People with COVID-like symptoms took up to nine months post-infection to regain mental well-being

New research finds that people with COVID-like symptoms returned to optimal physical well-being an average of three months after infection, but took up to nine months to return to top mental well-being.  Even one year after infection about 20% of study participants continued to experience overall suboptimal health-related quality of life (HRQoL).

The study, to be published June 10 in the peer-reviewed Open Forum Infectious Diseases, compared people who sought treatment for COVID-like symptoms, 75% of whom tested positive for the virus and the rest testing negative. The COVID-positive participants were statistically likelier to return to optimal health-related quality-of-life than their COVID-negative counterparts across up to a year post-infection, said Lauren Wisk, an assistant professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA and the study's co-lead author. This suggests that health authorities may have previously underestimated the long-term effects of other, non-COVID infections on one’s well-being,

"We have newly recognized the difference in recovery with respect to mental vs physical well-being after a COVID infection," Wisk said. "The findings showed that health care professionals need to pay more attention to their patients’ mental well-being after a COVID-19 infection and provide more resources that will help improve their mental health, in addition to their physical health."

The study was conducted under the umbrella of INSPIRE (Innovative Support for Patients with SARS-CoV-2 Infections Registry), a project funded by the U.S. Centers for Disease Control and Prevention (CDC). It comprised 4,700 participants who experienced COVID-like symptoms between December 11, 2020 and August 29, 2022, about 68% of whom were women.

The researchers examined responses from 1096 COVID-positive and 317 COVID-negative participants to questions regarding physical function, anxiety, depression, fatigue, social participation, sleep disturbance, pain interference and cognitive function. Four well-being categories emerged from their responses, the researchers write: optimal overall, poor mental, poor physical and poor overall health-related quality-of-life.

“In this large, geographically diverse study of individuals with 12 months of follow-up after COVID-19-like illness, a substantial proportion of participants continued to report poor HRQoL, whether or not the inciting acute symptoms were due to SARS-CoV-2 or another illness,” the researchers write. “The majority of the recovery in physical HRQoL was observed within 3 months after acute illness, whereas recovery in mental well-being appeared to be more gradual, with significant improvements manifesting more profoundly between 6 and 9 months after infection. Importantly for patient prognostics, we found somewhat more pronounced recovery (ie, return to the optimal HRQoL) for those in the COVID+ group compared to the COVID− groups, after adjustment.

“Regardless, approximately 1 in 5 respondents remained in the poor overall HRQoL group with a high likelihood of self-reporting long COVID up to 12 months after initial infection,” they write.

There are some limitations to the findings, suggesting the need for further research. Among them, the researchers may have been unable to capture all the differences among the study participants; it was unclear which conditions the symptomatic COVID-negative patients were suffering from; and COVID tests can yield both false-positive and -negative results.

"Future research should focus on how to improve the treatment models of care for patients who continue to experience COVID-19 symptoms and their impact on patients’ quality of life, especially as 1-in-5 patients may continue to suffer over a year after their initial infection, which likely reflects long COVID," Wisk said.

Study co-authors are Dr. Joann Elmore of UCLA, Dr. Michael Gottlieb and Dr. Robert Weinstein of Rush University, and others with the INSPIRE Group.

The study was funded by the Centers for Disease Control and Prevention and the National Center of Immunization and Respiratory Diseases (75D30120C08008).