Highly stressful events worsen long-term COVID symptoms
Abstract: Recent stressful experiences, such as the loss of a loved one or economic insecurity, are strong predictors of whether a person hospitalized for COVID-19 will experience long-term symptoms of COVID-19 a year later.
Source: NYU Langone
The death of a loved one, financial or food insecurity, or a newly developed disability were some of the strongest predictors of whether a patient hospitalized for COVID-19 would experience long-term symptoms of COVID-19 a year later, a new study finds.
Led by researchers at NYU Grossman School of Medicine, the study found that adult patients with such “major life stressors” — present in more than 50% of those followed — were at least twice as likely to struggle with depression, a fog in brain, fatigue, sleep problems and other long-term symptoms of COVID-19, say the authors of the study.
Published online this week at Journal of Neurological Sciences (JNS)the analysis also confirmed the contribution of traditional factors to a higher long-term risk of COVID as shown by previous studies — older age, degree of disability at onset, and more severe initial case of COVID-19.
“Our study is unique in that it examines the impact of life stressors—along with demographic trends and neurological events—as predictors of long-term cognitive and functional impairments that have impacted quality of life in a large population,” says lead study author Jennifer A. Frontera, MD. ., a professor in the Department of Neurology at NYU Langone Health.
“Therapies that reduce the trauma of the most stressful life events must be central to the treatment of long-term illness with COVID-19, and more research is needed to confirm the best approaches.”
The study used standard telephone field survey tools—the modified Rankin scale (mRS), the Barthel index, the Montreal Cognitive Assessment (t-MoCA), and the NIH/PROMIS Neurological Quality of Life (NeuroQoL) battery—to measure levels of daily function, clear thinking ( cognition), anxiety, depression, fatigue and sleep quality.
The team attempted to follow each of the 790 patients six months and one year after hospitalization with COVID-19 at NYU Langone Health between March 10, 2020, and May 20, 2020.
Of these surviving patients, 451 (57%) completed 6-month and/or 12-month follow-up, and of these, 17% died between discharge and 12-month follow-up, and 51% reported significant life stressors at 12 months .
In analyzes comparing factors with respect to their contribution to poorer outcomes, life stressors including financial insecurity, food insecurity, death by close contact, and new disability were the strongest independent predictors of prolonged COVID-19 symptoms.
These same stressors also best predict poorer functional status, depression, fatigue, sleep outcomes, and reduced ability to participate in activities of daily living such as feeding, dressing, and bathing.
Gender also contributed, as past studies have found that women are generally more susceptible to, for example, autoimmune diseases that could affect outcomes. In addition, undiagnosed mood disorders may have been exposed to pandemic-related stressors.
Long neurologic COVID may involve more than one condition
Another study, led by Frontera and colleagues, was published online on September 29, 2022 at VERY ONEfound that patients diagnosed with a long-term COVID neurological problem could be divided into three groups of symptoms.
Because there is no current biological definition of long-term COVID, many studies are lumping together different symptoms into what is currently an overall diagnosis without assessing clinical significance, Frontera says. The resulting ambiguity makes it difficult to assess treatment strategies.
For VERY ONE study, the research team collected data on symptoms, treatments received, and outcomes during the 12 months following hospitalization with COVID-19, with treatment success again measured by standard indicators (modified Rankin Scale, Barthel Index, NIH NeuroQoL). The three newly discovered groups of diseases were:
- Group 1: Few symptoms (most often headaches) in patients who received few therapeutic interventions
- Group 2: Many symptoms, including anxiety and depression, in patients who received several treatments, including antidepressants to psychological therapy
- Group 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 disturbances. The most severely affected patients had higher rates of disability, worse measures of anxiety, depression, fatigue, and sleep disturbances.
All patients whose treatment included psychiatric therapy reported improvement in symptoms, compared with 97% who received primarily physical or occupational therapy and 83% who received several interventions.
The Brookings Institution estimated in August 2022 that approximately 16 million working-age Americans (ages 18 to 65) have long-term illness from COVID, of which 2 to 4 million are out of work due to long-term COVID.
About this stress and the news about the research on COVID-19
Original research: Open access.
“Life stressors significantly affect long-term outcomes and post-acute symptoms 12 months after hospitalization for COVID-19” Jennifer A. Frontera et al. Journal of Neurological Sciences
“Post-acute consequences of COVID-19 symptom phenotypes and therapeutic strategies: a prospective, observational study” Jennifer A. Frontera et al. VERY ONE
Life stressors significantly affect long-term outcomes and post-acute symptoms 12 months after hospitalization for COVID-19
There are limited data assessing predictors of long-term outcomes after hospitalization for COVID-19.
We conducted a prospective, longitudinal cohort study of patients hospitalized for COVID-19. The following outcomes were collected 6 and 12 months after diagnosis: disability using the modified Rankin scale (mRS), activities of daily living assessed by the Barthel index, cognition assessed by the telephone-based Montreal Cognitive Assessment (t-MoCA), neuro-QoL batteries for anxiety, depression, fatigue and sleep and post-acute symptoms of COVID-19. Predictors of these outcomes, including demographics, pre-COVID-19 comorbidities, index metrics of COVID-19 hospitalizations, and life stressors, were assessed using multivariable logistic regression.
Of the 790 patients with COVID-19 who survived hospitalization, 451 (57%) completed the 6-month (N= 383) and/or 12 months (N= 242) follow-up, and 77/451 (17%) died between discharge and 12-month follow-up. Significant life stressors were reported in 121/239 (51%) at 12 months. In multivariable analyses, life stressors including financial insecurity, food insecurity, death by close contact, and new disability were the strongest independent predictors of deterioration in mRS, Barthel index, depression, fatigue and sleep scores, and long-term symptoms, with adjusted odds ratios ranging from 2.5 to 20.8. Other predictors of poor outcome included older age (associated with worse mRS, Barthel, t-MoCA, depression scores), initial disability (associated with worse mRS, fatigue, Barthel scores), female gender (associated with worse Barthel, anxiety scores), and severity index of COVID-19 (associated with worse Barthel index, prolonged symptoms).
Life stressors significantly contribute to worse functional, cognitive, and neuropsychiatric outcomes 12 months after hospitalization with COVID-19. Other predictors of poor outcome include older age, female sex, initial disability, and severity of the COVID-19 index.
Post-acute consequences of COVID-19 symptom phenotypes and therapeutic strategies: a prospective, observational study
Post-acute sequelae of COVID-19 (PASC) include a heterogeneous group of patients with variable symptomatology, who may respond to different therapeutic interventions. Identifying PASC phenotypes and therapeutic strategies for different subgroups would be a major step forward in treatment.
In a prospective cohort study of patients hospitalized with COVID-19, 12-month symptoms and quantitative outcome metrics were collected. Unsupervised hierarchical cluster analyzes were performed to identify patients with: (1) similar symptoms lasting ≥4 weeks after acute SARS-CoV-2 infection and (2) similar therapeutic interventions. Logistic regression analyzes were used to assess the association of these symptoms and therapy clusters with quantitative 12-month outcome measures (modified Rankin Scale, Barthel Index, NIH NeuroQoL).
Among 242 patients, 122 (50%) reported ≥1 PASC symptom (median 3, IQR 1–5) lasting a median of 12 months (range 1–15) after the diagnosis of COVID. Cluster analysis generated three groups of symptoms: Cluster 1 had several symptoms (most often headache); Cluster2 had many symptoms including high levels of anxiety and depression; and Cluster3 primarily included shortness of breath, headache, and cognitive symptoms. Cluster1 received several therapeutic interventions (OR 2.6, 95% CI 1.1-5.9), Cluster2 received several interventions, including antidepressants, anti-anxiety medications and psychological therapy (OR 15.7, 95% CI 4, 1-59.7), and Cluster3 primarily received physical and occupational therapy (OR 3.1, 95%CI 1.3–7.1). The most severely affected patients (Symptom Group 2) had higher rates of disability (worse modified Rankin scores), worse NeuroQoL measures of anxiety, depression, fatigue and sleep disturbances, and a greater number of stressors (all P<0.05). 100% of those who received a treatment strategy that included psychiatric therapy reported improvement in symptoms, compared with 97% who received primarily physical/occupational therapy and 83% who received several interventions (P = 0.042).
We identified three clinically relevant symptom-based phenotypes of PASCs, which received different therapeutic interventions with different response rates. This data can be helpful in tailoring individual treatment programs.