Stressful events may worsen long-Covid symptoms: Study

Adult patients with “major life stressors” were at least twice as likely to struggle with depression, brain fog, fatigue, sleep problems, and other long-term COVID-19 symptoms, a new study finds.

The death of a loved one, financial or food insecurity, or a newly developed disability were some of the strongest predictors – present in more than 50 per cent of those followed – of whether a patient hospitalized for COVID-19 would experience symptoms of long COVID a year later, the study said.

The analysis, published in the Journal of the Neurological Sciences (JNS), also confirmed the contribution of traditional factors to greater long COVID risk as shown by past studies – older age, disability level to start with, and a more severe initial case of COVID -19, the study said.

“Our study is unique in that it explores the impact of life stressors – along with demographic trends and neurological events – as predictors of long-term cognitive and functional disabilities that affected quality of life in a large population,” said lead study author Jennifer A Frontera, NYU School of Medicine.

“Therapies that lessons the trauma of the most stress-inducing life events need to be a central part of treatment for long COVID, with more research needed to validate the best approaches,” said Frontera.

In analyzes that compared factors against each other for their contribution to worse outcomes, life stressors including financial insecurity, food insecurity, death of a close contact, and new disability were the strongest independent predictors of prolonged COVID-19 symptoms.

These same stressors also best predicted worse functional status, depression, fatigue, sleep scores, and reduced ability to participate in activities of daily living such as feeding, dressing, and bathing.

The research used standard telephone survey tools in the field to measure level of daily function, clear thinking (cognition), anxiety, depression, fatigue and sleep quality.

The team attempted follow-up with each of 790 patients six months and a year after COVID-19 hospitalization within NYU Langone Health between March 10, 2020 and May 20, 2020.

Of these surviving patients, 451 (57 per cent) completed 6-month and/or 12-month follow-up, and of them, 17 per cent died between discharge and 12-month follow-up and 51 per cent reported significant life stressors at 12 months.

Gender was also a contributor, as past studies have found that women are more susceptible in general to, for instance, autoimmune diseases that could have an impact on outcomes. Additionally, undiagnosed mood disorders may have been unmasked by pandemic-related stressors.

A second study led by Frontera and colleagues, and published online September 29, 2022, in PLOS ONE, found that patients diagnosed as having long COVID neurological problems can be divided into three symptom groups.
For the PLOS One study, the research team collected data on symptoms, treatments received, and outcomes for 12 months after hospitalization with COVID-19, with treatment success measured again by standard metrics.

The three newly identified disease groups were: Cluster 1 – Few symptoms (most commonly headache) who received few therapeutic interventions, Cluster 2 – Many symptoms including anxiety and depression who received several treatments, including antidepressants to psychological therapy, Cluster 3 – Primarily pulmonary symptoms such as shortness of breath.

Many patients also complained of, headache and cognitive symptoms, and mostly received physical therapy.
The most severely affected patients (symptom Cluster 2) had higher rates of disability, worse measures of anxiety, depression, fatigue and sleep disorders.

All patients whose treatment included psychiatric therapies reported symptom improvement, compared to 97 per cent who received primarily physical or occupational therapy, and 83 per cent who received few interventions, the study said.

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