Do the mental health symptoms of Long-Covid indicate ‘the chicken or the egg’?

Study complicates the relationship between the psychological and physical presentations of Long-Covid with thought-provoking implications for the assessment and treatment of the condition.

Covid-19 has almost become synonymous with the enduring society-wide mental health crisis precipitated by, and pre-dating, the pandemic. In particular, the multisystem, post-infection and recovery disease of Long-Covid has become associated with the hard-to-source malaise of emotional turbulence experienced by millions over the last couple of years due to the condition’s multiple reported cognitive and emotional symptoms. In fact, treating the month- or even years-long presentations of Long-Covid has been identified as a significant factor in future planning by the NHS, as the health authority has estimated that the number of people living with self-reported Long-Covid has grown from 700,000 in June 2021 to 1.6 million in June 2022 in England alone.

However, the conclusions of a new study conducted by Harvard T.H. Chan School of Public Health have complicated the assumed aetiology of the condition’s psychological symptoms, causing scientists to re-consider whether the multiple mental health presentations of Long-Covid are caused by the initial viral infection and subsequent recovery process or effectually pre-date the illness.

How should professionals assess and treat the psychological symptoms associated with Long-Covid?

The study of more than 54,000 people asked participants in April 2020 about their psychological distress prior to contracting Covid-19, and then the following year surveyed the 3,000 participants who had recovered from an infection about their experience of symptoms and any long-term duration.

In analysing the responses and comparing those who developed Long-Covid to those who did not, researchers were able to determine that prior emotional distress before infection, including depression, anxiety, worry, perceived stress, and loneliness, was associated with a 32%-46% increased risk of Long-Covid. In addition to an associated 15-51% greater risk of reported daily impairment due to the condition.

The lead researcher Dr Siwen Wang, Department of Nutrition at Harvard Chan School, said the team were “surprised by how strongly psychological distress before a Covid-19 infection was associated with an increased risk of Long-Covid”.

She added:

“Distress was more strongly associated with developing Long-Covid than physical health risk factors such as obesity, asthma, and hypertension.”

The causational relationship between psychological and physical symptoms is well documented. Mental health is known by clinicians to affect the prognosis and outcomes of diseases; for instance, during the first months of the pandemic, mental ill-health was shown to be intimately connected to a greater risk of acute Covid-19 hospitalisation. Nevertheless, undoubtedly, the outcomes of the Harvard T.H. Chan School study pose multiple significant questions for mental health professionals as to the future assessment and treatment of the source of the psychological and physical symptoms reportedly linked to Long-Covid.