Severe stressful events can exacerbate symptoms of prolonged COVID (COVID sequelae)

A new study has found that death of a loved one, financial or food insecurity, or new disability are the strongest predictors
of prolonged COVID-19 symptoms in people hospitalized with COVID-19 one year later.

The study, led by researchers at New York University's Grossman School of Medicine, found that adult patients with this "primary life stressor" — which was present in more than 50 percent of follow-up patients — were at least twice as likely as other patients to struggle with depression, brain fog, fatigue, sleep problems and other long-term COVID-19 symptoms
, the authors said.

The analysis, published this week in the online edition of the Journal of Neuroscience (JNS), also confirms the impact of traditional factors on a greater risk of long-term COVID, as past studies have shown — older age, degree of disability, and severity
of first COVID-19 cases.

"Our study is unique in that it explores the effects of life stressors — as well as demographic trends — as predictors of long-term cognitive and functional disability that affects the quality of life of large populations," said
lead study author Jennifer A.
Frontera, M.
D.
, professor in the Department of Neurology at NYU Langone School of Health.
"Therapies that reduce trauma from the most stressful life events need to be a central part of prolonged COVID treatment, and more research is needed to validate the best approach
.
"

The study used standard telephone survey tools in the field—the modified Rankine Scale (mRS), the Battle Index, the Montreal Cognitive Assessment (t-MoCA), and the NIH/PROMIS NeuroQuality of Life (NeuroQoL) battery—to measure levels of daily functioning, clear thinking (cognitive), anxiety, depression, fatigue, and sleep quality
.
Between March 10, 2020 and May 20, 2020, the team attempted to follow
up each of the 790 patients at NYU Langone Medical Center who were hospitalized for 6 months and 1 year after COVID-19.

Of these surviving patients, 451 (57%) completed 6- and/or 12-month follow-up, of which 17% died during discharge and 12-month follow-up, and 51% reported significant life stress
at 12 months.

In an analysis comparing the interaction of factors leading to worse outcomes, life stressors including economic insecurity, food insecurity, death of close contacts, and new disability were the strongest independent predictors
of prolonged COVID-19 symptoms.
These same stressors were also the most predictable of worse functional status, depression, fatigue, sleep scores, and decreased
ability to participate in activities of daily living, such as eating, dressing, and bathing.

Gender is also a factor, as past studies have found that, in general, women are more susceptible to autoimmune diseases that can have an impact
on outcomes, for example.
In addition, undiagnosed mood disorders may be masked
by pandemic-related stressors.

Long COVID may include more than one situation

A second study, led by Frantra and colleagues, published online in PLoS Comprehensive on September 29, 2022, found that patients diagnosed with long-term COVID neurological problems could be divided into three symptom groups
.

Because there is currently no biological definition of long coronary, many studies have grouped different symptoms into the current comprehensive diagnosis without assessing
clinical relevance, Frantela said.
The resulting ambiguity makes it "difficult to evaluate treatment strategies.
"

In the PLoS Comprehensive study, the research team collected data on symptoms, treatments received, and outcomes 12 months after hospitalization with COVID-19, and again measured treatment success
with standard indicators (modified Rankine scale, Bartel index, NIH neuromass index).
The three newly identified categories of diseases are:

• Group 1: Few symptoms (most commonly headache) and few therapeutic interventions

• Group 2: Many symptoms, including anxiety and depression, received multiple treatments, including psychotherapy with antidepressant medications

• Group 3: Major pulmonary symptoms such as shortness
  of breath.
  Many patients also complain of headaches and cognitive symptoms, and most have received physical therapy
  .
  

The most affected patients (symptom group 2) had higher rates of disability and more severe anxiety, depression, fatigue, and sleep disturbances
.
The most affected patients have higher rates of disability and more severe levels of anxiety, depression, fatigue and sleep
disturbances.
All patients receiving psychiatric treatment reported improvement in symptoms, compared with 97% of those receiving primary physical or occupational therapy and 83%
receiving little intervention.

The Brookings Institution estimated in August 2022 that about 16 million working-age Americans (ages 18 to 65) have prolonged COVID, with 2 million to 4 million losing their jobs
due to prolonged COVID.

In addition to Frontera, authors of the JNS study from the Department of Neurology at NYU Langone School of Health include Sakinah Sabadia, Ariane Lewis, Aaron Lord, MD; Carla Melmid, Sugata Tavani, Laura Balsey; Thomas Wisniewski and Steven Galetta
.
The study was also written by Dixon Yang of the Department of Neurology at Columbia Medical Center of the Presbyterian Church in New York; Adam de Havenon, Department of Neurology, Yale School of Medicine; and Shadi Yaghi
in the Department of Neurology at Brown University School of Medicine.