Depression and stress are better Covid indicators than physical comorbidities in the long run. A new study suggests.
Research has repeatedly shown that medical conditions such as hypertension and immunosuppression may increase the risk of a patient not just developing serious Covid but also for prolonged Covid. However, in a recent study, researchers discovered that psychological stressors, such as anxiety, depression, and loneliness, were significantly indicative of Covid patients’ chances of suffering from prolonged Covid than conventionally related physical factors.
“Unfortunately, there’s a long history of people not taking these conditions as seriously as they might take physical health conditions that might be easier to measure or easier to see,” said Andrea Roberts, a senior researcher at the Harvard T.H. Chan School of Public Health and the lead author of this study. It was released on Wednesday in JAMA Psychiatry. “For long Covid, obviously, then, it becomes essential to look at psychological health, and it raises more broadly the question of the importance of identifying and treating mental health issues.”
The study followed over 54,000 survey participants, most of whom were either former or current health workers, for 19 months, beginning on April 1, 2020. When the epidemic occurred, these survey respondents assessed their anxiety level about Covid-19 and the frequency of depression or anxiety-related symptoms as a base measure. Health care workers who were not health professionals were examined on their feelings about anxiety or loneliness.
Researchers utilized surveys to monitor participants to see if they were positive for Covid and identified those suffering from prolonged Covid, defined as having at least four weeks of symptoms. More than 3,200 people ended up developing Covid. Researchers discovered that anxiety, depression, stress perception or loneliness, and worry about the condition were associated with a 1.3 up to 1.5-fold increase in the risk of having prolonged Covid symptoms. Patients who experienced two or more forms of distress had a 50% higher likelihood of suffering from long Covid.
Although the authors propose biological mechanisms that could link mental health and long Covid symptoms, they cannot prove that anxiety or stress causes the illness. “This is an observational study, not a randomized clinical trial,” said Siwen Wang, a research fellow at Harvard and the study’s lead author. “Under a randomized clinical trial, you will say ‘A’ is causal with ‘B.’ But for observational studies, we definitely cannot say for sure ‘this is a causal link that we find’; we only find association but not causal [relationships].”
However, Aric Prather, a psychologist and behavioural sciences instructor at the University of California, San Francisco, was not part of the study and praised the research team’s efforts to identify possible confounding variables for the long Covid “quite convincing.”
Researchers used three refinement models, initially accounting for demographic variables (age and sex, gender, identity as well as the status of health workers, as well as the partner’s education) and then adjusting for other factors such as smoking or body mass index, and lastly, adjusting for common comorbidities such as hypertension, diabetes and asthma, high cholesterol and cancer. The connection between prior mental distress and Covid was not diminished in all cases.
Additionally, among the participants who complained of lengthy Covid symptoms, those who reported previous signs of psychological distress before the time of the pandemic’s outbreak had a higher likelihood of suffering from prolonged Covid symptoms that were severe enough to impact their ability to function daily as compared to those who did not experience psychological distress before becoming sick.
The authors pointed out that these findings should not indicate that the long Covid symptoms are psychological.
“Often, ‘it’s all in your head is another way to say ‘we don’t know what’s going on,'” Roberts said. Roberts speaks of how doctors dismiss long Covid symptoms and can blame the patient.
In their study, Roberts and her colleagues highlighted many indicators that suggest that long Covid is not just psychosomatic. Besides, over 40 per cent of the respondents did not mention mental distress in the initial report and that the long Covid signs are significantly distinct from the symptoms of mental illness.
The self-reported nature of both the first psychological stressors and the positive Covid tests adds uncertainty to the study’s design. However, Wang pointed out that many validation studies show that health information reported by self-reported health professionals, such as those surveyed, has an extremely high degree of reliability.
Wang, Roberts, and Prather each pointed out that the data collected from a sample of predominantly female and white respondents (96.5 per cent and 96.6 per cent, respectively, of the initial 54,960 participants) and that until research is replicated across more people, it’s unclear if results can be applied to all populations. Yet, Roberts noted that they observed the same patterns and stronger associations in the tiny number of males in the study.
To Wang, the shocking finding that stressors from mental health were more reliable indicators of Covid danger than physical conditions “signals” to health care personnel and policymakers that mental health services should improve access to those who need it.
Prather agreed, saying that this study proves that “lived experience” and mental health stresses are crucial indicators of “who ends up getting sick and who ends up staying sick.”
“It’s a really great first step in this work and taking advantage of this large-scale data,” said Prather. “But obviously, it’s just the beginning of uncovering this story to really get to, more precisely, the factors that are at play.”