Gender differences in symptomatology, socio-demographic information and quality of life in Spanish population with long COVID condition: a cross-sectional study

Introduction: Long COVID patients experience a decrease in their quality of life due to the symptomatology produced by the disease. It is also important to understand how long COVID affects both men and women. The objective of this study is to examine the impact of long COVID symptomatology on the quality of life of Spanish adults from a gender perspective.

Methods: An observational and cross-sectional study was carried out. Participants were able to complete an online questionnaire using an online platform. A sample of 206 people participated in the study.

Results: The 80.6% of the sample were women with a mean age of 46.51 (±8.28) and the 19.4% were men with a mean age of 48.03 (±9.50). The medium score in the PAC19-QoL test was 141.47 (±24.96) and segmented by gender, 141.65 (±23.95) for women and 140.82 (±28.66) for men. The most common symptoms in women were muscle and joint pain (94.6%), fatigue (94.0%), discomfort (92.2%), difficulty concentrating (91.0%), and memory loss (88.6%). For men the symptoms included muscle and joint pain (97.5%) and fatigue (97.5%) both occupying first position, discomfort (92.0%), difficulty concentrating (90.0%), mood disturbances (90.0%), and memory loss (87.5%). The chi-square test showed statistical significance (p < 0.005) for socio-demographic information, quality of life scores, and long COVID symptoms by intensities.

Conclusion: This study shows that there are gender differences in the way that long COVID is experienced.

Introduction

The COVID-19 pandemic has had a global impact on various spheres of life worldwide (1). In addition to being a public health crisis and causing global economic disruption, this disease has had a significant impact on individual health (1, 2). Cases of incomplete recovery and persistence of symptoms months after the acute phase of the disease have been documented. This is a condition commonly referred to as long COVID (3, 4).

The World Health Organisation (WHO) has defined the term “long COVID” as the persistence of signs, symptoms, or abnormal clinical parameters persisting 3 months following the onset of COVID-19 (with or without a confirmed diagnosis) and with a duration of at least 2 months which cannot be explained by an alternative diagnosis (5). It is estimated that this disease affects 1 in 8 adults, or 12.7%, infected with COVID-19 (6, 7).

Long COVID can affect multiple organ systems and can include very heterogeneous symptoms (3, 8, 9). Although the exact cause of this disease is still not yet fully understood (3, 9, 10), the symptomatology has been well-studied. These more than 200 possible symptoms can be organized into categories such as general, respiratory, cardiac, neurological, psychological, otorhinological, ophthalmological, dermatological and digestive symptoms (3, 9, 11). Fatigue or asthenia, classified as general symptoms, has been reported as the most common symptomatology (3, 9, 11, 12). Other of the most prevalent symptoms reported have been respiratory and neurological symptoms (6, 11, 12). Although long COVID symptomatology has been studied, there is still very little information as regards its impact in terms of intensity (11, 12). Furthermore, long COVID seems to follow a pattern which points to the female gender in their 40s as the group most affected by this disease, however, there is a deficiency in knowledge as regards the differences between symptoms based on gender (3, 13, 14).

Several guidelines have been published on the treatment of long COVID, including rehabilitation and the use of drugs used in similar conditions such as fibromyalgia (10, 15). Additionally, clinical characterization of patients with the illness is essential to provide appropriate therapeutic options (4, 10). However, there is still a significant practical gap that needs to be addressed. Furthermore, to alleviate the burden on individuals with long COVID and the healthcare systems that support them, it is imperative to gain a better understanding of the pathogenesis, risk factors, symptoms and treatment methods of this condition (16).

The effects of an illness usually go beyond its clinical outcome such as mortality and morbidity and encompass the subjective plane in terms of poorer health-related quality of life (17, 18). This disease is known to affect the quality of life of those suffering from long COVID due to the frequency and the burden of persistent symptoms over time (19, 20). In certain circumstances, that situation can be extremely disabling. Unquestionably it is a public health issued that needs to be addressed (3). The importance of assessing the quality of life in people who suffer from this disease is crucial to finding solutions to this disease (3, 19). Emerging evidence suggests that these long-term symptoms have a negative impact on the health-related quality of life of afflicted patients and affect patients’ ability to function in everyday life, including their ability to work (21, 22). Whether persistent symptoms intensities impacts health-related quality of life and if it is differences per gender are still unclear (21, 23).

Currently, there are general validated instruments which assess the quality of life, including EQ-5D, SF-36, and SF-12, but there is likewise a specific tool, thus far, that specifically assesses the quality of life in people suffering from long COVID, the “PAC19-QoL”instrument (24). In addition to being validated in its original language, English, to the best of one’s knowledge, it has likewise been validated in other languages including Spanish (25), Slovak (26), and German (27).

Finally, the prognosis of this disease varies significantly among patients (28). Individual prognosis depends on several factors, including the severity of the initial infection, the presence of comorbidities, and the age and general health of the patient. Although there are currently limited studies on the prognosis and outcome of long COVID, further follow-up studies are necessary to determine the extent of the harm (29, 30).

Based on current knowledge to date, there have been no studies published which examine the impact of long COVID symptoms as regards the quality of life of these patients from a gender perspective. Therefore, the objective of this study is to examine the impact of long COVID symptomatology on the quality of life of Spanish adults from a gender perspective. The secondary objectives were (a) to analyse the influence of socio-demographic variables on quality of life and whether gender-related differences exist and (b) to assess how the intensity of the long COVID symptomatology influences quality of life and the role of gender.

Methods

Design

An observational and cross-sectional study was carried out with data collected using an online questionnaire to answer the research questions.

Participants and data collection

The study used convenience sampling to recruit adults suffering from long COVID in Spain. The researchers invited to participate individuals aged 18 years and above through various Spanish long COVID associations and social media. After receiving information about the study’s objectives and procedures of the study, all the interested participants completed the consent form and then, the online questionnaire via the provided link. Participants were also provided with the contact details (email and telephone number) of the research team to resolve any doubts or problems during the filling of the survey. Finally, 206 people participated in the study. The inclusion criteria were based on the following: to be age 18 and older, have had COVID-19 or suspicions due to compatible symptomatology, have or have had symptomatology over three or more months since the onset of COVID-19 infection, and be able to speak, read, and/or understand Spanish. Individuals with end-stage disease, institutionalization, intellectual disability, dementia, and language barriers were excluded. Participants completed the questionnaire in an online format in the SurveyMonkey online platform account of the University of Castilla-La Mancha between 20 June to 20 July 2022. Security protocols and protection of personal data were upheld.

Variables and measurement instruments

The variables obtained and the measurement instruments used in the questionnaire for each participant were as follows:

• Sociodemographic information: gender, age, weight, height, marital status, level of education, and dependency in the household.

• Clinical information: COVID-19 and long COVID symptomatology and habits such as drinking alcohol, smoking, sleep problems and comorbidities.

• PAC19-QoL Spanish tool. This questionnaire specifically assesses the quality of life in people with long COVID. This instrument has 5 domains (social, psychological, self-recognition, physical, and work) and 44 items. This enables estimating the impact of long-term COVID on the quality of life of affected patients. Scores range from 0 to 220, with higher scores indicating a lower quality of life.

Data analysis

The data analysis was performed using the version 28.0 of IBM SPSS statistical software. A descriptive analysis was carried out to provide a profile of participants in the study. For categorical variables, the sample characteristics and responses were presented as frequency and percentage. For continuous data, the variables were reported as mean and standard deviation and/or median/interquartile range. The Kolmmogorov-Smirnov test was used to verify the normality of the variables and the Levene test to verify the homogeneity of variance (Supplementary material). The relationship between sociodemographic characteristics, quartiles of quality of life and symptomatology was stablished using the Chi-Square test. The analysis was considered statistically significant at a p value ≤ 0.05.

Ethical considerations

The study protocol was registered and approved under number 2022/001 by the Clinical Research Ethics Committee from Hospital of Albacete. All research procedures used in this study were established as per the Declaration of Helsinki. All participants provided their consent to participate in the study after being duly information as regards the objectives and procedures.

Results

This study comprised 206 people with a mean age of 46.81 years (±8.53). Of the total participants 166 were women (80.6%) with a mean age of 46.51 (±8.28) and 40 were men (19.4%) with a mean age of 48.03 (±9.50). The sociodemographic data obtained are shown in Table 1.

Table 1

Table 1. Socio-demographic characteristics of the sample population.

To obtain the PAC19-QoL score, 45 questionnaires with unanswered items were considered missing dates. Therefore, 161 questionnaires were scored, 126 (78.3%) were from women, and 35 (21.7%) were from men. The average score in the test was 141.47 (±24.96) and segmented by gender, 141.65 (±23.95) for women and 140.82 (±28.66) for men. A ceiling or floor effect was absent, as any participants scored the minimum (0) or the maximum score (220). Quality of life was also calculated by percentiles. These were classified as 0 to 25th percentile high quality of life, 25th to 75th percentile moderate quality of life, and 75th to 100th percentile low quality of life (Figure 1).

Figure 1

Figure 1. Quality of life percentiles by gender.

Symptomatology did not follow a normal distribution. The five most common symptoms in female were muscle and joint pain (94.6%), fatigue (94.0%), discomfort (92.2%), difficulty concentrating (91.0%), and memory loss (88.6%). For men, the symptoms included muscle and joint pain (97.5%) and fatigue (97.5%) both occupying first position, discomfort (92.0%), difficulty concentrating (90.0%), mood disturbances (90.0%), and memory loss (87.5%). The frequency of long COVID symptomatology is shown in Table 2.

Table 2

Table 2. Frequency of long COVID symptoms of the sample population by per gender.

Insofar as symptomatology by intensities are concerned (Figure 2), the three strongest most prevalent symptoms in women were muscle and joint pain (62%), fatigue (61.4%), and concentration difficulties (54.8%). For male, there were fatigue (57.5%), muscle and joint pain (55.0%), and in the third same position were discomfort (47.5%), and mood disturbances (47.5%).

Figure 2

Figure 2. Intensity of long COVID symptoms by gender.

The Chi-square test with the socio-demographic information and the long COVID symptoms as per intensities with the quality-of-life scores of the participants was carried out. In terms of socio-demographic information and quality of life, women showed a p-value ≤ 0.05 for the dependency in the household (p = 0.045) and sleep problems (p = 0.025) variables. Men showed a p-value ≤ 0.05 for the overweight (p = 0.043), obesity (p = 0.032), married (p = 0.033), single (p = 0.033), primary education (p = 0.028), alcohol (p = 0.018), and sleep problems (p = 0.046) variables. In terms of intensity of symptomatology and quality of life, women showed a p-value ≤ 0.05 for all symptoms except for dyspnoea (p = 0.078), cough (p = 0.109), skin rashes (p = 0.104), and conjunctivitis (p = 0.090). For men, only taste loss showed a significant p-value (p = 0.007). For both genders, severe symptom modality was related closely to poorer quality of life score.

Table 3 shows the chi-square test to relate the intensity of the long COVID symptoms and the socio-demographic data. Women showed p-value ≤ 0.05 in the BMI category and the fatigue (p = 0.046) and diarrhea (p = 0.021) symptoms; in the marital status category and the diarrhea (p = 0.036), olfactory loss (p = 0.026) and difficulty swallowing (p = 0.002) symptoms; in the dependency in the household category and the memory loss (p = 0.001); in the education category and the diarrhea (p = 0.011) symptoms; in the alcohol category and the dyspnoea (p = 0.006) symptom; in the sleep problems category and the fatigue (p = 0.001), difficulty concentrating (p = 0.028), memory loss (p = 0.003), palpitations (p = 0.028), cough (p = 0.005), and difficulty swallowing (p = 0.031) symptoms. Men showed p-value ≤ 0.05 in the category education and the skin rashes (p = 0.036) and conjunctivitis (p = 0.046) symptoms; the tobacco category and the cough (p = 0.046) symptom; the alcohol category and the discomfort (p = 0.023) symptom; the sleep problems category and the difficulty concentrating (p = 0.004), and memory loss (p = 0.012) symptoms. Distributions and chi-square test of socio-demographic variables and long COVID symptomatology data based on intensity per gender are shown in Tables 4, 5.

Table 3

Table 3. Intensity of long COVID symptoms association with sociodemographic variables per gender.

Table 4

Table 4. Distribution of women data of socio-demographic and long COVID symptomatology variables based on intensity.

Table 5

Table 5. Distribution of men data of socio-demographic and long COVID symptomatology variables based on intensity.

Discussion

The main objective of this study was to examine the impact of long COVID symptomatology on the quality of life of Spanish adults from a gender perspective. Socio-demographic variables and intensity of the long COVID symptoms were significantly related with the quality-of-life scores obtained. Likewise, significant differences per gender were identified.

The findings suggest that long COVID is more prevalent in females. Several studies on individuals with long COVID condition have found that over half of the sample population is female, which is consistent with the results of our cross-sectional study (13, 31, 32). In addition, this trend is also consistent with the average age of those affected, which is around 40 years old. These findings align with the results previously reported in other studies on the subject (13, 33, 34).

Other similarities related with the more prevalent symptoms were compared with the findings obtained by Anaya et al. (35) and Aiyegbusi et al. (36) in which are fatigue and muscle and joint pain are the most common symptoms. In terms of quality of life, this element was reported to be affected by the disease in other studies (20, 37). Quality of life of long COVID patients was measured from different perspectives in two studies. The quantitative study (20), using generic quality of life scales as EQ-5D-5L, and the qualitative study (37). Although different methodologies were used, both concluded that long COVID influences the quality of life of those with the disease hindering same. It is important to note that, although they are distinct entities, long COVID shares some similarities in terms of symptoms and challenges in diagnosis and treatment with other conditions, such as fibromyalgia (15, 38, 39). Furthermore, studies have also shown that long COVID, fibromyalgia and chronic fatigue syndrome are more prevalent among females (40, 41).

Analyzing gender in health has proven to be crucial due to the differences between men and women (42). These gender differences occur not only in acute but similarly in chronic diseases (42, 43). In this regard, the study has likewise demonstrated differences between both genders in relation to long COVID symptomatology. Male participants in the study were not only more likely to have mood disturbances the female participants but similarly experienced that symptom more acutely than the latter. This can be explained by the fact that age plays a role on resilience, with middle-aged women being more resilient than men (44, 45). As a matter of fact low resilience has been shown to be related to the development of mood disorders (46). Nevertheless, more studies are required to analyse resilience in chronic diseases from a gender perspective.

In terms of quality of life, this study showed statistically significant relationship between the presence of a dependent person in the household and the female gender. Women in nurturing roles often experience a decrease in their quality of life as compared to men. These disparities are due to a number of socio-cultural and economic factors that have been comprehensively discussed in academic literature (47, 48). These factors have a substantial impact on women’s quality of life, as women assume an unequal burden of care responsibilities in the domestic sphere as compared to their male counterparts (48–50).

Another key point of the findings is that women had a higher number of symptoms which were closely related to a lower quality of life. Although it is important to take into account that pain perception is a complex and multifactorial phenomenon, certain studies suggest that women may have a greater sensitivity to pain as compared to men (51, 52). Furthermore, women are known to have a higher prevalence of chronic pain conditions, such as fibromyalgia (51, 53). Coupled with pain, whether chronic, acute or disease-related, can have a significant negative impact on a person’s quality of life (54).

It is likewise remarkable how sleep problems affect not only the symptoms but also the intensity with which these are experienced in both genders. Sleep plays a crucial role in a person’s health and well-being, and sleep deprivation can weaken the body and worsen the symptoms of a disease. In regard to this, being in pain likewise hinders the possibility of having good quality sleep (55). Sleep deprivation can increase stress levels and reduce pain tolerance (56). This fact can exacerbate the symptoms of an illness, especially if this entails chronic pain (55). Continuing with that series of factors which produces a more intense symptomatology, smoking was identified to be a condition that exacerbated long COVID symptomatology. These findings are consistent with those of a study carried out on patients with fibromyalgia which concluded that tobacco was closely related to more severe symptomatology (57).

Elsewhere, this study identified that both men and women who had a dependent in the household were more likely to have a household dependency experienced less severe symptoms of their illnesses than those who did not have this condition at home. The Hamptom & Newcomb study (58) has demonstrated that informal caregivers may have reduced perception of pain due to psychological factors such as an increased ability to handle stress. Furthermore, another important finding of the study as regards the intensity of symptomatology was that for both genders non-drinkers experienced the most intense symptoms. Although the reasons for this are unclear, the findings are consistent with the Kim et al. (59) study which concluded that low and moderate alcohol consumption is associated with a decrease in fibromyalgia symptoms.

Strengths and limitations

Insofar as the limitation of the present study are concerned, the following were identified. Firstly, the inherent factors of the disease hindered data collection. The cognitive problems associated with long COVID disease including difficulty concentrating and mental fogginess, was prejudicial to the sample numbers as many participants started the questionnaire but dropped out halfway through. Even so, participation was facilitated to the extent practicable by sending notifications as regards the status of the questionnaires and reminders to complete same. Secondly, research has been undertaken from a cross-sectional perspective. A follow-up study yield further information as regards the people participating in that study and the behavior of the disease over time. Likewise, causal relationships could be obtained. Moreover, studies with a higher sample and homogeneous number of men and women should be carried out. Nevertheless, difficulties may be experienced in this homogeneity as this disease seems to affect more women (3, 33, 34). Furthermore, other studies have likewise had more women in the sample (33, 34, 60). It is also important to note that factors as specifying the wave of the pandemic and the variant of the COVID-19 virus, may impact the symptoms of the disease and should therefore, be included in future studies. Finally, it should be noted as a strong point of this study is that it is the first of its kind to take into account the intensities of symptomatology and gender differences, which is of fundamental importance in health science research.

Conclusion

The findings of this research show that there are gender differences in the way that long COVID is experienced. The most acute symptoms experienced by females are muscle and joint pain, fatigue, and concentration difficulties. In males, the most acute symptoms are fatigue, muscle and joint pain, discomfort, and mood disturbances. Undertaking a gender-sensitive study is important because it helps to understand and address gender inequalities and promote gender equality. The findings suggest future lines of research to design more effective, specific, and personalized care for this emerging disease. Furthermore, longitudinal studies should be carried out to explore the risk factors closely related to long COVID and its relationship to quality of life. Finally, exploring differences in the experience of this disease between different groups of people, such as different ethnic groups or people with pre-existing conditions, should likewise be carried out.

Data availability statement

The datasets presented in this article are not readily available because the database is part of a cohort study. Requests to access the datasets should be directed to MM-A, maria.martinezandres@uclm.es.

Ethics statement

The studies involving humans were approved by the Clinical Research Ethics Committee from Hospital of Albacete (number 2022/001). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

Author contributions

IM-T: Writing – original draft, Writing – review & editing, Conceptualization, Formal analysis, Methodology. MM-C: Writing – original draft, Writing – review & editing, Conceptualization, Methodology. BN-P: Writing – original draft, Writing – review & editing, Formal analysis, Methodology, Resources. ME-L: Writing – original draft, Writing – review & editing. NM-C: Writing – original draft, Writing – review & editing. MM-A: Writing – original draft, Writing – review & editing, Conceptualization, Funding acquisition, Methodology, Resources, Supervision.

Funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was funded by the Provincial Council of Albacete (file number 33492).

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpubh.2024.1355973/full#supplementary-material

References

1. The Lancet Respiratory Medicine . Long COVID: confronting a growing public health crisis. Lancet Respir Med. (2023) 11:663. doi: 10.1016/S2213-2600(23)00268-0

Crossref Full Text | Google Scholar

2. Jassat, W, Reyes, LF, Munblit, D, Caoili, J, Bozza, F, Hashmi, M, et al. Long COVID in low-income and middle-income countries: the hidden public health crisis. Lancet 30 de septiembre de. (2023) 402:1115–7. doi: 10.1016/S0140-6736(23)01685-9

PubMed Abstract | Crossref Full Text | Google Scholar

3. Rodriguez, Ledo P. Guía clínica para la atención al paciente long covid/covid persistente. (2021); Available at: https://policycommons.net/artifacts/1692997/guia-clinica-para-la-atencion-al-paciente-long-covidcovid-persistente/2424645/ (Accessed October 4, 2023).

Google Scholar

4. Crook, H, Raza, S, Nowell, J, Young, M, and Edison, P. Long covid—mechanisms, risk factors, and management. BMJ. (2021) 374:n1648. doi: 10.1136/bmj.n1648

PubMed Abstract | Crossref Full Text | Google Scholar

5. World Health Organisation . A clinical case definition of post COVID-19 condition by a Delphi consensus (2021). Available at: https://www.who.int/publications-detail-redirect/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1 (Accessed October 4, 2023).

Google Scholar

6. Ballering, AV, van Zon, S, Olde Hartman, TC, and Rosmalen, JGMLifelines Corona Research Initiative. Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study. Lancet. (2022) 400:452–61. doi: 10.1016/S0140-6736(22)01214-4

PubMed Abstract | Crossref Full Text | Google Scholar

7. SPF . L’affection post-COVID-19 (appelée aussi COVID long) en France. (2022). Available at:https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-et-infections-respiratoires/infection-a-coronavirus/documents/enquetes-etudes/l-affection-post-covid-19-appelee-aussi-covid-long-en-france.-point-au-21-juillet-2022 (Accessed October 4, 2023).

Google Scholar

8. Lai, CC, Hsu, CK, Yen, MY, Lee, PI, Ko, WC, and Hsueh, PR. Long COVID: an inevitable sequela of SARS-CoV-2 infection. J Microbiol Immunol Infect. (2023) 56:1–9. doi: 10.1016/j.jmii.2022.10.003

PubMed Abstract | Crossref Full Text | Google Scholar

9. Akbarialiabad, H, Taghrir, MH, Abdollahi, A, Ghahramani, N, Kumar, M, Paydar, S, et al. Long COVID, a comprehensive systematic scoping review. Infection. (2021) 49:1163–86. doi: 10.1007/s15010-021-01666-x

PubMed Abstract | Crossref Full Text | Google Scholar

10. Yong, SJ . Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments. Scand J Infect Dis. (2021) 53:737–54. doi: 10.1080/23744235.2021.1924397

PubMed Abstract | Crossref Full Text | Google Scholar

11. López-Sampalo, A, Bernal-López, MR, and Gómez-Huelgas, R. Síndrome de COVID-19 persistente. Una revisión narrativa. Rev Clin Esp. (2022) 222:241–50. doi: 10.1016/j.rce.2021.10.003

PubMed Abstract | Crossref Full Text | Google Scholar

12. Lopez-Leon, S, Wegman-Ostrosky, T, Perelman, C, Sepulveda, R, Rebolledo, PA, Cuapio, A, et al. More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. MedRxiv. (2021) 30:2021.01.27.21250617. doi: 10.1101/2021.01.27.21250617

Crossref Full Text | Google Scholar

13. Bai, F, Tomasoni, D, Falcinella, C, Barbanotti, D, Castoldi, R, Mulè, G, et al. Female gender is associated with long COVID syndrome: a prospective cohort study. Clin Microbiol Infect. (2022) 28:611.e9–611.e16. doi: 10.1016/j.cmi.2021.11.002

Crossref Full Text | Google Scholar

14. Pelà, G, Goldoni, M, Solinas, E, Cavalli, C, Tagliaferri, S, Ranzieri, S, et al. Sex-related differences in long-COVID-19 syndrome. J Women's Health. (2002) 31:620–30. doi: 10.1089/jwh.2021.0411

Crossref Full Text | Google Scholar

15. Scaturro, D, Vitagliani, F, Di Bella, VE, Falco, V, Tomasello, S, Lauricella, L, et al. The role of acetyl-carnitine and rehabilitation in the Management of Patients with post-COVID syndrome: case-control study. Appl Sci. (2022) 12:4084. doi: 10.3390/app12084084

Crossref Full Text | Google Scholar

16. Koc, HC, Xiao, J, Liu, W, Li, Y, and Chen, G. Long COVID and its management. Int J Biol Sci. (2022) 18:4768–80. doi: 10.7150/ijbs.75056

PubMed Abstract | Crossref Full Text | Google Scholar

17. Poudel, AN, Zhu, S, Cooper, N, Roderick, P, Alwan, N, Tarrant, C, et al. Impact of Covid-19 on health-related quality of life of patients: A structured review. PLoS One. (2021) 16:e0259164. doi: 10.1371/journal.pone.0259164

Crossref Full Text | Google Scholar

18. Guo, L, Lin, J, Ying, W, Zheng, C, Tao, L, Ying, B, et al. Correlation study of short-term mental health in patients discharged after coronavirus disease 2019 (COVID-19) infection without comorbidities: a prospective study. Neuropsychiatr Dis Treat. (2020) 16:2661–7. doi: 10.2147/NDT.S278245

PubMed Abstract | Crossref Full Text | Google Scholar

19. Fischer, A, Zhang, L, Elbéji, A, Wilmes, P, Oustric, P, Staub, T, et al. Long COVID symptomatology after 12 months and its impact on quality of life according to initial coronavirus disease 2019 disease severity. Open Forum Infect Dis. (2022) 9:ofac397. doi: 10.1093/ofid/ofac397

PubMed Abstract | Crossref Full Text | Google Scholar

20. Malik, P, Patel, K, Pinto, C, Jaiswal, R, Tirupathi, R, Pillai, S, et al. Post-acute COVID-19 syndrome (PCS) and health-related quality of life (HRQoL)-a systematic review and meta-analysis. J Med Virol. (2022) 94:253–62. doi: 10.1002/jmv.27309

PubMed Abstract | Crossref Full Text | Google Scholar

21. Brus, IM, Spronk, I, Haagsma, JA, de Groot, A, Tieleman, P, Biere-Rafi, S, et al. The prolonged impact of COVID-19 on symptoms, health-related quality of life, fatigue and mental well-being: a cross-sectional study. Front Epidemiol. (2023) 3:1144707. doi: 10.3389/fepid.2023.1144707

Crossref Full Text | Google Scholar

22. Davis, HE, Assaf, GS, McCorkell, L, Wei, H, Low, RJ, Re'em, Y, et al. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine. (2021) 38:101019. doi: 10.1016/j.eclinm.2021.101019

PubMed Abstract | Crossref Full Text | Google Scholar

23. Munblit, D, Nicholson, TR, Needham, DM, Seylanova, N, Parr, C, Chen, J, et al. Studying the post-COVID-19 condition: research challenges, strategies, and importance of Core outcome set development. BMC Med. (2022) 20:50. doi: 10.1186/s12916-021-02222-y

PubMed Abstract | Crossref Full Text | Google Scholar

24. Jandhyala, R . Design, validation and implementation of the post-acute (long) COVID-19 quality of life (PAC-19QoL) instrument. Health Qual Life Outcomes. (2021) 19:229. doi: 10.1186/s12955-021-01862-1

PubMed Abstract | Crossref Full Text | Google Scholar

25. Marcilla-Toribio, I, Martinez-Andres, M, Moratalla-Cebrian, ML, Jandhyala, R, Femi-Ajao, O, and Galan-Moya, EM. Adaptation and validation of the PAC-19QoL-specific quality of life questionnaire for the Spanish population with long COVID. Curr Med Res Opin. (2023) 39:1685–93. doi: 10.1080/03007995.2023.2256222

Crossref Full Text | Google Scholar

26. Ulbrichtova, R, Vysehradsky, P, Bencova, A, Tatarkova, M, Osina, O, Svihrova, V, et al. Validation of the Slovakian version of the “post‑acute (long) COVID‑19 quality of life instrument” and pilot study. Patient Prefer Adherence. (2023) 17:1137–42. doi: 10.2147/PPA.S404377

PubMed Abstract | Crossref Full Text | Google Scholar

27. Umakanthan, S, Monice, M, Mehboob, S, Jones, CL, and Lawrence, S. Post-acute (long) COVID-19 quality of life: validation of the German version of (PAC19QoL) instrument. Front Public Health. (2023) 11, 11:1163360. doi: 10.3389/fpubh.2023.1163360

PubMed Abstract | Crossref Full Text | Google Scholar

28. Fernández-de-las-Peñas, C, Palacios-Ceña, D, Gómez-Mayordomo, V, Cuadrado, ML, and Florencio, LL. Defining post-COVID symptoms (post-acute COVID, long COVID, persistent post-COVID): an integrative classification. Int J Environ Res Public Health. (2021) 18:2621. doi: 10.3390/ijerph18052621

PubMed Abstract | Crossref Full Text | Google Scholar

29. Du, Y, Zhang, J, Wu, LJ, Zhang, Q, and Wang, YX. The epidemiology, diagnosis and prognosis of long-COVID. Biomed Environ Sci. (2022) 35:1133–9. doi: 10.3967/bes2022.143

PubMed Abstract | Crossref Full Text | Google Scholar

30. Baroni, C, Potito, J, Perticone, ME, Orausclio, P, and Luna, CM. How does long-COVID impact prognosis and the long-term sequelae? Viruses. (2023) 15:1173. doi: 10.3390/v15051173

PubMed Abstract | Crossref Full Text | Google Scholar

31. Mateu, L, Tebe, C, Loste, C, Santos, JR, Lladós, G, López, C, et al. Determinants of the onset and prognosis of the post-COVID-19 condition: A 2-year prospective observational cohort study. Lancet Reg Health Eur. 33:100724. doi: 10.1016/j.lanepe.2023.100724

Crossref Full Text | Google Scholar

32. Rodríguez-Pérez, MP, Sánchez-Herrera-Baeza, P, Rodríguez-Ledo, P, Huertas-Hoyas, E, Fernández-Gómez, G, Montes-Montes, R, et al. Influence of clinical and sociodemographic variables on health-related quality of life in the adult population with long COVID. J Clin Med. (2023) 12:4222. doi: 10.3390/jcm12134222

PubMed Abstract | Crossref Full Text | Google Scholar

33. Taquet, M, Dercon, Q, Luciano, S, Geddes, JR, Husain, M, and Harrison, PJ. Incidence, co-occurrence, and evolution of long-COVID features: a 6-month retrospective cohort study of 273,618 survivors of COVID-19. PLoS Med. (2021) 18:e1003773. doi: 10.1371/journal.pmed.1003773

PubMed Abstract | Crossref Full Text | Google Scholar

34. Perlis, RH, Santillana, M, Ognyanova, K, Safarpour, A, Lunz Trujillo, K, Simonson, MD, et al. Prevalence and correlates of long COVID symptoms among US adults. JAMA Netw Open. (2022) 5:e2238804. doi: 10.1001/jamanetworkopen.2022.38804

PubMed Abstract | Crossref Full Text | Google Scholar

35. Anaya, JM, Rojas, M, Salinas, ML, Rodríguez, Y, Roa, G, Lozano, M, et al. Post-COVID syndrome. A case series and comprehensive review. Autoimmun Rev. (2021) 20:102947. doi: 10.1016/j.autrev.2021.102947

PubMed Abstract | Crossref Full Text | Google Scholar

36. Aiyegbusi, OL, Hughes, SE, Turner, G, Rivera, SC, McMullan, C, Chandan, JS, et al. Symptoms, complications and management of long COVID: a review. J R Soc Med. (2021) 114:428–42. doi: 10.1177/01410768211032850

PubMed Abstract | Crossref Full Text | Google Scholar

37. Tíscar-González, V, Sánchez-Gómez, S, Lafuente Martínez, A, Peña Serrano, A, Twose López, M, Díaz Alonso, S, et al. Vivencias e impacto en la calidad de vida de personas con COVID persistente. Gac Sanit. (2023) 37:102247. doi: 10.1016/j.gaceta.2022.102247

PubMed Abstract | Crossref Full Text | Google Scholar

38. Mariette, X . Long COVID: a new word for naming fibromyalgia? Ann Rheum Dis. (2024) 83:12–4. doi: 10.1136/ard-2023-224848

PubMed Abstract | Crossref Full Text | Google Scholar

39. Colas, C, Le Berre, Y, Fanget, M, Savall, A, Killian, M, Goujon, I, et al. Physical activity in long COVID: a comparative study of exercise rehabilitation benefits in patients with long COVID, coronary artery disease and fibromyalgia. Int J Environ Res Public Health. (2023) 20:6513. doi: 10.3390/ijerph20156513

PubMed Abstract | Crossref Full Text | Google Scholar

40. Faro, M, Sàez-Francás, N, Castro-Marrero, J, Aliste, L, Fernández de Sevilla, T, and Alegre, J. Gender differences in chronic fatigue syndrome. Reumatol Clín. (2016) 12:72–7. doi: 10.1016/j.reuma.2015.05.007

Crossref Full Text | Google Scholar

41. Segura-Jiménez, V, Estévez-López, F, Soriano-Maldonado, A, Álvarez-Gallardo, IC, Delgado-Fernández, M, Ruiz, JR, et al. Gender differences in symptoms, health-related quality of life, sleep quality, mental health, cognitive performance, pain-cognition, and positive health in Spanish fibromyalgia individuals: the Al-Ándalus project. Pain Res Manag. (2016) 2016:5135176–14. doi: 10.1155/2016/5135176

PubMed Abstract | Crossref Full Text | Google Scholar

42. IRIS PAHO . Incorporar la perspectiva de género en la equidad en la salud: un análisis de la investigación y las políticas. Washington: Pan American Health Organization (2005). 53 p.

Google Scholar

43. Rohlfs, I, Borrell, C, Anitua, C, Artazcoz, L, Colomer, C, Escribá, V, et al. La importancia de la perspectiva de género en las encuestas de salud. Gac Sanit. (2000) 14:146–55. doi: 10.1016/S0213-9111(00)71448-8

PubMed Abstract | Crossref Full Text | Google Scholar

44. Gínez-Silva, MJ, Astorga, CM, and Urchaga-Litago, JD. Resiliencia psicológica a través de la edad y el sexo. Rev INFAD Psicol Int J Dev Educ Psychol. (2019) 4:85–94. doi: 10.17060/ijodaep.2019.n1.v4.1513

Crossref Full Text | Google Scholar

45. González-Arratia López Fuentes, NI, and Valdez Medina, JL. Resiliencia: Diferencias por Edad en Hombres y Mujeres Mexicanos. Acta Investig Psicol - Psychol Res Rec. (2013) 3:941–55. doi: 10.1016/S2007-4719(13)70944-X

Crossref Full Text | Google Scholar

46. Imran, A, Tariq, S, Kapczinski, F, and Cardoso, TA. Psychological resilience and mood disorders: a systematic review and meta-analysis. Trends Psychiatry Psychother. (2022) 1–37. doi: 10.47626/2237-6089-2022-0524

PubMed Abstract | Crossref Full Text | Google Scholar

47. Informe, CS . Salud y Género 2022. [Internet] Fundadeps (2023) Available at: https://fundadeps.org/recursos/informe-salud-y-genero-2022/.

Google Scholar

48. Del Río, LM, García-Calvente, MDM, Calle-Romero, J, Machón-Sobrado, M, and Larrañaga-Padilla, I. Health-related quality of life in Spanish informal caregivers: gender differences and support received. Qual Life Res. (2017) 26:3227–38. doi: 10.1007/s11136-017-1678-2

Crossref Full Text | Google Scholar

49. Cascella Carbó, GF, García-Orellán, R, and Cascella Carbó, GF, García-Orellán R. Sobrecarga y desigualdades de género en el cuidado informal. Investig Educ En Enferm [Internet]. (2020) 38. Available at: http://www.scielo.org.co/scielo.php?script=sci_abstract&pid=S0120-53072020000100010&lng=en&nrm=iso&tlng=es (Accessed November 7, 2023).

Google Scholar

50. Sanjuán-Quiles, Á, Alcañiz-Garrán M del MMontejano-Lozoya, R, Ramos-Pichardo, JD, and García-Sanjuán, S. La perspectiva de las personas cuidadoras desde un análisis de género. Rev Esp Salud Pública. (2023) 97:e202307062.

Google Scholar

51. Osborne, NR, and Davis, KD. Sex and gender differences in pain. Int Rev Neurobiol. (2022) 164:277–307. doi: 10.1016/bs.irn.2022.06.013

Crossref Full Text | Google Scholar

52. Fillingim, RB, King, CD, Ribeiro-Dasilva, MC, Rahim-Williams, B, and Riley, JL. Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain. (2009) 10:447–85. doi: 10.1016/j.jpain.2008.12.001

PubMed Abstract | Crossref Full Text | Google Scholar

53. Ruschak, I, Montesó-Curto, P, Rosselló, L, Martín, CA, Sánchez-Montesó, L, and Toussaint, L. Fibromyalgia syndrome pain in men and women: a scoping review. Healthcare Basel. 11:223. doi: 10.3390/healthcare11020223

Crossref Full Text | Google Scholar

54. Gatchel, RJ, Peng, YB, Peters, ML, Fuchs, PN, and Turk, DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. (2007) 133:581–624. doi: 10.1037/0033-2909.133.4.581

PubMed Abstract | Crossref Full Text | Google Scholar

55. Keskindag, B, and Karaaziz, M. The association between pain and sleep in fibromyalgia. Saudi Med J. (2017) 38:465–75. doi: 10.15537/smj.2017.5.17864

PubMed Abstract | Crossref Full Text | Google Scholar

56. Goldstein, AN, and Walker, MP. The role of sleep in emotional brain function. Annu Rev Clin Psychol. (2014) 10:679–708. doi: 10.1146/annurev-clinpsy-032813-153716

PubMed Abstract | Crossref Full Text | Google Scholar

57. Weingarten, TN, Podduturu, VR, Hooten, WM, Thompson, JM, Luedtke, CA, and Oh, TH. Impact of tobacco use in patients presenting to a multidisciplinary outpatient treatment program for fibromyalgia. Clin J Pain. (2009) 25:39–43. doi: 10.1097/AJP.0b013e31817d105e

PubMed Abstract | Crossref Full Text | Google Scholar

58. Hampton, MM, and Newcomb, P. Self-efficacy and stress among informal caregivers of individuals at end of life. J Hosp Palliat Nurs. (2018) 20:471–7. doi: 10.1097/NJH.0000000000000464

Crossref Full Text | Google Scholar

59. Kim, CH, Vincent, A, Clauw, DJ, Luedtke, CA, Thompson, JM, Schneekloth, TD, et al. Association between alcohol consumption and symptom severity and quality of life in patients with fibromyalgia. Arthritis Res Ther. (2013) 15:R42. doi: 10.1186/ar4200

PubMed Abstract | Crossref Full Text | Google Scholar

60. Mandal, S, Barnett, J, Brill, SE, Brown, JS, Denneny, EK, Hare, SS, et al. “long-COVID”: a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalisation for COVID-19. Thorax. (2021) 76:396–8. doi: 10.1136/thoraxjnl-2020-215818

PubMed Abstract | Crossref Full Text | Google Scholar