The disease caused by the pathogen SARS-CoV-2 is known as coronavirus disease with theacronym COVID-19. The acute phase of this condition typically lasts one to two weeks andusually results in a full recovery. However, in about 10-30% of those affected, thesymptoms persist for more than four weeks after the onset of the disease. In this case,there is an ongoing COVID-19 illness known as long COVID. Long COVID can persist for manymonths and cause significant distress and limitations to those affected due to thelong-term health consequences.The causes of long COVID are still unclear and, accordingly, therapeutic measures arestill insufficiently developed. It is assumed that long COVID can in principle affectanyone. Age, gender, obesity and the number of symptoms during an acute COVID-19 illnessare discussed as risk factors for long COVID. Another potential risk factor fordeveloping long COVID could be chronic stress, which has been shown to put a strain onthe immune system. It is known from infections with other coronaviruses and other viralrespiratory diseases that chronic stress can lead to prolonged illness and limitedrecovery. The aim of this study is to systematically examine chronic stress, as itexisted before infection with the coronavirus, as a possible risk factor for long COVID.For this purpose, 600 people who have been proven to be infected with SARS-CoV-2 and havedeveloped symptoms of COVID-19 will be included in this study.
Wider research context / theoretical framework: The pathophysiology leading to symptom
persistence after acute COVID-19, defining long COVID, is widely unknown. Chronic stress
may be a risk factor for long COVID as it can impair immune regulation and induce
exaggerated inflammatory responses. It is known to negatively influence upper respiratory
infections and was found to be associated with long-term symptoms following other
coronavirus infections (SARS). In addition, chronic stress is an established risk factor
for unspecific functional symptoms and mental health impairment. Data on these issues are
scanty, however much-needed for developing proper interventions.
Hypotheses/research questions/objectives: The primary aim of the study is to analyze the
influence of chronic stress on symptom persistence in COVID-19. The study team
hypothesizes that elevated levels of pre-existing self-reported chronic stress measured
at the beginning of infection predict a higher proportion of patients with symptom
persistence at one month after testing positive for SARS-CoV-2 infection (primary
outcome). Secondary aims are to investigate the influence of chronic stress on medium- to
long-term mental health outcome. In addition, the researchers longitudinally investigate
chronic stress, stress-related biomarkers and allostatic load in patients with symptom
persistence as compared to recovered patients.
Approach/methods: This is a longitudinal prospective observational study designed
according to STROBE guidelines in persons newly tested positive for SARS-CoV-2 infection
by qPCR with symptoms of acute COVID-19. Monitoring of COVID-19-related symptoms and
symptom persistence is conducted online, by phone and in outpatient clinic visits.
Pre-existing chronic stress is investigated by questionnaires on perceived stress and
negative life events and by analysis of hair cortisol concentrations prior to infection.
Collection of blood allows measurement of SARS-CoV-2 antibodies, stress-related
biomarkers and the calculation of allostatic load. Baseline and longitudinal data
collection encompasses comorbidities, regular medication, screening for anxiety,
depression, acute stress symptoms, and cognitive function.
Level of originality/innovation: This is the first study prospectively investigating
chronic stress as a risk factor for long COVID and associated mental health impairment by
a multimodal approach. In addition, the researchers probe for stress-related biomarkers
associated with symptom persistence and also investigate the impact of protective
factors, such as resilience, psychosomatic competence and social support, on symptom
persistence. Two novel bio-psycho-social assessment tools contribute to the results of
this study. Results of this project will lead to innovative preventive and treatment
interventions targeting symptom persistence and mental health sequelae after acute
COVID-19.
Primary researchers: Christian Fazekas (PI), Nandu Goswami, Barbara Hanfstingl, Voyko
Kavcic.
Inclusion Criteria:
- Adults (>18 years); qPCR-test positive for SARS-CoV-2 infection; symptom(s) of acute
COVID-19; inclusion within defined timeframe of one week after testing; data
collection online, by phone and at study visits feasible
Exclusion Criteria:
- Insufficient knowledge of German language; lengths of hair at rear vertex less than
2 cm; pregnancy or postpartum less than 3 months; refusal to give informed consent
Medical University Graz, Division of Medical Psychology, Psychosomatics and Psychotherapy
Graz, Styria, Austria
Not Provided