(030) Characterizing Mood Symptoms in Long Covid: A Qualitative Perspective

Abstract: Background

Mood symptoms are commonly experienced by individuals with Post-Acute Covid-19 Syndrome (PACS, or “Long Covid”), especially anxiety and depression (1). This qualitative study was performed to investigate experiences of PACS, in order to characterize the nature of self-reported mood symptoms associated with PACS.

Methods

Semi-structured interviews were conducted with 8 English-speaking adults who met WHO Criteria for PACS, recruited from a general rehabilitation clinic and by word-of-mouth in Chicago between November 2021-March 2022 (2). The interview guide consisted of a modified version of the McGill Illness Narratives Interview (MINI) to elicit descriptions of the nature and impact of the symptoms of PACS. Interviews were de-identified, transcribed, coded using grounded theory methodology, and analyzed for themes.

Results

Individuals evidenced four distinct trajectories of self-reported mood symptoms during PACS, compared to their pre-PACS baselines: persistence or worsening of pre-PACS mood symptoms, development of mood symptoms not present before PACS, relief of pre-PACS mood symptoms during PACS, or no mood symptoms before or during PACS. Five individuals reported histories of depression and anxiety before PACS occurred, including four individuals receiving ongoing psychiatric treatment. Among these, PACS was associated with worsening of symptoms for four individuals, and did not influence the symptoms of one individual. Three individuals reported no history of anxiety or depression before PACS. Among these, one reported the development of significant mood symptoms during PACS, while two did not. Several themes emerged regarding the contextual factors associated with mood symptoms. Participants described depression, anxiety, insomnia, hopelessness, apathy, and irritability as resulting from multiple sources, including the debilitating nature of symptoms, uncertainty about their ability to work, exposure to distressing news stories, lack of support from family members, financial impact, poor treatment from employers, hopelessness about living with symptoms indefinitely, negative impact on self-image, and the harmful impact of symptoms on marriage, dating life, sexual function, and future childbearing ability.



Discussion

While epidemiological data has established the prevalence of neuropsychiatric symptoms of PACS, debate exists over their mechanistic etiology, which if known could help refine treatment approaches or identify predictive factors. Themes from this dataset support the hypothesis that circumstantial stressors of PACS are associated with self-reported mood symptoms. However, this relationship was not universal, and supports the practice of a highly individualized treatment approach for individuals with PACS. Finally, while circumstances caused by PACS may influence mood symptoms, research must be conducted to understand primary mechanistic explanations for neuropsychiatric symptoms of PACS.

(1) Davis, H. E., Assaf, G. S., Mccorkell, L., Wei, H., Low, R. J., Re’em, Y., et al. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. E Clinical Medicine. 2021.

(2) World Health Organization. Coronavirus disease (COVID-19): Post COVID-19 condition. 2021.