Prevalence of depression, anxiety, fatigue, and headache before and after long COVID onset: a case–control study in … Region Stockholm, 2025,Lindblom+

[Chandelier]

Prevalence of depression, anxiety, fatigue, and headache before and after long COVID onset: a case–control study in the total population of Region Stockholm

Spoiler: Authors

Lindblom, Sebastian; Lindberg, Pia; Ljunggren, Gunnar; Lee, Seika; Kisiel, Marta A.; Kolosenko, Iryna; Petrovic, Predrag; Sklivanioti Greenfield, Myrto; Wachtler, Caroline; Fedorowski, Artur; Wheelock, Åsa M.; Carlsson, Axel C.

Abstract​

Background​

Post-acute sequelae of SARS-CoV-2 infection, or long COVID, include diverse symptoms and remain a major concern worldwide.
This study investigates the occurrence of depression, anxiety, fatigue, and headache 1 year prior to the COVID-19 pandemic (2019), 12 months prior to, and 6 months after long COVID diagnosis in individuals diagnosed with long COVID and matched population-based controls.

Methods​

This case–control study included nonhospitalized individuals diagnosed with long COVID compared with controls without long COVID, matched by age, sex, and neighborhood socioeconomic status.
Data were collected from the Stockholm Regional Health Care Data Warehouse (VAL), including diagnoses in 2019, 12 months before, and 6 months after the long COVID diagnosis.
Conditional logistic regression was used to calculate odds (OR) ratios and 99% confidence intervals (CI).

Results​

A total of 5589 cases (mean age: 47 years, 69% female) and 47,561 controls were included. Individuals with long COVID had a higher pre-pandemic frequency of the following diagnoses: depression (women: OR 1.57 (1.26–1.97), men: OR 1.40 (0.88–2.23)), anxiety (women: OR 1.65 (1.41–1.93), men: OR 2.10 (1.56–2.84)), fatigue syndrome after viral infection (women: OR1.96 (0.86–4.48), men: OR 2.22 (0.29–17)), and headache (women: OR 2.45 (1.96–3.05), men: OR 2.89 (1.86–4.50)).
Individuals with long COVID also had a higher frequency of these diagnoses 12 months before and 6 months after the long COVID diagnosis was made, regardless of sex.

Conclusions​

Individuals with long COVID had a higher prevalence of depression, anxiety, fatigue, and headache both before and after being diagnosed with long COVID compared with controls without long COVID.
The findings suggest an association between mental health vulnerabilities and long COVID, while the frequency of registered mental health diagnoses remained largely similar after the long COVID diagnosis.

Web | DOI | PDF | BMC Medicine

 

[SNT Gatchaman]

Our findings indicate that the mental health burden in both sexes who later develop long COVID was already elevated before the pandemic in 2019, remained elevated 12 months prior to diagnosis, and continued 6 months after the long COVID diagnosis, compared with matched controls unaffected by long COVID

Our study showed that fatigue syndrome after viral infection and headache exhibited the strongest associations across all time points in both sexes. While the odds ratio for fatigue syndrome after viral infection declined 6-month post-diagnosis in women, and for headache in men, both conditions remained significantly elevated compared to pre-pandemic levels.

Compared to pre-pandemic levels, we observed a significant increase in the occurrence of fatigue syndrome following viral infection during the 12 months before, i.e., after the presumed COVID-19 infection, and 6 months after a long COVID diagnosis. Interestingly, this trend differed by sex: in women, the odds ratios for fatigue syndrome after viral infection decreased 6-month post-long COVID diagnosis, whereas in men they increased.

Individuals with ME/CFS and dysautonomia are frequently assigned psychiatric diagnoses prior to receiving their current diagnosis, reflecting the diagnostic uncertainty and the complexity involved in distinguishing between these conditions in clinical practice.

Many standard mental health screening instruments, such as anxiety and depression scales, incorporate physiological symptoms that overlap with autonomic dysfunction and post-viral fatigue. For instance, tachycardia, a common feature of dysautonomia, can contribute to inflated scores on anxiety scales, while profound fatigue, a hallmark of ME/CFS and long COVID, may be misinterpreted as a symptom of depression.

The failure to account for these overlaps can lead to overestimations of mental health diagnoses in long COVID. Further, it has also been debated whether there is a functional component in long COVID, but our data can neither confirm nor refute this hypothesis. These multidirectional considerations emphasize the need for a nuanced approach in distinguishing between physiological and psychiatric components of long COVID, ensuring that patients receive appropriate and targeted care.

 

[Utsikt]

Huh, that’s the first time I’ve seen someone call out how bad the questionnaires are.

 

[rvallee]

Huh, that’s the first time I’ve seen someone call out how bad the questionnaires are.

And not just that but interpret things in a more or less coherent and cogent fashion. That's... odd. Although they still go for the traditional conclusions:

Individuals with long COVID had a higher prevalence of depression, anxiety, fatigue, and headache both before and after being diagnosed with long COVID compared with controls without long COVID.

But, no, they don't. For all the reasons they laid out in the quotes above. The questionnaires for those concepts aren't about those concepts, they ask overlapping questions and ultimately function about the same way as almost every webmd search ends up at cancer, because of all the overlapping symptoms.

It's mostly showing how the concept of mental health doesn't really mean much in real life. It's not just the questionnaires, it's the concepts that are bad. The questionnaires only reflect those bad ideas, but they are not the problem by themselves. Things are basically as chaotic as concepts such as liberty in politics, with various groups and individuals and their myriad ways to interpret those concepts. For all the work done on mental health in the last century, things really have not progressed at all, everything is completely static.

These multidirectional considerations emphasize the need for a nuanced approach in distinguishing between physiological and psychiatric components of long COVID, ensuring that patients receive appropriate and targeted care.

What's especially annoying is that the quacks also say this, but for opposite reasons. So, good and bad both sound reasonable to someone who knows very little about this. Or somewhat knows, or even knows a lot.

Because right now no one is getting appropriate or targeted care. At best it may not be harmful, but it's never appropriate or targeted. The whole thing is firmly stuck in its pre-science state.

 

[Kalliope]

Cidrap: COVID patients have higher rates of depression, anxiety, headache, and fatigue before diagnosis, study suggests

quote:

The study authors emphasize that higher rates of depression, anxiety, headache, and fatigue before COVID infection don’t imply that they cause post-COVID symptoms. Instead, they propose that shared biological pathways such as chronic inflammation, neuroinflammation, autonomic dysfunction, and immune responses, may explain the association between pre- and post-diagnosis symptom burden. Psychosocial factors may also play a role.

COVID patients have higher rates of depression, anxiety, headache, and fatigue before diagnosis, study suggests

www.cidrap.umn.edu

 

[rvallee]

Psychosocial factors may also play a role.

It's odd that they put this there because if there's one thing that has been made clear out of Long Covid, it's that, no, not at all, they are entirely irrelevant and can be safely ignored, it's not as if anyone could do anything about it even if they were relevant.

The infection is the trigger point, everything derives from it, the rest matters exactly as much as moon phases and wherever Mercury is at any given moment. It's so annoying that it still has to be put there because of decades of reflexive "eh, could be, whatever".

 

[Sean]

It's odd that they put this there because if there's one thing that has been made clear out of Long Covid, it's that, no, not at all, they are entirely irrelevant and can be safely ignored, it's not as if anyone could do anything about it even if they were relevant.

Not entirely.

As primary causal factors, they have no demonstrated role, despite endless and often quite dishonest attempt to portray them as having.

But as secondary exacerbating factors, they are definitely a thing. Meaning misdiagnosis, mistreatment, and the poverty and despair, etc, etc, etc, that comes with all that. That is, factors that have nothing to do with the disease process itself. The completely unnecessary and avoidable ones.

Which is the part of psychosocial that the psychosocial advocates do everything they can to avoid recognising and taking into proper account.

 

[rvallee]

But as secondary exacerbating factors, they are definitely a thing. Meaning misdiagnosis, mistreatment, and the poverty and despair, etc, etc, etc, that comes with all that. That is, factors that have nothing to do with the disease process itself. The completely unnecessary and avoidable ones.

Which is the part of psychosocial that the psychosocial advocates do everything they can to avoid recognising and taking into proper account.

Oh absolutely 100%, but I have not once seen this perspective from the supply side of the issue, the professionals, only from the patients, as you say. Or not once from the traditional biopsychosocial perspective anyway. There is the odd effort at it, but it's almost always from people who get it, and so it gets entirely ignored.

So it remains that they are entirely irrelevant because they make the choices that make them irrelevant. Or to be more accurate, psychosocial factors are irrelevant as causes, but relevant as aggravating factors not to the illness itself but as cumulative on top of the illness and its consequences, but of course that's why the ideologues shifted to make it all about being perpetuating factors on their own, except they're not that either.

It's all a really giant mess, uh? A stalemate. A sort of zugzwang, a term in chess for when a player must make a move, but every more available to them will lead to a loss. And we're definitely the ones playing the losing moves, because on the other side of a zugzwang is the player whose every subsequent move is a win to them. And they seem to love winning the game more than anything.