure assessment (SOFA) score. The modified Rankin scale (mRS) was used to assess the subjects’ baseline functional status before COVID-19.

Longitudinal assessments were made through telephone interviews. Contact was attempted six and 12 months after the initial COVID-19 diagnosis. Functional and disability status were assessed using mRS; Cognitive outcomes were assessed by telephone Montreal Cognitive Assessment (t-MoCA).

The Barthel index was used to evaluate activities of daily living (ADL), and self-reported health measures of depression, fatigue, sleep, and anxiety were collected through quality of life in neurological disorders (NeuroQoL) in short forms. PASC outcomes were defined as new/persistent symptoms occurring four weeks after COVID-19.


At 6 and 12 months, follow-up interviews were attempted on 790 and 590 patients, respectively. Of these, only 382 (48%) and 242 (41%) patients completed the interviews at the sixth and 12th months, respectively. Participants who completed only the six-month interview were older (median age: 69 years) than those who completed the 12-month interview (65 years).

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There was no difference between the patients who completed the interviews at the age of 6 months and 12 years in terms of gender, education level, race, pre-COVID-19 mRS scores, dementia/psychiatric disease history, COVID-19 severity, and rates of neurological complications during hospitalization. moon. Headache, anxiety, cognitive abnormalities, depression, fatigue, and sleep disturbances were common neurological symptoms at 12 months.

Approximately 90% of patients at 6 months and 87% at 12 months showed abnormality in at least one metric evaluated; the most common were abnormalities in mRS and t-MoCA. A small but significant correlation was observed between post-acute COVID-19 symptoms and NeuroQoL anxiety scores ≥ 60. In addition, the authors stated that there was an association between advanced age and poor mRS, t-MoCA scores and Barthel Index at both time points. with NeuroQoL depression scores at one year.

Female gender was associated with high anxiety scores at one year and poor Barthel Index at six and 12 months. Neurological complications such as hypoxic-ischemic brain injury and toxic metabolic encephalopathy strongly predicted poor Barthel Index and mRS at 6 and 12 months and worse fatigue and depression scores at 1 year. Poor SOFA scores and mechanical ventilation predicted a poor Barthel Index at six months.

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Researchers did not find any consistent effects of COVID-19 drugs on outcome measures. However, more than 50% of participants reported experiencing at least one life stressor in the month preceding follow-up at 12 months. Recent personal illness, social isolation, financial insecurity, and illness/death of a close acquaintance were the most common life stressors.

The presence of stress factors was strongly associated with post-acute COVID-19 symptoms and poor NeuroQoL scores. There was a significant association between personal illness and food and financial insecurity, new disability/death from close contact, social isolation, and worse NeuroQoL measures. In contrast, new disability and personal illness were associated with the Barthel Index and mRS.


In summary, the authors found independent associations between traditional predictors of poor outcome, such as advanced age, poor pre-COVID-19 functional status, and disease severity, and worse t-MoCA, Barthel Index and mRS scores, and post-acute symptoms. of COVID-19. Additionally, they found that life stressors negatively affected post-acute COVID-19 symptoms, depression, fatigue, sleep, and measures of disability. Taking life stressors into account, interventions aimed at alleviating life stress are associated with better cognitive, neuropsychiatric and functional outcomes 12 months after hospitalization with COVID-19.


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