Stress Plays Key Role in Developing Long COVID and Cognitive Symptoms

Madeleine Haase

April 15, 2022

The study covered in this summary was published in as a preprint and has not yet been peer reviewed.

Key Takeaways

  • The results from this study suggest that the experience of stress in the time preceding acute SARS-CoV-2 infection plays a key role in the development of long COVID, specifically in regard to problems involving cognition.

  • This study's findings point to the importance of mitigating worries and experiences of adversities during pandemics both to reduce their psychological impact and also to help reduce the societal burden of longer-term illness.

Why This Matters

  • Long COVID is increasingly recognized as a public health burden.

  • Long COVID often results in reduced productivity or an inability to work and places additional strain on other aspects of one's life.

  • Demographic and infection-related characteristics have been identified as risk factors, but less research has focused on psychosocial predictors, such as stress immediately preceding the index infection.

Study Design

  • Data from 1966 UK adults who had previously been infected with SARS-CoV-2 and who took part in the UCL COVID-19 Social Study were analyzed.

  • The number of adversity experiences and the number of worries about adversity experiences within the month prior to SARS-CoV-2 infection were used to predict the development of self-reported long COVID and the presence of three specific long-COVID symptoms: difficulty with mobility, cognition, and self-care.

  • The interaction between a three-level index of socioeconomic position (SEP) and the exposure variables in relation to long-COVID status was also examined.

  • The researchers controlled for a range of SARS-CoV-2 infection characteristics, sociodemographics, and health-related factors.

Key Results

  • Odds of self-reported long COVID increased by 1.25 (95% CI: 1.04 – 1.51) for each additional worry about adversity in the month prior to SARS-CoV-2 infection.

  • Individuals in the lowest SEP group were nearly twice as likely to have developed long COVID as those in the highest SEP group (odds ratio [OR]: 1.95; 95% CI: 1.19 – 3.19), and worries about adversity experiences remained a predictor of long COVID (OR: 1.43; 95% CI: 1.04 – 1.98).

  • The number of worries about adversity experiences also corresponded with increased odds of certain long-COVID symptoms, such as difficulty with cognition, by 1.46 (95% CI: 1.02 – 2.09) but not with mobility or self-care.


  • Systematic reviews have found that a large number of symptoms are associated with long COVID, but researchers assessed a limited number of long-COVID symptoms and did not ask explicitly about fatigue.

  • Owing to insufficient numbers, researchers were not able to include vaccination status at the time of infection as a covariate, which may decrease the likelihood of developing long COVID.

  • Participants were left to decide for themselves whether they believed themselves to have or to have had long COVID; only around 1 in 5 (19%) had been diagnosed.

  • The sample was insufficiently powered to detect the extent of difficulty participants had had with each of the three long-COVID symptoms.


  • The study was funded by the Nuffield Foundation, the MARCH Mental Health Network, which is funded by the Cross-Disciplinary Mental Health Network Plus initiative and is supported by UK Research and Innovation, and the Wellcome Trust.

  • The authors have disclosed no relevant financial relationships..

This is a summary of a preprint research study, "Does Pre-infection Stress Increase the Risk of Long COVID? Longitudinal Associations Between Adversity Worries and Experiences in the Month Prior to COVID-19 Infection and the Development of Long COVID and Specific Long COVID Symptoms," written by Elise Paul from the Department of Behavioral Science and Health, University College London, and colleagues and published on It was provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on

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