Perceived stress and associated societal, community, interpersonal, and individual factors in adults with post-COVID-19 condition: the PRIME study

Background Post-COVID-19 condition (PCC) is a global health concern with a profound impact on physical, mental, and social health, potentially leading to stress. This study compared perceived stress levels between adults with PCC and those without PCC (non-PCC). Additionally, environmental (societal, community, interpersonal) and individual factors were explored for their association with stress.

Cross-sectional questionnaire data from participants with SARS-CoV-2 infection were obtained from the prospective PRIME post-COVID cohort (2022). PCC was defined as feeling unrecovered (≥ 3 months) after SARS-CoV-2 infection. Associations between societal, community, interpersonal and individual factors and the outcome perceived stress (measured by the Perceived Stress Scale 14; PSS-14) were assessed in PCC and non-PCC using logistic regressions, adjusted for gender and age.

In total, 3275 participants were included (PCC: n=1044, non-PCC: n=2231). PCC had higher perceived stress scores (mean± SE: 20.75± 0.27) than non-PCC (mean± SE: 15.65± 0.19), adjusted for age and gender (p<0.001). Factors associated with more perceived stress included lower neighborhood livability and cohesion (societal level), higher absenteeism and presenteeism (community level), less social support, less dense and diverse social network (interpersonal level), being female, having co-morbidities, post-exertional malaise, orthostatic intolerance, loneliness, and lower coping score (individual level). These factors and their effect-sizes were largely comparable between PCC and non-PCC, but nearly all were more prevalent in PCC compared to non-PCC group.

Adults with PCC perceived higher stress levels compared to adults without PCC, which may be attributable to higher prevalences of a multitude of stress-associated environmental and individual factors. Competing Interest Statement The authors have declared no competing interest. Clinical Trial N/A, NCT05128695 Funding Statement Yes Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Medical Ethical Committee of Maastricht University Medical Center+, Maastricht Netherlands waived this study (METC2021-2884), as the Medical Research Involving Human Subjects Act (WMO) did not apply to this study. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable Data Availability The datasets presented in this article are not readily available because the data contains potentially identifying patient information. Data are available on request from the head of the data-archiving South Limburg Public Health Service for researchers who meet the criteria for access to confidential data. Requests to access the datasets should be directed to tamara.kleine{at}ggdzl.nl.