These mental disorders may predict who develops long COVID. Here's what you need to know

By Jules Murtha | Fact-checked by Barbara Bekiesz
Published October 18, 2022

Key Takeaways

  • Patients with long COVID may experience various symptoms including depression, anxiety, and other neurological issues.

  • Research suggests that those who experience stress, anxiety, depression, and other mental health issues prior to contracting COVID may be at higher risk of developing long COVID.

  • Clinicians can better serve patients with psychological long COVID symptoms by addressing them early on with trauma therapies, cognitive behavioral therapies, and acceptance and commitment therapies.

Emerging research suggests that individuals who had mental health issues prior to contracting COVID-19 may be at higher risk of developing long COVID.

To effectively treat patients with long COVID, it is key for clinicians to validate their patients’ struggles and work with psychologists to employ applicable therapeutic approaches.

Can mental illness increase susceptibility?

In July 2021, the American Psychological Association (APA) reported that an estimated 3.2 million Americans were struggling with lasting COVID-19 symptoms.[] Long COVID has since come to be considered its own mysterious condition that can entail a wide range of symptoms.

Long COVID often presents at the 4-week-post-infection mark.

Long COVID symptoms are myriad and can range from general fatigue, difficulty breathing, heart palpitations, and cough to headache, depression, and anxiety, as noted by the CDC.[] But what determines one’s susceptibility to long COVID?

Research indicates that patients who have mental health issues before contracting COVID-19 may be more likely to experience post-COVID conditions and are 1.3 to 1.5 times more likely to self-report them. This population may also be at higher risk of “​​daily life impairment” as a result of long COVID symptoms.

A study published by JAMA Psychiatry looked at data from the Nurses’ Health Study II, Nurses’ Health Study 3, and the Growing Up Today Study.[] Each participant completed periodic follow-up surveys between April 2020 and November 2021.

Of the 54,960 participants, 6% reported testing positive for COVID-19 during a follow-up. Among this group, probable depression, worry about COVID-19, perceived stress, and loneliness were linked to the development of long COVID (of which there were 1,403 cases). The survey adjusted for sociodemographic factors, comorbidities, and health behaviors.

Those who reported having two or more types of psychological distress prior to infection were at an approximately 50% increased risk for post-COVID conditions. All distress types were linked to daily life impairment in patients with long COVID, as well.

This evidence points to the possibility that living with pre-infection psychological distress may increase one’s susceptibility to developing long COVID.

The authors of the study therefore called for further research on the effects of stress reduction on post-COVID conditions. They noted the importance of delving deeper into the mechanisms behind distress and its impact on patients with COVID-19.

"Identification and treatment of biological pathways linking distress with long-term COVID-19 symptoms may benefit individuals with post–COVID-19 conditions or other chronic post-infection syndromes."

Wang S, et al.

Post-COVID mental health issues

As researchers explore the mechanisms behind long COVID and the populations that are most susceptible to it, doctors can lean on several forms of therapeutic treatments to help patients.

According to an article published by the APA, psychologists are well-equipped to address COVID-19’s psychological symptoms through cognitive behavioral therapy (CBT), trauma therapy, and acceptance and commitment therapy.

CBT can be used to help patients establish new behaviors such as better sleep hygiene, while acceptance and commitment therapy helps patients deal with the unknowns associated with long COVID.

Patients may also benefit from having a collaborative care team.

If you’re a PCP, you can touch base with the patient’s psychologist and other specialists to problem-solve together. This way, you can rule out underlying psychological issues and focus on finding the patient’s “new normal.”

Finally, remember how far validation goes.

Your patient may be experiencing symptoms you can’t see, which could worsen if dismissed or left untreated. As the science behind long COVID unfolds, it may help explain the symptoms that many patients experience in the wake of a bout with COVID-19.

What this means for you

Although long-COVID symptoms are not well understood, research suggests they are common in patients who experienced mental health issues before getting infected. The wide range of symptoms suggests that a collaborative approach to management may be most effective. Securing psychological support for the patient early in the post-infection stage may help in validating the reality of the long-COVID condition and ameliorating its impact on daily living.

Read Next: How long COVID is cutting HCP careers short

Caring During COVID speaks directly to clinicians who are still facing the realities of the pandemic. Each week we feature perspectives, lessons, research, guidance, and more. Submit any question or topic you'd like to see covered, and let us know if you’d like to be a guest author.

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