Association of SARS-CoV-2 With Health-related Quality of Life 1 Year After Illness Using Latent Transition Analysis, 2025, Wisk

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Journal Article

Association of SARS-CoV-2 With Health-related Quality of Life 1 Year After Illness Using Latent Transition Analysis ​

Lauren E Wisk , Michael Gottlieb , Peizheng Chen , Huihui Yu , Kelli N O’Laughlin , Kari A Stephens , Graham Nichol , Juan Carlos C Montoy , Robert M Rodriguez , Michelle Santangelo , Kristyn Gatling , Erica S Spatz , Arjun K Venkatesh , Kristin L Rising , Mandy J Hill , Ryan Huebinger , Ahamed H Idris , Michael Willis , Efrat Kean , Samuel A McDonald , Joann G Elmore , Robert A Weinstein for the INSPIRE Group
Author Notes
Open Forum Infectious Diseases, Volume 12, Issue 6, June 2025, ofaf278, https://doi.org/10.1093/ofid/ofaf278
Published:

10 June 2025

Abstract​

Background

Long-term sequelae after SARS-CoV-2 infection may impact health-related quality-of-life (HRQoL), yet it is unknown how HRQoL changes during recovery. We compared patient-reported HRQoL among adults with COVID-19–like illness who tested SARS-CoV-2 positive (COVID+) with those who tested negative (COVID−).

Methods

Participants in this prospective, multicenter, longitudinal registry study were enrolled from December 2020 through August 2022 and completed 3-month follow-up assessments until 12 months after enrollment. Participants were adults (≥18 years) with acute symptoms suggestive of COVID-19 who received a Food and Drug Administration–approved SARS-CoV-2 test. Participants received questions from PROMIS-29 (subscales: physical function, anxiety, depression, fatigue, social participation, sleep disturbance, and pain interference) and PROMIS SF-8a (cognitive function). Latent transition analysis was used to identify meaningful patterns in HRQoL scores over time; 4 HRQoL categories were compared descriptively and using multivariable regression. Inverse probability weighting was used to adjust for covariate imbalance.

Results

There were 1096 (75%) COVID+ and 371 (25%) COVID−. Four distinct well-being classes emerged: optimal overall, poor mental, poor physical, and poor overall HRQoL. COVID+ participants were more likely to return to the optimal HRQoL class compared to COVID− participants. The most substantial transition from poor physical to optimal HRQoL occurred by 3 months, whereas movement from poor mental to optimal HRQoL occurred by 9 months.

Conclusions

In adults with COVID-19–like illness, COVID+ participants demonstrated meaningful recovery in their physical HRQoL by 3 months after infection, but mental HRQoL took longer to improve. Suboptimal HRQoL at 3 to 12 months after infection remained in approximately 20%.

Trial Registration
NCT04610515.
COVID-19, health-related quality of life, prospective cohort study, SARS-CoV-2
 
www.eurekalert.org

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

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. One year after infection about 20% of study participants continued to experience overall suboptimal health-related...
www.eurekalert.org

News Release 10-Jun-2025

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

Physical well-being, by contrast, returned after three months; up to 20% of patients continued experiencing suboptimal overall health-related quality of life one year after infection

Peer-Reviewed Publication
University of California - Los Angeles Health Sciences


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).

Journal​

Open Forum Infectious Diseases

Method of Research​

Observational study

Subject of Research​

People

Article Title​

Association of SARS-CoV-2 With Health-related Quality of Life 1 Year After Illness Using Latent Transition Analysis

Article Publication Date​

10-Jun-2025
 
This other study was part of INSPIRE:

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome After SARS-CoV-2 Infection

Wyva

Thread 'Myalgic Encephalomyelitis/Chronic Fatigue Syndrome After SARS-CoV-2 Infection, 2024, Unger et al'

Key Points

Question Does prevalence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)–like illness differ between individuals with an acute infection–like index illness who are COVID-19 positive or negative?

Findings In this cohort study of 4378 participants, the weighted prevalence of ME/CFS-like illness was 4.5% or less at 3 to 12 months after the index illness in the COVID-19–positive and COVID-19–negative groups, with no significant differences in odds of ME/CFS-like illness.

Meaning The findings suggest that ME/CFS-like illness following an...
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The sample sizes look different so I'm not sure how much overlap there is but I haven't compared the two at all.
 
I fear this is going to be used to claim that covid is no worse than whatever other bugs are going around so we shouldn’t care about it, even though the findings are that people can be affected by infections for a long time, so we should probably try to prevent all of them to a higher degree that what we do today.
 
Seems to be an awful lot of uncertainty in this study - selection biases, lack of clarity around diagnoses and pre-existing conditions.. . I'm not sure there is much of use that can be taken away from it.

To support the latent transition analysis, we included all participants who completed all assessments during the first 12 months of follow-up (conducted every 3 months after the baseline assessment); see flow diagram (Figure 1).
Click to expand...
6044 were eligible for inclusion, but only some 1700 completed all the assessments, and other things like missing data reduced the numbers down to 1467 (Figure 1).

Table 1 gives the details at baseline for the 1467, reporting that 733 tested positive to Covid and 734 tested negative.

But the results section says
The study sample included 1096 (75%) COVID+ and 371 (25%) COVID− participants
Click to expand...

Turns out, Table 1 has 'weighted data'. The numbers of participants has been adjusted to give equal numbers in each Covid status group. That seems like an odd thing to do, making it harder to check the analysis.
 
Poor mental HRQoL was characterized by poor scores for anxiety, depression, cognitive function, and fatigue (57.3 ± 5.9, 53.6 ± 6.1, 45.2 ± 7.8, and 54.3 ± 5.5 at baseline, respectively).
Click to expand...

Oh, for goodness sake. I suspected the definition of mental health might be dodgy, and so it proved to be. Cognitive function and fatigue are mixed up with anxiety and depression.

(Edit - actually they seem to have divided patient up into four groups, with the 'poor mental HRQoL' being characterised by anxiety, depression, fatigue and lowered cognitive function)
 
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Merged

Many COVID patients needed 9 months to regain baseline well-being study suggests

Open Forum Infectious Diseases:

Abstract​

Background
Long-term sequelae after SARS-CoV-2 infection may impact health-related quality-of-life (HRQoL), yet it is unknown how HRQoL changes during recovery. We compared patient-reported HRQoL among adults with COVID-19–like illness who tested SARS-CoV-2 positive (COVID+) with those who tested negative (COVID−).
Methods
Participants in this prospective, multicenter, longitudinal registry study were enrolled from December 2020 through August 2022 and completed 3-month follow-up assessments until 12 months after enrollment. Participants were adults (≥18 years) with acute symptoms suggestive of COVID-19 who received a Food and Drug Administration–approved SARS-CoV-2 test. Participants received questions from PROMIS-29 (subscales: physical function, anxiety, depression, fatigue, social participation, sleep disturbance, and pain interference) and PROMIS SF-8a (cognitive function). Latent transition analysis was used to identify meaningful patterns in HRQoL scores over time; 4 HRQoL categories were compared descriptively and using multivariable regression. Inverse probability weighting was used to adjust for covariate imbalance.
Results
There were 1096 (75%) COVID+ and 371 (25%) COVID−. Four distinct well-being classes emerged: optimal overall, poor mental, poor physical, and poor overall HRQoL. COVID+ participants were more likely to return to the optimal HRQoL class compared to COVID− participants. The most substantial transition from poor physical to optimal HRQoL occurred by 3 months, whereas movement from poor mental to optimal HRQoL occurred by 9 months.
Conclusions
In adults with COVID-19–like illness, COVID+ participants demonstrated meaningful recovery in their physical HRQoL by 3 months after infection, but mental HRQoL took longer to improve. Suboptimal HRQoL at 3 to 12 months after infection remained in approximately 20%.
Click to expand...
 
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The nine month recovery mark is interesting. It took 9 months as predicted by the endocrinologist to recover from my sudden viral onset in 1991. All symptoms were gone, but I didn't recover, I relapsed soon after I returned to work.

I fully recovered from Covid in 6 months.
 
From the abstract:

Background:

"...We compared patient-reported HRQoL among adults with COVID-19–like illness who tested SARS-CoV-2 positive (COVID+) with those who tested negative (COVID−)..."

Results:
"...COVID+ participants were more likely to return to the optimal HRQoL class compared to COVID− participants..."

Now I am confused. If that is what the study authors found shouldn't they say earlier in the abstract whether / how the outcomes of participants that tested negative for Covid differed in the beginning from the Covid+ group and how that related to the other time points?

And why don't they mention the differences for both groups in the conclusion?


Edited for clarity
 
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