There’s a strong link between psychological distress and long COVID, new Harvard study shows

“The takeaway is that, like with a lot of other physical health outcomes, mental health is really important."

A woman holds boxes of rapid COVID-19 tests in Los Angeles in March. Alisha Jucevic/The New York Times

Psychological distress, like anxiety and depression, increases people’s chance of experiencing long COVID, a new study from researchers at the Harvard T.H. Chan School of Public Health shows.

The increased risk of long COVID came independently of other risk factors like a history of smoking or asthma. However, psychological distress led to a larger increased risk of long COVID than many physical health risk factors.

“The thing that was surprising was that these associations were stronger than with things like obesity or asthma or diabetes,” Andrea Roberts, a senior author on the study, told  


To Roberts, a senior research scientist in the Department of Environmental Health at the Chan School, this study is another call to health professionals to consider mental health in conjunction with physical health, not as some separate entity. 

“The takeaway is that, like with a lot of other physical health outcomes, mental health is really important. And it has been historically ignored, not so much in the past couple decades but it is really pretty recent that people have been paying serious attention,” Roberts said. “Your brain sits in your body. It’s not separate.”

Mental health has only recently made it into the medical curriculum, Roberts said, and some traditionally trained doctors have a tendency of dismissing mental health concerns. 

“Our brain also is not just doing our thinking for us. It does a ton of other stuff that’s intimately connected with our body,” Roberts said. 


The study had 54,960 participants, pulled from already existing research cohorts. Researchers started looking at this topic in a more general sense, Roberts said. It was clear early on to experts that the pandemic would have widespread mental health effects, she said, so researchers added questions about psychological distress to other questionnaires. Data collection started in April 2020. 


“They were asked a bunch of questions about their current life situation and living arrangements, and a bunch of questions about their mental health and well being including the ones we looked at here: anxiety, depression, stress, loneliness, and specifically how worried they were about COVID,” Roberts said. “Then they were followed for about a year and they answered questions intermittently.”

Any participants who suspected they had COVID early in the pandemic, when testing wasn’t widely available, weren’t considered, Roberts said. Instead, researchers focused on people who reported signs of psychological distress at the start of the pandemic and then later tested positive. 

“They were asked at the end of the year, ‘Did you have COVID symptoms lasting more than a month? Did they last more than two months? Do you still have them? What symptoms are they and are they affecting your ability to do your daily life activities?’” Roberts said. 

Once data collection was well underway, things got interesting. Long COVID appeared on the scene and it stood out to Roberts. 

“It struck me that the symptoms of long COVID were sort of overlapping with other, frankly poorly understood things like chronic Lyme [disease] and fibromyalgia, chronic fatigue syndrome,” Roberts said. “I just thought these [syndromes] are very related to mental health … so I thought, ‘Well, maybe this is too.’”


And the data agreed — researchers determined that people with distress before a COVID-19 infection had a 32-46% increased risk of long COVID. People with probable anxiety had a 42% increased risk and those with probable depression had a 32% increased risk.

These levels of increased risk are higher than the risks associated with conditions like diabetes, asthma, and cancer (clocking in at 12, 18, and 6% increased risks respectively).

The researchers looked deeper than that and saw that not only are people with psychological distress more likely to develop long COVID, they are also more likely to be impared in their daily lives by it. 

“To us it raises the question of whether making sure people are in good mental health — which is not so straightforward, but to the extent that we can — whether that might help some of the physical symptoms of long COVID,” Roberts said. 

There is still much that is unknown about long COVID, and Roberts said she hopes further exploration can lead to answers about how to address the effects of the condition. 

“I think what we really want to know is what the physical mechanisms are, because ultimately, the stuff is embodied,” Roberts said. “Step one is, ‘It’s happening.’ Step two is, ‘Why is it happening?’ Step three is, ‘Let’s stop it from happening.’”

The study was published on JAMA Psychiatry Sept. 7.


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