Psychological Burden and the Course of Incident Persistent Symptoms During the COVID-19 Pandemic: A Prospective Population-Based Study

Background: Identifying factors that predict the course of persistent symptoms after COVID-19 is a clinical and public health issue. This prospective population-based study aimed to examine whether the psychological burden associated with persistent symptoms that occurred from March 2020 would be associated with having at least one persistent symptom 6 to 10 months later.Methods: A total of 8424 participants (Mean age (standard deviation): 54.6 (12.6) years, 57.2% women) having at least one persistent symptom at baseline (i.e., between December 2020 and January 2021), including 770 with SARS-CoV-2 infection prior to baseline, were included. Psychological burden associated with persistent symptoms was assessed with the Somatic Symptom Disorder-B Criteria Scale (SSD-12). The outcome was having at least one persistent symptom at follow-up (i.e., between June and October 2021). Adjusted binary logistic regression models examined the association between the SSD-12 score and the outcome.Findings: At follow-up, 1124 participants (13.3%) still had at least one persistent symptom. The SSD-12 score at baseline was associated with persistent symptoms at follow-up in the whole population (OR [95% CI] for one interquartile range increase: 1.36 [1.24-1.49]), and in both participants with and without infection prior to baseline. Female gender, older age, poorer self-rated health, and SARS-CoV-2 infection prior to baseline were also associated with higher risk of persistent symptoms at follow-up. There was no interaction between the SSD-12 score and infection prior to baseline.Interpretation: Intervention studies should test whether reducing the psychological burden associated with persistent symptoms could improve the course of these symptoms.Funding: The CONSTANCES cohort benefits from grant ANR-11-INBS-0002 from the French National Research Agency. CONSTANCES is supported by the Caisse Nationale d’Assurance Maladie, the French Ministry of Health, the Ministry of Research, and the Institut National de la Santé et de la Recherche Médicale (INSERM). CONSTANCES is also partly funded by AstraZeneca, Lundbeck, L’Oréal, and Merck Sharp & Dohme Corp. The Santé, Pratiques, Relations et Inégalités Socials en Population Générale Pendant la Crise COVID-19 (SAPRIS) and SAPRIS-Sérologie (SERO) study was supported by grants ANR- 10-COHO-06 and ANR-20-COVI-000 from the Agence Nationale de la Recherche; grant 20DMIA014-0 from Santé Publique France; grant 20RR052-00 from the Fondation pour la Recherche Médicale; and grant C20-26 from INSERM. The present study was supported by a grant “AAP Covid long 2022-1” from the Agence nationale de recherches sur le sida et les hépatites virales (ANRS) | Maladies infectieuses émergentes. Dr. Gouraud and Prof. Lemogne were supported by a grant from “la Fondation de l’Assistance Publique - Hôpitaux de Paris”.Declaration of Interest: Dr. Robineau reported personal fees and nonfinancial support from Gilead, ViiV Healthcare, and Merck Sharp & Dohme Corp outside the submitted work. Dr. Pitron reported personal fees from Grunenthal, outside the submitted work. Dr. Lemogne reported non-financial support from Nordic Pharma, outside the submitted work. No other disclosures were reported.Ethical Approval: The French CONSTANCES population-based cohort study received ethical approval by the institutional review board of the National Institute for Medical Research (Authorization number 910486) and included more than 200,000 volunteers aged 18-69 years at inclusion (i.e., between 2012 and 2019) who gave informed consent to be followed-up through annual questionnaire.