Older women with a history of anxiety and depressive symptoms were significantly more likely to develop long COVID than those without such symptoms, according to a large prospective analysis published this week in Menopause.
A University of California (UC)–led research team followed up on 18,820 postmenopausal participants in the Women’s Health Initiative who completed assessments of mental illness symptoms over nearly three decades and reported COVID symptoms, testing results, and compliance with COVID-19 safety measures in 2020 and 2021. The average participant age was 83 years.
Depression, anxiety confer 78% higher odds of long COVID
Overall, 1,501 women (8.0%) reported a positive COVID test. Among the 1,008 women with sufficient follow-up data to assess long-COVID symptoms, 414 (41.0%) met the study’s definition of long COVID, which was the persistence of at least one symptom, such as fatigue, cough, shortness of breath, cognitive difficulties, or sleep disruptions, for more than two months after infection.
A history of depressive or anxiety symptoms was not associated with higher odds of testing positive for COVID. But women who reported mental illness symptoms before the pandemic had significantly higher odds of developing long COVID. Compared with women reporting neither condition, women with both clinically significant depressive symptoms and self-reported anxiety symptoms had 78% higher odds of long COVID.
Mental illness symptoms were also associated with lower adherence to COVID mitigation behaviors. Women with both depression and anxiety were more likely to report no use of preventive measures such as masking and physical distancing and were less likely to report using three or more mitigation strategies. Women with self-reported anxiety symptoms were slightly more likely to comply with mitigation measures.
“These findings suggest that having a history of both depressive symptoms and anxiety symptoms may be more likely associated with long COVID than having a history of either depressive or anxiety symptoms,” write the authors. “This indicates a higher risk and severity of mental illnesses predicting long COVID.”
Immune system dysfunction may play a role
Poor compliance with public health guidelines may not fully explain why those with mental illnesses are at increased risk for long COVID, note the authors. Specific biological mechanisms may contribute. “The immune system has been shown to play a role in psychiatric illnesses,” they write. “Therefore, those with mental illnesses are likely to have aberrant immunity, possibly making them more vulnerable to long COVID.
At the same time, the findings underscore how people experiencing mental illnesses may have trouble following public health guidelines and be more susceptible to COVID and other diseases.
“We hope that by characterizing these mental health risk factors public health officials and policymakers can target preventative measures to those with the greatest need,” coauthor William Bruno, MD, MPH, associate physician in the Department of Emergency Medicine at the UC San Diego School of Medicine, said in a university news release.
