Self-reported Anxiety, Depression, and Health-Related Quality of Life during Two Years Following Hospitalization for COVID-19: A longitudinal study

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Larsson, Roda Alhasan, Annie Palstam, Lena Rafsten, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7986804/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Apr, 2026 Read the published version in Scientific Reports → Version 1 posted 11 You are reading this latest preprint version Abstract Introduction: Coronavirus disease 2019 (COVID-19) is a respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Health-related quality of life (HRQoL) has been observed to decline after COVID-19 hospitalization, with anxiety and depression contributing to reduced HRQoL and emphasizing the need for research on long-term outcomes. The aim of the study was to longitudinally explore self-reported symptoms of anxiety, depression, and associated factors of HRQoL during 2 years after hospital-treated COVID-19, and to compare differences based on age, sex, and initial disease severity. Methods: Participants were included from the Life in the Time of COVID study in Gothenburg, comprising individuals hospitalized with COVID-19 during the first and second waves of the pandemic in Sweden. This prospective study includes follow-ups at 3 months, 1 year, and 2 years after discharge, using patient-reported outcomes assessing symptoms of anxiety, depression, HRQoL, and clinical data. Results: The study comprised 125 participants, of whom 111 were eligible for longitudinal analysis. Two years after COVID-19, individuals with initial moderate infection reported higher levels of anxiety ( p = 0.031) and pain/discomfort ( p = 0.039) than did those with severe infection. Symptoms of anxiety did not change significantly over the study period. Depressive symptoms increased significantly worse between 3 and 12 months after COVID-19 (Z = − 2.957, p = 0.003). Older age was significantly associated with lower HRQoL (B = − 0.003, 95% CI [–0.004, − 0.001], p = .010). Conclusions: Symptoms of anxiety remained generally within the normal range throughout the two-year follow-up after hospital-treated COVID-19. Symptoms of depression were lower at 3 months after hospitalization but subsequently stabilized at a higher, yet still normal, level. At two years after COVID-19, lower HRQoL was associated with older age, highlighting the importance of addressing age-related vulnerabilities in long-term follow-up care. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Biological sciences/Psychology Social science/Psychology Health sciences/Signs and symptoms COVID-19 HRQoL rehabilitation recovery of function hospitals anxiety depression Post-Acute COVID-19 Syndrome Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Coronavirus disease 2019 (COVID-19) is a communicable respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 1 . Vaccines and improved treatments have reduced the burden of acute COVID-19 1 ]. Post COVID condition is estimated to affect millions worldwide 2 . According to the WHO’s definition, Post COVID condition is characterized by new or persistent symptoms that appear 3 months after the initial infection, persist for at least 2 months, and cannot be explained by other causes 3 . Commonly reported symptoms include fatigue, breathlessness, and cognitive impairment, all of which reduce quality of life 1 , 3 . Individuals who have required hospitalization for COVID-19 have been shown to be more prone to long-term effects of the disease and tend to recover more slowly 4 – 6 . Additionally, a decline in health-related quality of life (HRQoL) has been described in patients up to 6 months following hospitalization for COVID-19 7 . Previous studies have reported anxiety and depression as persistent symptoms following COVID-19 8–12 ]. A higher prevalence of anxiety has been observed among females, younger individuals, and those not hospitalized during the acute phase 10 . An increased burden of depression and anxiety over time after COVID-19 hospitalization has also been documented 9 . In previously hospitalized individuals (the same cohort as the present study), 28% reported symptoms of anxiety and 24% reported symptoms of depression 12 . Moreover, post-COVID depression and anxiety have been linked to a decline in health-related quality of life (HRQoL) 11 . Understanding factors associated with long-term anxiety and depression after COVID-19 may help to improve long-term quality of life. The aim of the study was to longitudinally explore self-reported symptoms of anxiety, depression, and associated factors of HRQoL during 2 years after hospital-treated COVID-19, and to compare differences based on age, sex, and initial disease severity. Methods Study design and participants This prospective longitudinal study included individuals hospitalized for COVID-19, with the first assessment conducted at hospital discharge, with follow-ups at 3 months, 1 year, and 2 years. Participants comprised of the longitudinal Life in the Time of COVID Study in Gothenburg (GOT-LOCO) cohort 13 , 14 , for which participants were enrolled consecutively from five hospitals in the Västra Götaland region of Sweden between July 2020 and February 2021. Inclusion criteria were age ≥ 18 years at the time of inclusion, hospitalization for COVID-19, noncontagious when included, at least 5 days of hospital care for COVID-19, and living independently in the community prior to admission. Exclusion criteria included inability to provide informed consent, severe comorbidities with an anticipated life expectancy of less than 1 year and not being a Swedish resident. All participants received both written and oral information about the study. Prior written informed consent was obtained. The study followed the ethical principles of the Declaration of Helsinki and was approved by the Swedish Ethical Review Authority (ref. no. 2020–03046, 2020–03922, 2021 − 00444 and 2021–03556). The manuscript was prepared in accordance with the STROBE guidelines 15 . Data Collection Clinical characteristics Clinical characteristics from the hospital stay were extracted from medical records and included length of stay, ICU admission, comorbidities, and COVID-19 severity (dichotomized as moderate or severe) using the WHO Clinical Progression Scale. Moderate infection corresponds to scores of 4–5, and severe infection to scores of 6–9 16 . Comorbidities were categorized according to the ICD-10 version of the Charlson Comorbidity Index (CCI) 17 , 18 , and classified as none, mild (one comorbidity), or severe (two or more comorbidities). Three-month data collection At the 3-month follow-up, participants completed patient reported outcome measures (PROMs) during a scheduled telephone follow-up conducted by a research nurse, trained for the study. PROMs included self-reported symptoms of anxiety and depression, using the Hospital Anxiety and Depression Scale (HADS). Anxiety and depression scores both range from 0 to 21, with higher scores indicating greater distress. Scores ≤ 7 are considered normal, 8–10 elevated, and ≥ 11 concerning, and in the present study a subscore of ≥ 8 was used as a proxy for anxiety and / or depression 19 , 20 . PROMs were sent to participants in advance to allow preparation and the opportunity to ask questions during the follow-up. One-year data collection In addition to HADS, the EuroQol-5 Dimension (EQ-5D) was used to self-report HRQoL across five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, each rated on three levels (1 = no problems, 2 = some problems, 3 = extreme problems). A response level of ≥ 2 on any dimension was used as a proxy for reduced HRQoL. The EQ Visual Analogue Scale (VAS) measures overall health from 0 (“worst imaginable health state”) to 100 (“best imaginable health state”). Responses are combined into an EQ-5D index ranging from − 0.594 to 1.0, with higher numbers indicating better HRQoL [21]. The PROMs were sent by mail or digitally, with at least one reminder sent via text message if no response was received. Two-year data collection At the 2-year follow-up, participants again completed HADS and EQ-5D. PROMs were distributed by mail or digitally, followed by a text-message reminder. Additional questions were included regarding patient characteristics and COVID-19–related information. Participants also rated the level of difficulty experienced in various domains: activity, transferring, pain and sensitivity, bowel function, smell and taste, swallowing, vision, sleep, voice, cardiac function, skin, and recurrence of fever. Responses were recorded on a Likert scale from 0 (no difficulties) to 4 (severe difficulties). Statistical analysis Demographic data are presented as percentages, mean ± standard deviation (SD), or median and interquartile range (IQR), as appropriate. The level of statistical significance was set at p ≤ 0.05. Group comparisons were conducted based on sex, age group (≥ 65 or < 65 years), and COVID-19 severity (moderate or severe). Dropout analyses were performed using the chi-square test and the Mann–Whitney U-test. The Friedman test was used to evaluate changes across the three follow-up time points, and the Wilcoxon signed-rank test was applied for pairwise comparisons between time points. For longitudinal analyses, only individuals who participated in the assessments at 3 months, 1-year and 2-year follow-ups were eligible to be included ( n = 111). Due to internal dropouts, the number of participants in each analysis varies. The Z-value in the shift analysis represents standardized differences between the distributions of the groups. Multivariable linear regression analysis was used to examine relationship with HRQoL 2 years after COVID-19. The EQ-5D index was used as the dependent variable. Potential independent variables included age, sex, COVID-19 severity (moderate/severe), ICU treatment (yes/no), total length of hospital stay (days), and comorbidities (none/mild/severe). Assumptions for linear regression—normality, linearity, absence of multicollinearity, and lack of influential cases—were assessed. Initial analyses included scatterplots for continuous data and boxplots for categorical data. Multicollinearity was assessed using Spearman correlation ( p > 0.7). All analyses were conducted using SPSS Statistics version 28 (IBM Corporation, Armonk, NY, USA). Microsoft Excel and SankeyMATIC.com were used for visual presentations. Results A total of 211 participants were enrolled in the GOT-LOCO study. Of these, 168 participated in the 3-month follow-up, 169 in the 1-year follow-up, and 125 in the 2-year follow-up (Fig. 1 ). Of the 211 participants, a total of 111 participants completed follow-ups at 3 months, 1 year and 2 years. No significant differences were found between participants ( n = 111) and nonparticipants ( n = 83) in terms of sex, COVID-19 severity, level of hospital care (ICU yes/no), or length of hospital stay. However, the mean age was higher in participants (66 ± 11) than in nonparticipants (62 ± 15; p = 0.002). Among the 125 participants in the 2-year follow-up, 68% ( n = 85) were men. The vast majority, 96% ( n = 118), reported having received at least one or more doses of COVID-19 vaccine since their hospitalization. Two-thirds of the participants (62%, n = 77) lived in a shared household, and over one-third ( n = 45) required assistance with daily activities. Additionally, 17% ( n = 21) reported ongoing rehabilitation for COVID-19–related impairments 2 years after discharge (Table 1 ). Table 1 Characteristics of participants at the 2-year follow up.n = 125. At hospital discharge Age, years, mean ± SD 66 ± 12 Sex, male, number (%) 85 (68) LOS, days, mean ± SD 32 ± 32 Treated at ICU, number (%) 64 (51) - LOS in ICU, number (%) 19 ± 19 COVID severity, number (%) - Moderate 37 (30) - Severe 88 (70) CCI, number (%), n = 124 - None 45 (36) - Mild 59 (48) - Severe 20 (16) At the 2-year follow-up Dependent on ADL assistance, number (%) 45 (36) Living situation, number (%) - Alone 48 (38) - Shares household with another adult 62 (50) - Shares household with children 12 (10) - Shares household with both children and another adult 3 (2) Vaccination, number (%), n = 123 - No 5 (4) - Yes (number of doses unknown) 2 (2) - Yes, two doses 12 (10) - Yes, multiple doses 104 (84) Abbreviations: ADL activities of daily living, CCI Charlson comorbidity index: none = 0, mild = 1–2, severe = ≥ 3, ICU intensive care unit, LOS length of hospital stay, SD standard deviation COVID severity is reported according to the WHO Clinical Progression Scale 21 ]. At the 2-year follow-up, the most self-reported difficulties were related to the domains: transferring (21%, n = 26), activity (20%, n = 25), and pain and sensitivity (19%, n = 24). A small number of participants (n = 8) reported a high symptom burden (> 25), while there were no participants who reported not having symptoms at all (Fig. 2 ). Thirty percent of participants ( n = 37) reported symptoms of anxiety, and 24% ( n = 29) reported symptoms of depression at the 2-year follow-up. No significant differences in self-reported anxiety or depression were found based on sex or age (Table 2 ). Participants with moderate initial COVID-19 severity reported levels of anxiety higher than those reported by individuals hospitalized with severe COVID-19 ( p = 0.031). Regarding HRQoL, participants with moderate initial COVID-19 also reported higher levels of pain and discomfort than those reported by individuals hospitalized with severe COVID-19 ( p = 0.039). A significant difference was also observed between participants over and under 65 years of age regarding mobility difficulties, where older individuals reported mobility difficulties to a higher extent ( p = 0.001). Table 2 Outcomes of self-reported anxiety, depression, and health-related quality of life at 2 years after COVID-19, depending on sex, age, and COVID severity. Outcome Overall n = 125 Sex P Age (years) P Severity P Male n = 85 Female n = 40 ≥ 65 n = 53 < 65 n = 72 Moderate n = 37 Severe n = 88 HADS-A score n = 122 Median (IQR) 4 (1–8) 4 (1–8) 3 (2–8) 0.638 4 (1–8) 3 (1–9) 0.521 6 (8) 3 (6) 0.031 HADS-D score n = 122 Median (IQR) 3 (1–7) 3 (1–8) 2.5 (1–5) 0.487 3 (1–7) 2 (1-7.5) 0.956 4 (2–8) 2 (1–7) 0.095 EQ5D Mobility n = 123 Median (IQR) 1 (1–2) 1 (1–2) 2 (1–2) 0.158 2 (1–2) 1 (1–2) < 0.001 2 (1–2) 1 (1–2) 0.214 Self-care n = 123 Median (IQR) 1 (1–1) 1 (1–1) 1 (1–1) 0.894 1 (1–1) 1 (1–1) 0.173 1 (1–1) 1 (1–1) 0.468 Activity n = 122 Median (IQR) 1 (1–2) 1 (1–2) 1 (1–2) 0.287 1 (1–2) 1 (1–2) 0.692 1 (1–2) 1 (1–2) 0.629 Pain / discomfort n = 121 Median (IQR) 2 (1) 2 (1–2) 2 (1–2) 0.486 2 (1–2) 2 (1–2) 0.076 2 (2–2) 2 (1–2) 0.039 Anxiety / depression n = 123 Median (IQR) 1 (1–2) 1 (1–2) 2 (1–2) 0.105 1 (1–2) 1 (1–2) 0.384 2 (1–2) 1 (1–2) 0.161 EQ-VAS (%) Median (IQR) n = 105 62 (45–80) 62,5 (45–80) 61 (40–89) 0.863 61 (45–80) 65 (47–80) 0.784 60 (50–80) 63.5 (40–80) 0.704 Significant P -values are presented in bold. Abbreviations : A anxiety, D depression, EQ5D EuroQol-5 Dimension, EQ-VAS EuroQol Visual Analogue Scale, HADS Hospital anxiety and depression scale. Health-related quality of life declined slightly between the 1- (median 0.88) and 2-year (median 0.86) follow-ups- with lower EQ-5D index ( p = 0.046) with increased proportions of participants reporting moderate problems in mobility, self-care, and usual activities ( Table 3). Table 3 Health-related quality of life at 1 and 2 years after COVID-19 1-year follow-up 2-year follow-up n = 117 n = 123 EQ5D EQ5D Index, Median (IQR) 0.88 (0.79–93) 0.86 (0.75–0.93) Mobility , % n = 114 n = 120 Moderate problems 43.1 49.6 Extreme problems - - Self-care , % Moderate problems 6.9 13.8 Extreme problems - 0.8 Usual Activity , % Moderate problems 20.7 34.4 Extreme problems 2.6 1.6 Pain/Discomfort , % Moderate problems 56.1 53.7 Extreme problems 9.6 12.4 Anxiety/Depression , % Moderate problems 35.3 39.0 Extreme problems 3.4 4.9 VAS n = 108 n = 105 Median (IQR) 70 (53–85) 62 (45–80) Mean (SD) 68 ± 20 64 ± 20 Data are presented as count and percentages ( n , %). Abbreviations: EQ-5D EuroQol-5 Dimension, EQ-VAS EuroQol-Visual Analog Scale. Self-reported symptoms of depression were low 3 months after hospital discharge (median 2, IQR 1-5) but increased for some participants throughout the follow-up period (1 year: median.3 IQR 1-7, year 2: median 3 IQR 1-7.5) Longitudinal analyses showed significant change in symptoms of depression during the study period ( p = 0.014). Pairwise comparisons showed a significant increase in depressive symptoms from 3 months to 1 year (Z = –2.913, p = 0.004) and from 3 months to 2 years (Z = –2.726, p = 0.006), indicating a worsening trend during the first-year post discharge. However, no significant difference was found between 1 and 2 years (Z = –0.677, p = 0.498) (Fig. 2). Self-reported anxiety levels remained largely stable over the follow-up period: 3 months (median: 4, IQR: 1–7), 1 year (median: 4, IQR: 1–8), and 2 years (median: 4, IQR: 2–8) after hospital discharge. No statistically significant difference was observed across the time points ( p = 0.535). These results are visualized in Fig. 3. Older age was significantly associated with lower EQ-5D index 2 years after hospital-treated COVID-19 (B = –0.003, 95% CI [–0.004, –0.001], p = 0.010), indicating that older participants reported lower HRQoL. Sex, COVID-19 severity, ICU admission, comorbidities, and hospital length of stay did not contribute significantly to the model (Table 4). Table 4 , Explanatory factors associated with health-related quality of life 2 years after COVID-19 infection ( n = 116) Unstandardized coefficients p-value 95% CI for (B) Variables Reference B Std. Error Lower Upper Sex Females (0) −0.037 0.025 0.140 −0.087 0.012 Age, years −0.003 0.001 0.010 −0.004 −0.001 Covid severity Moderate (0) 0.007 0.033 0.832 −0.059 0.073 ICU No ICU (0) −0.014 0.032 0.668 −0.077 0.050 Comorbidities −0.005 0.009 0.593 −0.022 0.013 Length of hospital stay 0.000 0.000 0.239 −0.001 0.000 Reference categories are shown for categorical variables. Continuous variables (age, comorbidities, and hospital stay) were entered as linear terms. B unstandardized coefficient. Discussion In this longitudinal study, self-reported symptoms of anxiety were normal and unchanged during 2 years after COVID-19 infection. Self-reported symptoms of depression were initially low, increased during the first year but were stable thereafter, within normal levels. Older age was significantly associated with lower HRQoL 2 years after COVID-19. Individuals who experienced moderate disease reported higher levels of anxiety, pain, and discomfort than did those with severe illness. This finding contrasts with previous research that reported individuals with severe COVID-19 had more anxiety than less severe cases 22 [. Why individuals with moderate COVID-19 report higher levels of anxiety, pain, and discomfort remains unclear. One possible explanation is post-traumatic growth (PTG) among individuals who experienced severe COVID-19. PTG refers to positive psychological change, such as increased personal strength and altered life priorities, 23 . Evidence of PTG in COVID-19 survivors has been documented from days after hospital discharge up to 1 year post 22,24,25 . Another possible explanation could be that individuals with severe COVID-19 may have received more rehabilitation and support, including tools and strategies to manage their symptoms, from healthcare services. Previous research has also highlighted the crucial role of hospital care for mental and emotional outcomes, emphasizing the importance of feeling supported by the healthcare system as a protective factor for mental health 26 . Overall, 30% of participants continued to experience symptoms of anxiety 2 years after COVID-19. No significant differences in anxiety were found based on sex or age, which contrasts with previous research showing higher anxiety levels among women 26,27 . In this cohort, men reported higher median symptoms of anxiety than the general population, while women’s scores were similar to their population norms 27 . However, it is important to note that anxiety levels prior to infection were unknown. This reversal of the commonly observed sex pattern warrants further research and clinical attention. Like the scores for anxiety, the 2-year median scores concerning depression resembled those reported in the general Swedish population, in both men and women 27 . This suggests that depressive symptoms are lower during the early recovery phase, perhaps as a result of the post-traumatic life event of being hospitalized for COVID-19 and eventually return to levels similar to the population norm. HRQoL 2 years after COVID-19 revealed that older individuals more frequently reported mobility problems, consistent with age-related expectations 28 . In comparison with the median values of the general Swedish population, higher levels of mobility problems were reported by the COVID-19 cohort. For example, compared with 10% of the general population, 50% of participants in this cohort reported moderate mobility problems 29 . Notably, participants who had experienced moderate initial COVID-19 severity reported significantly more pain and discomfort than those with severe illness ( p = 0.039). Although this study did not examine potential associations between moderate COVID-19 severity, elevated anxiety, and increased pain and discomfort, such connections may be important. Around half of the participants reported moderate pain and discomfort, and one in ten reported extreme problems — both slightly higher than in the general population 29 . That pain/discomfort are commonly affected domains after COVID-19 has recently been confirmed by a review article 30 . The high prevalence of pain and discomfort among individuals previously hospitalized with COVID-19 may be relevant for a wide range of healthcare professionals, including those who regularly encounter this patient group or work with pain management. The regression model identified older age as significantly associated with lower HRQoL 2 years after hospitalization for COVID-19, independent of sex, initial disease severity, ICU admission, comorbidities, or length of hospital stay. This suggests that COVID-19 may have lasting impacts on older individuals regardless of pre-existing health status. The natural decline in fitness with ageing should be considered 28 but does not lessen the impact that COVID-19 has on the older population 31 . Together, these findings highlight the importance of long-term follow-up and targeted interventions to support older adults in their recovery after severe COVID-19. The strengths of this study include its longitudinal design, which followed hospitalized participants over a 2-year period. This approach allowed observation of changes in symptoms, anxiety, depression, and self-reported HRQoL. These outcomes were reported using well-established PROMs. As this study used a consecutive inclusion process, some caution is warranted when generalizing the findings: certain individuals hospitalized for COVID-19 were overlooked during inclusion, mainly because of heavy workloads in the clinics. The risk of reporting bias also needs to be taken into consideration, as this study relies on PROMs. Conclusion Symptoms of anxiety remained generally within the normal range throughout the two-year follow-up after hospital-treated COVID-19. Symptoms of depression were lower at 3 months after hospitalization but subsequently stabilized at a higher, yet still normal, level. At two years after COVID-19, lower HRQoL was associated with older age, highlighting the importance of addressing age-related vulnerabilities in long-term follow-up care. Abbreviations Confidence interval (CI), EuroQol-5 Dimension (EQ-5D), Hospital anxiety and depression scale (HADS), Health related quality of life (HRQoL), Intensive care unit (ICU), Inter quartile range (IQR) Length of hospital stay (LOS), standard deviation (SD), patient reported outcome measures (PROMs), post traumatic growth (PTG), Visual analog scale (VAS). Declarations Ethics approval: The Swedish Ethical Review Authority approved this study (DNR 2020–03046), along with subsequent amendments (DNR 2020–03922, DNR 2021–03556, and DNR 2021 − 00444). All procedures complied with local legislation and institutional regulations. Consent to participate : Written informed consent as well as consent for publication was obtained from all participants prior to inclusion in the study. Funding: The authors acknowledge financial support for the research, authorship, and/or publication of this article. Funding was provided through grants from the Swedish state under the ALF agreement between the Swedish government and the county councils (ALFGBG 977727, 992228, 942914, and 965653), Västra Götaland regional research funding (VGFOUREG 940508, 969267), Forte/Formas (2020–02775), the Sahlgrenska University Hospital research funds (SU-961951), and AFA Insurance (Grant number 200324). Author Contribution ACL: Conceptualization, formal analysis, visualization, drafting of the original manuscript, and review and editing. RA: Review and editing. LR: Supervision, review, and editing. AP: Conceptualization, funding acquisition, methodology, supervision, and review and editing. HCP: Conceptualization, data curation, funding acquisition, methodology, project administration, supervision, and review and editing. 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Gidey, K., Niriayo, Y. L., Asgedom, S. W. & Lubetkin, E. Health-related quality of life in COVID-19 patients: a systematic review and meta-analysis of EQ-5D studies. Health Qual. Life Outcomes . 23 , 97. 10.1186/s12955-025-02421-8 (2025). Rahmati, M. et al. A systematic review and meta-analysis of long-term sequelae of COVID-19 2-year after SARS-CoV-2 infection: A call to action for neurological, physical, and psychological sciences. J. Med. Virol. 95 , e28852. 10.1002/jmv.28852 (2023). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 17 Apr, 2026 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 20 Jan, 2026 Reviews received at journal 16 Jan, 2026 Reviewers agreed at journal 15 Dec, 2025 Reviewers agreed at journal 10 Dec, 2025 Reviews received at journal 03 Dec, 2025 Reviewers agreed at journal 11 Nov, 2025 Reviewers invited by journal 11 Nov, 2025 Editor invited by journal 04 Nov, 2025 Editor assigned by journal 03 Nov, 2025 Submission checks completed at journal 03 Nov, 2025 First submitted to journal 30 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7986804","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":546174120,"identity":"5fe3139b-9202-44ac-b202-6a740904638c","order_by":0,"name":"Alexandra C. Larsson","email":"data:image/png;base64,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","orcid":"","institution":"University of Gothenburg","correspondingAuthor":true,"prefix":"","firstName":"Alexandra","middleName":"C.","lastName":"Larsson","suffix":""},{"id":546174121,"identity":"58a13fde-2287-4b71-b76c-4f4ead86f4bc","order_by":1,"name":"Roda Alhasan","email":"","orcid":"","institution":"University of Gothenburg","correspondingAuthor":false,"prefix":"","firstName":"Roda","middleName":"","lastName":"Alhasan","suffix":""},{"id":546174122,"identity":"eb6c5667-be63-4078-8fda-895495217ce3","order_by":2,"name":"Annie Palstam","email":"","orcid":"","institution":"Sahlgrenska University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Annie","middleName":"","lastName":"Palstam","suffix":""},{"id":546174123,"identity":"2d81f724-7883-480e-b42d-36419d26f850","order_by":3,"name":"Lena Rafsten","email":"","orcid":"","institution":"University of Gothenburg","correspondingAuthor":false,"prefix":"","firstName":"Lena","middleName":"","lastName":"Rafsten","suffix":""},{"id":546174124,"identity":"88558a36-4239-437d-9ad3-9c2e7eb43451","order_by":4,"name":"Hanna C. Persson","email":"","orcid":"","institution":"University of Gothenburg","correspondingAuthor":false,"prefix":"","firstName":"Hanna","middleName":"C.","lastName":"Persson","suffix":""}],"badges":[],"createdAt":"2025-10-30 08:23:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7986804/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7986804/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-026-48440-3","type":"published","date":"2026-04-17T15:58:28+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":96604339,"identity":"9f389dd9-0cb7-4ed4-a110-737c9b32cc61","added_by":"auto","created_at":"2025-11-24 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11:46:16","extension":"png","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":32511,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7986804/v1/491fe7868fc53b1488d4c495.png"},{"id":96556372,"identity":"d41badfb-6b97-40f6-a4dc-770a94cbfcca","added_by":"auto","created_at":"2025-11-23 11:46:17","extension":"xml","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":110469,"visible":true,"origin":"","legend":"","description":"","filename":"9addfe2a022f418bbaccec193e1a09d41structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7986804/v1/af08edac5b73a8e8a2644668.xml"},{"id":96556374,"identity":"6cc220da-b575-4211-bb8e-02e39841dca8","added_by":"auto","created_at":"2025-11-23 11:46:17","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":122956,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7986804/v1/234446760231a53b649c5be2.html"},{"id":96556362,"identity":"902e0b63-590d-4107-a562-6b0814ff5b93","added_by":"auto","created_at":"2025-11-23 11:46:16","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":35791,"visible":true,"origin":"","legend":"\u003cp\u003eFlow-chart of participants\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7986804/v1/5e15edf866c743297f282ca0.png"},{"id":96556363,"identity":"00937e53-60e8-4c36-a96c-3f79034b3432","added_by":"auto","created_at":"2025-11-23 11:46:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":46587,"visible":true,"origin":"","legend":"\u003cp\u003eSelf-reported areas of difficulty among participants (\u003cem\u003en\u003c/em\u003e = 108), rated from 0 to 4 in each domain. The x-axis shows the combined total score, with higher values indicating greater self-perceived difficulties related to COVID-19. Each line on the y-axis represents an individual participant.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7986804/v1/ba56eaded032029fd8b801f7.png"},{"id":96556367,"identity":"2e1b6dff-d187-4cc7-8d8d-d9ffa4c0e6c5","added_by":"auto","created_at":"2025-11-23 11:46:16","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":69896,"visible":true,"origin":"","legend":"\u003cp\u003eFig. 2\u003cstrong\u003e \u003c/strong\u003eSelf-reported levels of depression (\u003cem\u003en\u003c/em\u003e = 103) at the 3-month, 1-year, and 2-year follow-ups, with the number of participants in each category at each time point.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7986804/v1/4c014aeec80248b1d9e00c33.jpeg"},{"id":96604799,"identity":"f702ccaf-a241-4a0f-8336-5c777a31c23d","added_by":"auto","created_at":"2025-11-24 09:15:05","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":77754,"visible":true,"origin":"","legend":"\u003cp\u003eFig. 3 Self-reported levels of anxiety (\u003cem\u003en\u003c/em\u003e= 103) at the 3-month, 1-year, and 2-year follow-ups, with the number of participants in each category at each time point.\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7986804/v1/f091dd41d74c3e253d14040e.jpeg"},{"id":107350767,"identity":"8cfb145d-bef4-45d3-98b8-0ff3ddfa82c5","added_by":"auto","created_at":"2026-04-20 16:03:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":912958,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7986804/v1/6398a35d-7efe-4195-8653-d2fd9da4b323.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Self-reported Anxiety, Depression, and Health-Related Quality of Life during Two Years Following Hospitalization for COVID-19: A longitudinal study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCoronavirus disease 2019 (COVID-19) is a communicable respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) \u003csup\u003e1\u003c/sup\u003e. Vaccines and improved treatments have reduced the burden of acute COVID-19 \u003csup\u003e1\u003c/sup\u003e].\u003c/p\u003e\u003cp\u003ePost COVID condition is estimated to affect millions worldwide \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. According to the WHO\u0026rsquo;s definition, Post COVID condition is characterized by new or persistent symptoms that appear 3 months after the initial infection, persist for at least 2 months, and cannot be explained by other causes \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Commonly reported symptoms include fatigue, breathlessness, and cognitive impairment, all of which reduce quality of life \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Individuals who have required hospitalization for COVID-19 have been shown to be more prone to long-term effects of the disease and tend to recover more slowly \u003csup\u003e\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Additionally, a decline in health-related quality of life (HRQoL) has been described in patients up to 6 months following hospitalization for COVID-19 \u003csup\u003e7\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003ePrevious studies have reported anxiety and depression as persistent symptoms following COVID-19 \u003csup\u003e8\u0026ndash;12\u003c/sup\u003e]. A higher prevalence of anxiety has been observed among females, younger individuals, and those not hospitalized during the acute phase \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. An increased burden of depression and anxiety over time after COVID-19 hospitalization has also been documented \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. In previously hospitalized individuals (the same cohort as the present study), 28% reported symptoms of anxiety and 24% reported symptoms of depression \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Moreover, post-COVID depression and anxiety have been linked to a decline in health-related quality of life (HRQoL) \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Understanding factors associated with long-term anxiety and depression after COVID-19 may help to improve long-term quality of life.\u003c/p\u003e\u003cp\u003eThe aim of the study was to longitudinally explore self-reported symptoms of anxiety, depression, and associated factors of HRQoL during 2 years after hospital-treated COVID-19, and to compare differences based on age, sex, and initial disease severity.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and participants\u003c/h2\u003e\u003cp\u003eThis prospective longitudinal study included individuals hospitalized for COVID-19, with the first assessment conducted at hospital discharge, with follow-ups at 3 months, 1 year, and 2 years. Participants comprised of the longitudinal Life in the Time of COVID Study in Gothenburg (GOT-LOCO) cohort \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e, for which participants were enrolled consecutively from five hospitals in the V\u0026auml;stra G\u0026ouml;taland region of Sweden between July 2020 and February 2021.\u003c/p\u003e\u003cp\u003eInclusion criteria were age\u0026thinsp;\u0026ge;\u0026thinsp;18 years at the time of inclusion, hospitalization for COVID-19, noncontagious when included, at least 5 days of hospital care for COVID-19, and living independently in the community prior to admission. Exclusion criteria included inability to provide informed consent, severe comorbidities with an anticipated life expectancy of less than 1 year and not being a Swedish resident.\u003c/p\u003e\u003cp\u003eAll participants received both written and oral information about the study. Prior written informed consent was obtained. The study followed the ethical principles of the Declaration of Helsinki and was approved by the Swedish Ethical Review Authority (ref. no. 2020\u0026ndash;03046, 2020\u0026ndash;03922, 2021\u0026thinsp;\u0026minus;\u0026thinsp;00444 and 2021\u0026ndash;03556). The manuscript was prepared in accordance with the STROBE guidelines \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eClinical characteristics\u003c/h2\u003e\u003cp\u003eClinical characteristics from the hospital stay were extracted from medical records and included length of stay, ICU admission, comorbidities, and COVID-19 severity (dichotomized as moderate or severe) using the WHO Clinical Progression Scale. Moderate infection corresponds to scores of 4\u0026ndash;5, and severe infection to scores of 6\u0026ndash;9 \u003csup\u003e16\u003c/sup\u003e. Comorbidities were categorized according to the ICD-10 version of the Charlson Comorbidity Index (CCI) \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e, and classified as none, mild (one comorbidity), or severe (two or more comorbidities).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eThree-month data collection\u003c/h3\u003e\n\u003cp\u003eAt the 3-month follow-up, participants completed patient reported outcome measures (PROMs) during a scheduled telephone follow-up conducted by a research nurse, trained for the study. PROMs included self-reported symptoms of anxiety and depression, using the Hospital Anxiety and Depression Scale (HADS). Anxiety and depression scores both range from 0 to 21, with higher scores indicating greater distress. Scores\u0026thinsp;\u0026le;\u0026thinsp;7 are considered normal, 8\u0026ndash;10 elevated, and \u0026ge;\u0026thinsp;11 concerning, and in the present study a subscore of \u0026ge;\u0026thinsp;8 was used as a proxy for anxiety and / or depression \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. PROMs were sent to participants in advance to allow preparation and the opportunity to ask questions during the follow-up.\u003c/p\u003e\n\u003ch3\u003eOne-year data collection\u003c/h3\u003e\n\u003cp\u003eIn addition to HADS, the EuroQol-5 Dimension (EQ-5D) was used to self-report HRQoL across five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, each rated on three levels (1\u0026thinsp;=\u0026thinsp;no problems, 2\u0026thinsp;=\u0026thinsp;some problems, 3\u0026thinsp;=\u0026thinsp;extreme problems). A response level of \u0026ge;\u0026thinsp;2 on any dimension was used as a proxy for reduced HRQoL. The EQ Visual Analogue Scale (VAS) measures overall health from 0 (\u0026ldquo;worst imaginable health state\u0026rdquo;) to 100 (\u0026ldquo;best imaginable health state\u0026rdquo;). Responses are combined into an EQ-5D index ranging from \u0026minus;\u0026thinsp;0.594 to 1.0, with higher numbers indicating better HRQoL [21]. The PROMs were sent by mail or digitally, with at least one reminder sent via text message if no response was received.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eTwo-year data collection\u003c/h2\u003e\u003cp\u003eAt the 2-year follow-up, participants again completed HADS and EQ-5D. PROMs were distributed by mail or digitally, followed by a text-message reminder. Additional questions were included regarding patient characteristics and COVID-19\u0026ndash;related information. Participants also rated the level of difficulty experienced in various domains: activity, transferring, pain and sensitivity, bowel function, smell and taste, swallowing, vision, sleep, voice, cardiac function, skin, and recurrence of fever. Responses were recorded on a Likert scale from 0 (no difficulties) to 4 (severe difficulties).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eDemographic data are presented as percentages, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), or median and interquartile range (IQR), as appropriate. The level of statistical significance was set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.05. Group comparisons were conducted based on sex, age group (\u0026ge;\u0026thinsp;65 or \u0026lt;\u0026thinsp;65 years), and COVID-19 severity (moderate or severe). Dropout analyses were performed using the chi-square test and the Mann\u0026ndash;Whitney U-test.\u003c/p\u003e\u003cp\u003eThe Friedman test was used to evaluate changes across the three follow-up time points, and the Wilcoxon signed-rank test was applied for pairwise comparisons between time points. For longitudinal analyses, only individuals who participated in the assessments at 3 months, 1-year and 2-year follow-ups were eligible to be included (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;111). Due to internal dropouts, the number of participants in each analysis varies. The Z-value in the shift analysis represents standardized differences between the distributions of the groups.\u003c/p\u003e\u003cp\u003eMultivariable linear regression analysis was used to examine relationship with HRQoL 2 years after COVID-19. The EQ-5D index was used as the dependent variable. Potential independent variables included age, sex, COVID-19 severity (moderate/severe), ICU treatment (yes/no), total length of hospital stay (days), and comorbidities (none/mild/severe). Assumptions for linear regression\u0026mdash;normality, linearity, absence of multicollinearity, and lack of influential cases\u0026mdash;were assessed. Initial analyses included scatterplots for continuous data and boxplots for categorical data. Multicollinearity was assessed using Spearman correlation (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.7).\u003c/p\u003e\u003cp\u003eAll analyses were conducted using SPSS Statistics version 28 (IBM Corporation, Armonk, NY, USA). Microsoft Excel and SankeyMATIC.com were used for visual presentations.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 211 participants were enrolled in the GOT-LOCO study. Of these, 168 participated in the 3-month follow-up, 169 in the 1-year follow-up, and 125 in the 2-year follow-up (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Of the 211 participants, a total of 111 participants completed follow-ups at 3 months, 1 year and 2 years. No significant differences were found between participants (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;111) and nonparticipants (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;83) in terms of sex, COVID-19 severity, level of hospital care (ICU yes/no), or length of hospital stay. However, the mean age was higher in participants (66\u0026thinsp;\u0026plusmn;\u0026thinsp;11) than in nonparticipants (62\u0026thinsp;\u0026plusmn;\u0026thinsp;15; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e\n\u003cp\u003eAmong the 125 participants in the 2-year follow-up, 68% (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;85) were men. The vast majority, 96% (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;118), reported having received at least one or more doses of COVID-19 vaccine since their hospitalization. Two-thirds of the participants (62%, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;77) lived in a shared household, and over one-third (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;45) required assistance with daily activities. Additionally, 17% (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;21) reported ongoing rehabilitation for COVID-19\u0026ndash;related impairments 2 years after discharge (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eCharacteristics of participants at the 2-year follow up.n\u0026thinsp;=\u0026thinsp;125.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"12\" align=\"left\"\u003e\n\u003cp\u003eAt hospital discharge\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAge, years, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e66\u0026thinsp;\u0026plusmn;\u0026thinsp;12\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSex, male, number (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e85 (68)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eLOS, days, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e32\u0026thinsp;\u0026plusmn;\u0026thinsp;32\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTreated at ICU, number (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e64 (51)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e- LOS in ICU, number (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e19\u0026thinsp;\u0026plusmn;\u0026thinsp;19\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCOVID severity, number (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e- Moderate\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e37 (30)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e- Severe\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e88\u0026nbsp;(70)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCCI, number (%), \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;124\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e- None\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e45 (36)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e- Mild\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e59 (48)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e- Severe\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e20 (16)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"11\" align=\"left\"\u003e\n\u003cp\u003eAt the 2-year follow-up\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDependent on ADL assistance, number (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45 (36)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLiving situation, number (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e- Alone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e48 (38)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e- Shares household with another adult\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e62\u0026nbsp;(50)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e- Shares household with children\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12 (10)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e- Shares household with both children and another adult\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (2)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVaccination, number (%), \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;123\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e- No\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (4)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e- Yes (number of doses unknown)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (2)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e- Yes, two doses\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12 (10)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e- Yes, multiple doses\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e104 (84)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eAbbreviations: ADL activities of daily living, \u003cem\u003eCCI\u003c/em\u003e Charlson comorbidity index: none\u0026thinsp;=\u0026thinsp;0, mild\u0026thinsp;=\u0026thinsp;1\u0026ndash;2, severe\u0026thinsp;=\u0026thinsp;\u0026ge;\u0026thinsp;3, \u003cem\u003eICU\u003c/em\u003e intensive care unit, \u003cem\u003eLOS\u003c/em\u003e length of hospital stay, SD standard deviation COVID severity is reported according to the WHO Clinical Progression Scale \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e].\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAt the 2-year follow-up, the most self-reported difficulties were related to the domains: transferring (21%, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;26), activity (20%, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;25), and pain and sensitivity (19%, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;24). A small number of participants (n\u0026thinsp;=\u0026thinsp;8) reported a high symptom burden (\u0026gt;\u0026thinsp;25), while there were no participants who reported not having symptoms at all (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThirty percent of participants (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;37) reported symptoms of anxiety, and 24% (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;29) reported symptoms of depression at the 2-year follow-up. No significant differences in self-reported anxiety or depression were found based on sex or age (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Participants with moderate initial COVID-19 severity reported levels of anxiety higher than those reported by individuals hospitalized with severe COVID-19 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.031). Regarding HRQoL, participants with moderate initial COVID-19 also reported higher levels of pain and discomfort than those reported by individuals hospitalized with severe COVID-19 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.039). A significant difference was also observed between participants over and under 65 years of age regarding mobility difficulties, where older individuals reported mobility difficulties to a higher extent (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001).\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eOutcomes of self-reported anxiety, depression, and health-related quality of life at 2 years after COVID-19, depending on sex, age, and COVID severity.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eOutcome\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOverall\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;125\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eSex\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eAge (years)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eSeverity\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e=\u0026thinsp;85\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e=\u0026thinsp;40\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026ge;\u0026thinsp;65\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e=\u0026thinsp;53\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;65\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e=\u0026thinsp;72\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eModerate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e=\u0026thinsp;37\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSevere\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u0026thinsp;\u003cstrong\u003e=\u0026thinsp;88\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHADS-A\u003c/p\u003e\n\u003cp\u003escore \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;122\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMedian (IQR)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (1\u0026ndash;8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (1\u0026ndash;8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (2\u0026ndash;8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.638\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (1\u0026ndash;8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (1\u0026ndash;9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.521\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 (8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.031\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHADS-D score \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;122\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMedian (IQR)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (1\u0026ndash;7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (1\u0026ndash;8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.5 (1\u0026ndash;5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.487\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (1\u0026ndash;7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (1-7.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.956\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (2\u0026ndash;8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (1\u0026ndash;7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.095\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEQ5D\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMobility\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;123\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMedian (IQR)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.158\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.214\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSelf-care\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;123\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMedian (IQR)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1\u0026ndash;1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1\u0026ndash;1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1\u0026ndash;1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.894\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1\u0026ndash;1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1\u0026ndash;1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.173\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1\u0026ndash;1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1\u0026ndash;1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.468\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eActivity\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;122\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMedian (IQR)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.287\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.692\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.629\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePain /\u003c/p\u003e\n\u003cp\u003ediscomfort\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;121\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMedian (IQR)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.486\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.076\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (2\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.039\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAnxiety /\u003c/p\u003e\n\u003cp\u003edepression\u003c/p\u003e\n\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;123\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMedian (IQR)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.105\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.384\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.161\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEQ-VAS (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMedian (IQR) \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;105\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e62\u003c/p\u003e\n\u003cp\u003e(45\u0026ndash;80)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e62,5\u003c/p\u003e\n\u003cp\u003e(45\u0026ndash;80)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e61\u003c/p\u003e\n\u003cp\u003e(40\u0026ndash;89)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.863\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e61\u003c/p\u003e\n\u003cp\u003e(45\u0026ndash;80)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e65\u003c/p\u003e\n\u003cp\u003e(47\u0026ndash;80)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.784\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003cp\u003e(50\u0026ndash;80)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e63.5\u003c/p\u003e\n\u003cp\u003e(40\u0026ndash;80)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.704\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\nSignificant \u003cem\u003eP\u003c/em\u003e-values are presented in bold. \u003cstrong\u003eAbbreviations\u003c/strong\u003e: \u003cem\u003eA\u003c/em\u003e anxiety, \u003cem\u003eD\u003c/em\u003e depression, \u003cem\u003eEQ5D\u003c/em\u003e EuroQol-5 Dimension, \u003cem\u003eEQ-VAS\u003c/em\u003e EuroQol Visual Analogue Scale, \u003cem\u003eHADS\u003c/em\u003e Hospital anxiety and depression scale.\u003c/div\u003e\n\u003cp\u003eHealth-related quality of life declined slightly between the 1- (median 0.88) and 2-year (median 0.86) follow-ups- with lower EQ-5D index (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.046) with increased proportions of participants reporting moderate problems in mobility, self-care, and usual activities (\u003cstrong\u003eTable\u0026nbsp;3).\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003eTable\u0026nbsp;3 Health-related quality of life at 1 and 2 years after COVID-19\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Taba\" style=\"width: 350.819px;\" border=\"1\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth style=\"width: 428.611px;\" colspan=\"10\" align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 30px;\" colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 40px;\" colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e1-year\u003c/p\u003e\n\u003cp\u003efollow-up\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 358.611px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e2-year\u003c/p\u003e\n\u003cp\u003efollow-up\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 30px;\" colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 40px;\" colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;117\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 358.611px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;123\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 30px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEQ5D\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 40px;\" colspan=\"4\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 358.611px;\" colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 30px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eEQ5D Index,\u003c/p\u003e\n\u003cp\u003eMedian (IQR)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 40px;\" colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e0.88 (0.79\u0026ndash;93)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 358.611px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.86 (0.75\u0026ndash;0.93)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 30px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMobility\u003c/strong\u003e, %\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 40px;\" colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;114\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 358.611px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;120\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 30px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eModerate problems\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 40px;\" colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e43.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 358.611px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e49.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 30px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eExtreme problems\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 40px;\" colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 358.611px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 30px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSelf-care\u003c/strong\u003e, %\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 40px;\" colspan=\"4\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 358.611px;\" colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 30px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eModerate problems\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 40px;\" colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e6.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 358.611px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e13.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 30px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eExtreme problems\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 40px;\" colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 358.611px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 30px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eUsual Activity\u003c/strong\u003e, %\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 40px;\" colspan=\"4\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 358.611px;\" colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 30px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eModerate problems\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 40px;\" colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e20.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 358.611px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e34.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 30px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eExtreme problems\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 40px;\" colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e2.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 358.611px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e1.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 30px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePain/Discomfort\u003c/strong\u003e, %\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 40px;\" colspan=\"4\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 358.611px;\" colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 30px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eModerate problems\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 40px;\" colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e56.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 358.611px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e53.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 30px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eExtreme problems\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 40px;\" colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e9.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 358.611px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e12.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 30px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAnxiety/Depression\u003c/strong\u003e, %\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 40px;\" colspan=\"4\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 358.611px;\" colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 30px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eModerate problems\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 40px;\" colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e35.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 358.611px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e39.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 30px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eExtreme problems\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 40px;\" colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e3.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 358.611px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e4.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 30px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eVAS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 40px;\" colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;108\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 358.611px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;105\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 30px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eMedian (IQR)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 40px;\" colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e70 (53\u0026ndash;85)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 358.611px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e62 (45\u0026ndash;80)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 30px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eMean (SD)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 40px;\" colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e68\u0026thinsp;\u0026plusmn;\u0026thinsp;20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 358.611px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e64\u0026thinsp;\u0026plusmn;\u0026thinsp;20\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eData are presented as count and percentages (\u003cem\u003en\u003c/em\u003e, %).\u003c/p\u003e\n\u003cp\u003eAbbreviations: \u003cem\u003eEQ-5D\u003c/em\u003e EuroQol-5 Dimension, \u003cem\u003eEQ-VAS\u003c/em\u003e EuroQol-Visual Analog Scale.\u003c/p\u003e\n\n\u003cdiv class=\"colspec\" align=\"left\"\u003eSelf-reported symptoms of depression were low 3 months after hospital discharge (median 2, IQR 1-5) but increased for some participants throughout the follow-up period (1 year: median.3 IQR 1-7, year 2: median 3 IQR 1-7.5) Longitudinal analyses showed significant change in symptoms of depression during the study period (\u003cem\u003ep \u003c/em\u003e= 0.014). Pairwise comparisons showed a significant increase in depressive symptoms from 3 months to 1 year (Z = \u0026ndash;2.913, p = 0.004) and from 3 months to 2 years (Z = \u0026ndash;2.726, p = 0.006), indicating a worsening trend during the first-year post discharge. However, no significant difference was found between 1 and 2 years (Z = \u0026ndash;0.677, p = 0.498) (Fig. 2).\u003c/div\u003e\n\u003cp class=\"colspec\" align=\"left\"\u003eSelf-reported anxiety levels remained largely stable over the follow-up period: 3 months (median: 4, IQR: 1\u0026ndash;7), 1 year (median: 4, IQR: 1\u0026ndash;8), and 2 years (median: 4, IQR: 2\u0026ndash;8) after hospital discharge. No statistically significant difference was observed across the time points (\u003cem\u003ep\u003c/em\u003e = 0.535). These results are visualized in Fig. 3.\u003c/p\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\n\u003cp\u003eOlder age was significantly associated with lower EQ-5D index 2 years after hospital-treated COVID-19 (B = \u0026ndash;0.003, 95% CI [\u0026ndash;0.004, \u0026ndash;0.001], p = 0.010), indicating that older participants reported lower HRQoL. Sex, COVID-19 severity, ICU admission, comorbidities, and hospital length of stay did not contribute significantly to the model (Table 4).\u003c/p\u003e\n\u003c/div\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003e, Explanatory factors associated with health-related quality of life 2 years after COVID-19 infection (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;116)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eUnstandardized coefficients\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e95% CI for (B)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStd. Error\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLower\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUpper\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSex\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemales (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;0.037\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.025\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.140\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;0.087\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.012\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge, years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;0.003\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.010\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;0.004\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCovid severity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eModerate (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.007\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.033\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.832\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;0.059\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.073\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eICU\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo ICU (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;0.014\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.032\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.668\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;0.077\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.050\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eComorbidities\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;0.005\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.593\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;0.022\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.013\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLength of hospital stay\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.239\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\" align=\"left\"\u003e\n\u003cp\u003eReference categories are shown for categorical variables. Continuous variables (age, comorbidities, and hospital stay) were entered as linear terms. \u003cem\u003eB\u003c/em\u003e unstandardized coefficient.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this longitudinal study, self-reported symptoms of anxiety were normal and unchanged during 2 years after COVID-19 infection. Self-reported symptoms of depression were initially low, increased during the first year but were stable thereafter, within normal levels. Older age was significantly associated with lower HRQoL 2 years after COVID-19. Individuals who experienced moderate disease reported higher levels of anxiety, pain, and discomfort than did those with severe illness.\u003c/p\u003e\n\u003cp\u003eThis finding contrasts with previous research that reported individuals with severe COVID-19 had more anxiety than less severe cases \u003csup\u003e22\u003c/sup\u003e[. Why individuals with moderate COVID-19 report higher levels of anxiety, pain, and discomfort remains unclear. One possible explanation is post-traumatic growth (PTG) among individuals who experienced severe COVID-19. PTG refers to positive psychological change, such as increased personal strength and altered life priorities,\u0026nbsp;\u003csup\u003e23\u003c/sup\u003e. Evidence of PTG in COVID-19 survivors has been documented from days after hospital discharge up to 1 year post\u0026nbsp;\u003csup\u003e22,24,25\u003c/sup\u003e.\u0026nbsp;Another possible explanation could be that individuals with severe COVID-19 may have received more rehabilitation and support, including tools and strategies to manage their symptoms, from healthcare services. Previous research has also highlighted the crucial role of hospital care for mental and emotional outcomes, emphasizing the importance of feeling supported by the healthcare system as a protective factor for mental health\u0026nbsp;\u003csup\u003e26\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eOverall, 30% of participants continued to experience symptoms of anxiety 2 years after COVID-19. No significant differences in anxiety were found based on sex or age, which contrasts with previous research showing higher anxiety levels among women \u003csup\u003e26,27\u003c/sup\u003e. In this cohort, men reported\u0026nbsp;higher median symptoms of anxiety than the general population, while women’s scores were similar to their population norms\u0026nbsp;\u003csup\u003e27\u003c/sup\u003e. However, it is important to note that anxiety levels prior to infection were unknown. This reversal of the commonly observed sex pattern warrants further research and clinical attention.\u003c/p\u003e\n\u003cp\u003eLike the scores for anxiety, the 2-year median scores concerning depression resembled those reported in the general Swedish population, in both men and women \u003csup\u003e27\u003c/sup\u003e. This suggests that depressive symptoms are lower during the early recovery phase, perhaps as a result of the post-traumatic life event of being hospitalized for COVID-19 and eventually return to levels similar to the population norm.\u003c/p\u003e\n\u003cp\u003eHRQoL 2 years after COVID-19 revealed that older individuals more frequently reported mobility problems, consistent with age-related expectations \u003csup\u003e28\u003c/sup\u003e. In comparison with the median values of the general Swedish population, higher levels of mobility problems were reported by the COVID-19 cohort. For example, compared with 10% of the general population, 50% of participants in this cohort reported moderate mobility problems \u003csup\u003e29\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNotably, participants who had experienced moderate initial COVID-19 severity reported significantly more pain and discomfort than those with severe illness (\u003cem\u003ep\u003c/em\u003e = 0.039). Although this study did not examine potential associations between moderate COVID-19 severity, elevated anxiety, and increased pain and discomfort, such connections may be important. Around half of the participants reported moderate pain and discomfort, and one in ten reported extreme problems — both slightly higher than in the general population \u003csup\u003e29\u003c/sup\u003e. That pain/discomfort are commonly affected domains after COVID-19 has recently been confirmed by a review article \u003csup\u003e30\u003c/sup\u003e. The high prevalence of pain and discomfort among individuals previously hospitalized with COVID-19 may be relevant for a wide range of healthcare professionals, including those who regularly encounter this patient group or work with pain management.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe regression model identified older age as significantly associated with lower HRQoL 2 years after hospitalization for COVID-19, independent of sex, initial disease severity, ICU admission, comorbidities, or length of hospital stay. This suggests that COVID-19 may have lasting impacts on older individuals regardless of pre-existing health status. The natural decline in fitness with ageing should be considered \u003csup\u003e28\u003c/sup\u003e but does not lessen the impact that COVID-19 has on the older population \u003csup\u003e31\u003c/sup\u003e. Together, these findings highlight the importance of long-term follow-up and targeted interventions to support older adults in their recovery after severe COVID-19.\u003c/p\u003e\n\u003cp\u003eThe strengths of this study include its longitudinal design, which followed hospitalized participants over a 2-year period. This approach allowed observation of changes in symptoms, anxiety, depression, and self-reported HRQoL. These outcomes were reported using well-established PROMs. As this study used a consecutive inclusion process, some caution is warranted when generalizing the findings: certain individuals hospitalized for COVID-19 were overlooked during inclusion, mainly because of heavy workloads in the clinics. The risk of reporting bias also needs to be taken into consideration, as this study relies on PROMs.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSymptoms of anxiety remained generally within the normal range throughout the two-year follow-up after hospital-treated COVID-19. Symptoms of depression were lower at 3 months after hospitalization but subsequently stabilized at a higher, yet still normal, level. At two years after COVID-19, lower HRQoL was associated with older age, highlighting the importance of addressing age-related vulnerabilities in long-term follow-up care.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eConfidence interval (CI), EuroQol-5 Dimension (EQ-5D), Hospital anxiety and depression scale (HADS), Health related quality of life (HRQoL), Intensive care unit (ICU), Inter quartile range (IQR) Length of hospital stay (LOS), standard deviation (SD), patient reported outcome measures (PROMs), post traumatic growth (PTG), Visual analog scale (VAS).\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval:\u003c/strong\u003e\u003cp\u003eThe Swedish Ethical Review Authority approved this study (DNR 2020\u0026ndash;03046), along with subsequent amendments (DNR 2020\u0026ndash;03922, DNR 2021\u0026ndash;03556, and DNR 2021\u0026thinsp;\u0026minus;\u0026thinsp;00444). All procedures complied with local legislation and institutional regulations.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent to participate\u003c/em\u003e:\u003c/strong\u003e\u003cp\u003e Written informed consent as well as consent for publication was obtained from all participants prior to inclusion in the study.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eThe authors acknowledge financial support for the research, authorship, and/or publication of this article. Funding was provided through grants from the Swedish state under the ALF agreement between the Swedish government and the county councils (ALFGBG 977727, 992228, 942914, and 965653), V\u0026auml;stra G\u0026ouml;taland regional research funding (VGFOUREG 940508, 969267), Forte/Formas (2020\u0026ndash;02775), the Sahlgrenska University Hospital research funds (SU-961951), and AFA Insurance (Grant number 200324).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eACL: Conceptualization, formal analysis, visualization, drafting of the original manuscript, and review and editing. RA: Review and editing. LR: Supervision, review, and editing. AP: Conceptualization, funding acquisition, methodology, supervision, and review and editing. HCP: Conceptualization, data curation, funding acquisition, methodology, project administration, supervision, and review and editing.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to thank the participants for their contribution to this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData are available from the authors upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. \u003cem\u003eCoronavirus disease (COVID-19)\u003c/em\u003e, (2023). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/coronavirus-disease-(covid-19)\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/coronavirus-disease-(covid-19)\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. \u003cem\u003eStatement\u0026ndash;36 million people across the European Region may have developed long COVID over the first 3 years of the pandemic\u003c/em\u003e, \u0026lt; (2023). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/azerbaijan/news/item/27-06-2023-statement---36-million-people-across-the-european-region-may-have-developed-long-covid-over-the-first-3-years-of-the-pandemic\u003c/span\u003e\u003cspan address=\"https://www.who.int/azerbaijan/news/item/27-06-2023-statement---36-million-people-across-the-european-region-may-have-developed-long-covid-over-the-first-3-years-of-the-pandemic\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. 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Virol.\u003c/em\u003e \u003cb\u003e95\u003c/b\u003e, e28852. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/jmv.28852\u003c/span\u003e\u003cspan address=\"10.1002/jmv.28852\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"COVID-19, HRQoL, rehabilitation, recovery of function, hospitals, anxiety, depression, Post-Acute COVID-19 Syndrome","lastPublishedDoi":"10.21203/rs.3.rs-7986804/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7986804/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction:\u003c/p\u003e\u003cp\u003eCoronavirus disease 2019 (COVID-19) is a respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Health-related quality of life (HRQoL) has been observed to decline after COVID-19 hospitalization, with anxiety and depression contributing to reduced HRQoL and emphasizing the need for research on long-term outcomes.\u003c/p\u003e\u003cp\u003eThe aim of the study was to longitudinally explore self-reported symptoms of anxiety, depression, and associated factors of HRQoL during 2 years after hospital-treated COVID-19, and to compare differences based on age, sex, and initial disease severity.\u003c/p\u003e\u003cp\u003eMethods:\u003c/p\u003e\u003cp\u003e Participants were included from the Life in the Time of COVID study in Gothenburg, comprising individuals hospitalized with COVID-19 during the first and second waves of the pandemic in Sweden. This prospective study includes follow-ups at 3 months, 1 year, and 2 years after discharge, using patient-reported outcomes assessing symptoms of anxiety, depression, HRQoL, and clinical data.\u003c/p\u003e\u003cp\u003eResults:\u003c/p\u003e\u003cp\u003eThe study comprised 125 participants, of whom 111 were eligible for longitudinal analysis. Two years after COVID-19, individuals with initial moderate infection reported higher levels of anxiety (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.031) and pain/discomfort (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.039) than did those with severe infection. Symptoms of anxiety did not change significantly over the study period. Depressive symptoms increased significantly worse between 3 and 12 months after COVID-19 (Z = \u0026minus;\u0026thinsp;2.957, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003). Older age was significantly associated with lower HRQoL (B = \u0026minus;\u0026thinsp;0.003, 95% CI [\u0026ndash;0.004, \u0026minus;\u0026thinsp;0.001], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.010).\u003c/p\u003e\u003cp\u003eConclusions:\u003c/p\u003e\u003cp\u003eSymptoms of anxiety remained generally within the normal range throughout the two-year follow-up after hospital-treated COVID-19. Symptoms of depression were lower at 3 months after hospitalization but subsequently stabilized at a higher, yet still normal, level. At two years after COVID-19, lower HRQoL was associated with older age, highlighting the importance of addressing age-related vulnerabilities in long-term follow-up care.\u003c/p\u003e","manuscriptTitle":"Self-reported Anxiety, Depression, and Health-Related Quality of Life during Two Years Following Hospitalization for COVID-19: A longitudinal study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-23 11:46:12","doi":"10.21203/rs.3.rs-7986804/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-20T17:46:43+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-16T23:08:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"124734644451387930771316885576718836903","date":"2025-12-15T16:14:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"34725020737323150771392210769932883916","date":"2025-12-10T17:32:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-03T16:20:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"141578917121222956766259669668584002165","date":"2025-11-11T20:15:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-11T20:13:11+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-04T09:13:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-03T11:15:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-03T11:15:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-10-30T08:16:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5a69d4d3-853a-44f6-b52a-21877ab9e311","owner":[],"postedDate":"November 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":58099536,"name":"Health sciences/Diseases"},{"id":58099537,"name":"Health sciences/Health care"},{"id":58099538,"name":"Health sciences/Medical research"},{"id":58099539,"name":"Biological sciences/Psychology"},{"id":58099540,"name":"Social science/Psychology"},{"id":58099541,"name":"Health sciences/Signs and symptoms"}],"tags":[],"updatedAt":"2026-04-20T16:01:30+00:00","versionOfRecord":{"articleIdentity":"rs-7986804","link":"https://doi.org/10.1038/s41598-026-48440-3","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2026-04-17 15:58:28","publishedOnDateReadable":"April 17th, 2026"},"versionCreatedAt":"2025-11-23 11:46:12","video":"","vorDoi":"10.1038/s41598-026-48440-3","vorDoiUrl":"https://doi.org/10.1038/s41598-026-48440-3","workflowStages":[]},"version":"v1","identity":"rs-7986804","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7986804","identity":"rs-7986804","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}