Anxiety, depression, and fear after coronavirus disease 2019 infection and their association with long coronavirus disease symptoms

Ayaka Saito¹Shiro Otake¹Keiko Ohgino^1*Shogyoku Bun²Yu Mimura²Daisuke Ito³Naoki Miyazaki⁴Kengo Nagashima⁴Hideki Terai¹Shotaro Chubachi¹Katsunori Masaki¹Jun Miyata¹Ichiro Kawada¹Ho Namkoong⁵Mizuha Hashiguchi⁶Junko Kagyo⁶Tetsuya Shiomi⁶Keita Masuzawa⁷Takanori Asakura¹Sohei Nakayama⁷Yusuke Suzuki⁷Naoto Minematsu⁸Tadashi Manabe⁹Takahiro Fukui⁹Yohei Funatsu⁹Hidefumi Koh⁹Koichi Fukunaga¹

• ¹Division of Pulmonary Medicine, Keio University School of Medicine, Tokyo, Japan., Tokyo, Japan
• ²Keio Gijuku Daigaku Igakubu Daigakuin Igaku Kenkyuka Seishin Shinkei Kagaku Kyoshitsu, Shinjuku, Japan
• ³Keio Gijuku Daigaku Igakubu Daigakuin Igaku Kenkyuka Shinkei Naika, Shinjuku, Japan
• ⁴Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan., Tokyo, Japan
• ⁵Keio Gijuku Daigaku Igakubu Daigakuin Igaku Kenkyuka Kansenshogaku, Shinjuku, Japan
• ⁶Department of Internal Medicine, Keiyu Hospital, Kanagawa, Japan., kanagawa, Japan
• ⁷Department of Respiratory Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan., Tokyo, Japan
• ⁸Hino Shiritsu Byoin, Hino, Japan
• ⁹Tachikawa Byoin, Tachikawa, Japan

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has had widespread physical and psychological repercussions. Additionally, long COVID symptoms such as fatigue, dyspnea, and cognitive impairment have been well-documented; however, their associations with mental health symptoms remain unclear. This study investigated the relationships between long COVID and symptoms of anxiety, depression, and COVID-19-related fear using validated psychological assessment tools. Methods: This nationwide, prospective cohort study enrolled 1,066 individuals who recovered from COVID-19. The participants completed self-report questionnaires at 3, 6, and 12 months after diagnosis. Long COVID symptoms and psychological status were assessed using the Hospital Anxiety and Depression Scale (HADS) and Fear of COVID-19 Scale (FCV-19S). Statistical analyses were used to examine associations between long COVID symptoms and psychological scores while accounting for clinicodemographic factors. Results: Three months after diagnosis, 20.1% of the participants exhibited high anxiety (HADS-Anxiety [A] score ≥ 8), 23.6% had high depression (HADS-Depression [D] score ≥ 8), and 35.3% reported high levels of COVID-19-related fear (FCV-19S score ≥ 21). High HADS-A and HADS-D scores were significantly associated with younger age, female sex, and mild initial illness severity. Individuals with high HADS scores reported significantly greater long COVID symptoms; headaches and fatigue were associated with high anxiety scores and impaired concentration was associated with high depression scores. Conclusions: This study highlighted the significant associations between mental health symptoms and long COVID, emphasizing the need for integrated psychological support in post-COVID care. Addressing anxiety, depression, and fear-related concerns may contribute to improved management of long COVID symptoms and enhance overall patient well-being.