Extremely stressful events worsen symptoms of long COVID

JThe death of a loved one, financial or food insecurity, or a newly developed disability were among the strongest predictors of whether a patient hospitalized with COVID-19 would experience COVID-long symptoms 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 fight depression, brain fog, fatigue, sleep problems and other long-term symptoms of COVID-19.

Published online this week in the Journal of Neurological Sciencesthe analysis also confirmed the contribution of traditional factors to greater long-term COVID risk, as shown in previous studies – older age, level of disability to begin with, and more severe initial case of COVID-19 .

“Our study is unique in that it explores the impact of life stressors, as well as demographic trends and neurological events, as predictors of long-term cognitive and functional impairments that affect the quality of lives of a large population,” says the study’s lead author, Jennifer A. Frontera, MD, a professor in the Department of Neurology at NYU Langone Health. “Therapies that lessen the trauma of the most stressful life events must be a central part of the treatment of long COVIDs, with more research needed to validate the best approaches.”

The research used standard telephone survey tools in the field – the Modified Rankin Scale (mRS), Barthel Index, Montreal Cognitive Assessment (t-MoCA) and National Institutes of Health (NIH )/Patient-Reported Outcomes Measurement Information System (PROMIS) Neurological Quality of Life (NeuroQoL) batteries – to measure level of daily functioning, clear thinking (cognition), anxiety, depression, fatigue and quality of sleep. The team attempted to follow each of the 790 patients 6 months and one year after hospitalization for 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 important factors stress at the time of consultation. 12 months.

In analyzes that compared factors against each other for their contribution to worst outcomes, life stressors including financial insecurity, food insecurity, death of a close contact, and new disability, were the strongest independent predictors of prolonged COVID-19 symptoms. These same stressors also 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 also played a role, as previous studies have shown that women are generally more susceptible to, for example, autoimmune diseases which could impact the results. Additionally, undiagnosed mood disorders may have been unmasked by pandemic-related stressors.

The long neurological COVID can include more than one condition

A second study led by Dr. Frontera and colleagues, and published online September 29, 2022, in PLOS ONEfound that patients diagnosed with long-lasting COVID neurological issues can be divided into three symptom clusters.

Because there is no current biological definition of long COVID, many studies lump together disparate symptoms into what is currently a general diagnosis, and without assessment of clinical relevance, Dr. Frontera says. The resulting vagueness has made it “difficult to assess treatment strategies”.

For the PLOS A study, the research team collected data on symptoms, treatments received, and outcomes for 12 months after hospitalization with COVID-19, with treatment success again measured by standard measures (modified Rankin Scale , Barthel Index, NIH NeuroQoL). The three newly identified disease groups were:

  • Group 1: few symptoms (most often headaches) having received few therapeutic interventions
  • Group 2: many symptoms including anxiety and depression who received multiple treatments, including antidepressants to psychological therapy
  • Group 3: mainly pulmonary symptoms such as shortness of breath; many patients also complained of headaches and cognitive symptoms, and mostly received physical therapy

The most severely affected patients (symptom group 2) had higher rates of disability and worse measures of anxiety, depression, fatigue and sleep disturbance. All patients whose treatment included psychiatric therapies reported improvement in symptoms, compared with 97% who received primarily physical or occupational therapy and 83% who received little intervention.

The Brookings Institution estimated in August 2022 that approximately 16 million Americans of working age (ages 18–65) have Long COVID, of which 2–4 million are out of work due to Long COVID.

With Dr Frontera, authors of the Journal of Neurological Sciences NYU Langone Health Department of Neurology study were Sakinah B. Sabadia, Ariane Lewis, Aaron S. Lord, Kara R. Melmed, Sujata P. Thawani, Laura J. Balcer, Thomas M. Wisniewski, and Steven L. Galetta. The authors were also Dixon Yang of the Department of Neurology at NewYork-Presbyterian, Columbia Medical Center; Adam de Havenon of the Department of Neurology at Yale University School of Medicine; and Shadi Yaghi from the Department of Neurology at Brown University School of Medicine.

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