There were few risk factors for COVID-19 symptoms that continued for ≥4 weeks. For a study, researchers sought to ascertain if high levels of psychological distress, including depression, anxiety, concern, perceived stress, and loneliness, before SARS-CoV-2 infection were prospectively linked to a higher likelihood of acquiring post-COVID-19 disorders (sometimes called long COVID).

The Growing Up Today Research, Nurses’ Health Study II, and Nurses’ Health Study 3 were the 3 major continuing, predominately female cohorts that provided the data for the prospective cohort study. Periodic surveys were used to check in with participants between April 2020 and November 2021. At the baseline survey in April 2020, when distress was evaluated, participants were considered if they reported having no current or former SARS-CoV-2 infection and responded to one or more follow-up surveys. During each of the 6 monthly and subsequently quarterly follow-up surveys, SARS-CoV-2 infection was self-reported. On the final questionnaire, administered one year after baseline, participants self-reported COVID-19-related symptoms lasting four weeks or longer and daily life impairment resulting from these symptoms.

Over 96.6% (n = 53,107) of the 54,960 participants were female, and 38.0% (n = 20,902) were active healthcare professionals. The mean (SD) age was 57.5 (13.8) years. During follow-up, 6% of participants (3,193) reported a positive SARS-CoV-2 test result (1-47 weeks after baseline). In generalized estimating equation models adjusted for sociodemographic factors, health behaviors, and comorbid conditions, probable depression (risk ratio [RR], 1.32; 95% CI = 1.12-1.55), probable anxiety (risk ratio [RR], 1.42; 95% CI, 1.23-1.65), worry about COVID-19 (RR, 1.37; 95% CI, 1.17-1.61), perceived stress (highest vs. lowest quartile: RR., 1.46; 95% 1.18-1.81), and loneliness (RR, 1.32; 95% CI, 1.08-1.61) were each associated with post–COVID-19 conditions (1,403 cases) in generalized estimating equation models adjusted for sociodemographic factors, health behaviors, and comorbidities. Participants were almost 50% more likely to develop post-COVID-19 symptoms (RR range, 1.15-1.51) if they had experienced two or more categories of distress before infection (RR, 1.49; 95% CI, 1.23-1.80). Among those with post-COVID-19 symptoms, all categories of distress were linked to an elevated likelihood of daily living impairment (783 instances).

The study’s results implied that psychological distress before infection might be a risk factor for post-COVID-19 problems in those with SARS-CoV-2 infection. The biobehavioral mechanism connecting psychological distress with enduring postinfection symptoms should be studied in further research.