Long-term symptoms of COVID are exacerbated by stressful events

Long-term symptoms of COVID are exacerbated by stressful events

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

Post-acute sequelae of COVID-19 (PASC) were observed in 25% to 69% of non-hospitalized patients and 33% to 90% of hospitalized patients. The variable prevalence could result from differences in study design, symptoms, and timing of assessment. Despite numerous studies reporting the prevalence of sequelae after COVID-19, there are limited data on predictors of long-term quality of life and cognitive and functional outcomes.

study: Life stressors significantly affect long-term outcomes and post-acute symptoms 12 months after hospitalization for COVID-19. Image Credit: / Shutterstock

About the study

In this study, researchers prospectively examined the impact of demographics, hospital clinical variables, comorbid conditions prior to COVID-19, and life stressors on six-month and one-year outcome metrics after inpatient hospitalization. This observational study was conducted on patients hospitalized with COVID-19 from March 10 to May 20, 2022.

Follow-up interviews were conducted six months and one year after the initial diagnosis of COVID-19. Subjects were eligible if they were 18 years of age or older and had been hospitalized with a positive reverse transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2, with consent for a follow-up interview. Individuals were excluded if they were evaluated in the emergency room or on an outpatient basis.

Data on demographics, medical/neurological history, new hospital neurological or other complications, and medications used during acute COVID-19 were recorded. Disease severity was assessed based on ventilatory requirements and Sequential Organ Failure Assessment (SOFA) results. The Modified Rankin Scale (mRS) was used to assess subjects’ baseline functional status prior to COVID-19.

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

The Barthel Index was used to assess activities of daily living (ADL), and self-reported health metrics of depression, fatigue, sleep, and anxiety were collected through the Neurological Disorders Short Form Quality of Life (NeuroQoL). PASC outcomes were defined as new/persistent symptoms occurring four weeks after COVID-19.


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

No differences were found in sex, education level, race, mRS scores before COVID-19, history of dementia/psychiatric illness, severity of COVID-19, and rates of neurologic complications during hospitalization between patients who completed interviews at six months and 12 years. months. Headache, anxiety, cognitive abnormalities, depression, fatigue, and sleep disturbances were common neurological symptoms at 12 months.

About 90% of patients at six months and 87% at 12 months showed abnormalities on at least one metric assessed, with mRS and t-MoCA abnormalities being the most prevalent. A small but significant correlation was observed between post-acute COVID-19 symptoms and NeuroQoL anxiety scores ≥ 60. In addition, the authors observed an association of older age with poor mRS, t-MoCA scores, and Barthel index at both time periods and with NeuroQoL depression scores for one year.

Female gender was associated with elevated anxiety scores at one year and poor Barthel scores 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 six and 12 months and poorer fatigue and depression scores at one year. Poor SOFA scores and mechanical ventilation predicted poor Barthel index at six months.

The researchers found no consistent effect of the COVID-19 drugs on the outcome metrics. However, more than 50% of participants reported experiencing at least one life stressor in the month preceding the 12-month follow-up. A new personal illness, social isolation, financial insecurity, and the illness/death of a close acquaintance were the most common life stressors.

The presence of stressors is strongly associated with post-acute symptoms of COVID-19 and poor NeuroQoL outcomes. There was a significant association between food and financial insecurity, new disability/death in a close contact, social isolation and personal illness with worse NeuroQoL metrics. In contrast, new disability and personal illness were associated with Barthel index and mRS.


In summary, the authors found independent associations of conventional predictors of poor outcomes, such as older age, poor pre-COVID-19 functional status, and disease severity, with worse t-MoCA, Barthel index, and mRS scores and post-acute symptoms of COVID-19. In addition, they found that life stressors negatively affected post-acute COVID-19 symptoms, depression, fatigue, sleep, and disability metrics. Considering life stressors, 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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