Long COVID may confer elevated psychological distress among young adults

In a recent article published in the Journal of Affective Disorders, researchers analyzed data from 44,652 United States (US) college students who completed a survey of the American College Health Association-National College Health Assessment III (ACHA NCHA) in the Spring of 2022 to assess whether post-acute sequelae of COVID-19 (PASC) elevated psychological distress in young adults. 

The study also assessed whether prior mental health diagnoses moderated this association. 

Study: Long COVID and psychological distress in young adults: Potential protective effect of a prior mental health diagnosis. Image Credit: RalfLiebhold/Shutterstock.com

Background

PASC, also known as long COVID, has affected ~16 million Americans aged 18 or older, of which 25% are out of work. Thus, public health advocates have labeled the coronavirus disease 2019 (COVID-19) pandemic as one of the mass disabling events in recent history.

The definition of PASC is still evolving; however, the World Health Organization (WHO) defines PASC as the persistence of long-term symptomatology for at least two months starting within three months of COVID-19 onset.

However, some of the effects of PASC on mental health are well-documented. Yet, research on PASC’s effects on well-being is limited. Given the associations between severe COVID-19 and confusion-, depression-, and anxiety-like mental health symptoms, it is critical to examine these associations in young adulthood when people typically have robust physical health but significant psychological vulnerability. 

Another important consideration is that if PASC exacerbates psychological concerns early in the lifespan, this might have substantial public health implications with long-term effects on the community’s well-being.

About the study

As previous research has suggested mental illness as a risk factor for PASC, researchers of the present study examined the relationship between PASC and psychological distress among young adults.

The analytic sample comprised 44,652 undergraduate students in the US aged 18 to 30 who responded to electronically administered surveys by ACHA-NCHA III in the Spring of 2022.

The team assessed measures, such as their COVID-19 history and PASC status, i.e., symptoms continuing for >four weeks post-COVID-19-onset.

They also ascertained if these students were ever diagnosed with any of the 35 relevant physical health conditions from 104 listed chronic health conditions, including mental health diagnosis. 

They used the Kessler Psychological Distress Scale to measure non-specific psychological distress among these students. Students meeting the threshold for all these conditions were assigned code 1, and the remaining were assigned code 0.

Based on previous research, the team selected many covariates, age, gender, race/ethnicity, body mass index (BMI), time spent in physical activity, health insurance status, COVID-19 vaccination status, symptom severity, whether they had lost a loved one to COVID-19 or COVID-19-related financial stress.

They dichotomized responses to all these assessments and assigned code 1 to students who responded with ‘yes’ and code 0 to the rest.

The researchers used multilevel binary logistic regression models to estimate the odds of meeting the clinical threshold for serious psychological distress in the past 30 days. 

Further, they did a moderation analysis to assess whether a previous mental health diagnosis moderated the likelihood of psychological distress as a function of PASC. First, they tested the effect of the interaction term. Next, if the interaction term was significant, the team decomposed it for subgroup analyses. 

Results

In the analytic sample of this study, the prevalence rate of acute COVID-19 was 44.4%, of which 26.4% had PASC. COVID-19-positive young adults were less likely to meet the clinical threshold for serious psychological distress, i.e., the need for further mental health screening, as surviving COVID-19 increased their feeling of relief and reduced the sense of risk.

The study results pointed toward the mental health associations of PASC. Thus, young adults with PASC were more likely to meet clinical criteria for serious psychological distress.

It is possible that functional limitations conferred by PASC heightened their psychological distress. It disenchanted young people that although they were less vulnerable to COVID-19, they developed long-term health complications.

Young adults with a prior mental health diagnosis were better equipped to manage distress associated with PASC. Thus, they better navigated the psychological distress daily. On the contrary, other young adults with no prior mental health issues found it difficult to manage these long-term effects of COVID-19, resulting in elevated distress. 

Conclusions

Further research should pursue the directionality of the association between PASC and psychological distress and assess its potential effect on PASC-related patient outcomes. Studies should also explore mechanisms linking psychological distress to PASC.

Young adults mourning the new loss of functionality due to PASC might benefit from mental health care focused on grief and identity reconstruction.

Most importantly, the study results could help initiate a discussion around the need for mental health screening in diagnosing PASC, especially symptom-based disorders, such as depression, anxiety, and post-traumatic stress disorder (PTSD).