Researchers from NYU Grossman School of Medicine led a study that found that adult patients with “major life stressors”, present in more than 50 per cent of those followed, were at least twice as likely to struggle with depression, brain fog, fatigue, sleep problems, and other long-term Covid-19 symptoms.
Published online in the Journal of the Neurological Sciences (JNS), the analysis 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.
"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 the quality of life in a large population," says lead study author Jennifer A. Frontera, MD, professor in the Department of Neurology at NYU Langone Health. "Therapies that lessen 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.”
The research used standard telephone survey tools in the field -- the modified Rankin Scale (mRS), the Barthel Index, the Montreal Cognitive Assessment (t-MoCA), and the NIH/PROMIS Neurological Quality Of Life (NeuroQoL) batteries -- to measure the level of daily function, clear thinking (cognition), anxiety, depression, fatigue and sleep quality. The team attempted follow-up with each of the 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%) completed 6-month and/or 12-month follow-ups, 17% died between discharge and 12-month follow-ups and 51% reported significant life stressors at 12 months.
In analyses that compared factors against each other for their contribution to worse outcomes, life stressors including financial insecurity, food insecurity, death of 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.
Gender was also a contributor, as past studies have found that women are more susceptible in general too, for instance, autoimmune diseases that could have an impact on outcomes. Additionally, undiagnosed mood disorders may have been unmasked by pandemic-related stressors.