Engelmann Petra, Reinke Max, Stein Clara, Salzmann Stefan, Löwe Bernd, Toussaint Anne, Shedden-Mora Meike
Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Division of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany.
EClinicalMedicine. 2024 Jul 26;74:102756. doi: 10.1016/j.eclinm.2024.102756. eCollection 2024 Aug.
Despite the immense impact of Long COVID on public health and those affected, its aetiology remains poorly understood. Findings suggest that psychological factors such as depression contribute to symptom persistence alongside pathophysiological mechanisms, but knowledge of their relative importance is limited. This study aimed to synthesise the current evidence on psychological factors potentially associated with Long COVID and condition-relevant outcomes like quality of life.
In this systematic review and meta-analysis, MEDLINE, PsycINFO, and the Cochrane Database of Systematic Reviews were searched for peer-reviewed studies published in English from 2019 to January 2, 2024. Studies providing cross-sectional or longitudinal data on the association between at least one psychological variable and the presence of Long COVID (primary outcome) or condition-relevant secondary outcomes (symptom severity, impairment, quality of life, and healthcare utilisation) were included. Psychological constructs with at least five comparisons were pooled as odds ratio (OR) for categorical data and standardised mean difference (SMD) for continuous data in random-effects meta-analyses of cross-sectional studies with control groups. This review is registered with PROSPERO, CRD42023408320.
113 studies (n = 312,831 patients with Long COVID) provided data on at least one psychological variable, 63 in cross-sectional group comparisons, 53 in cross-sectional associations, and 18 longitudinal. Most reported findings related to depression and anxiety, and - less frequently - to physical activity, posttraumatic stress disorder, stress, and history of mental illness. Depression (OR 2.35; 95% CI, 1.49-3.70) and anxiety (OR 2.53; 95% CI, 1.76-3.61) were significantly associated with Long COVID and higher in affected patients than controls (depression: SMD 0.88; 95% CI, 0.66-1.11; anxiety: SMD 0.74; 95% CI, 0.50-0.99), while results for physical activity and stress were non-significant. In most prospective studies, the investigated psychological constructs significantly predicted Long COVID.
Evidence suggests depression and anxiety to be co-occurring phenomena and predictive factors of Long COVID. Future studies should prospectively investigate psychological constructs such as emotion regulation or dysfunctional symptom expectations, which are well-known risk factors and therapeutic targets of persistent somatic symptoms in other medical conditions, but are so far understudied in Long COVID.
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尽管长新冠对公众健康及患者产生了巨大影响，但其病因仍知之甚少。研究结果表明，诸如抑郁等心理因素与病理生理机制共同导致症状持续存在，但其相对重要性的相关知识有限。本研究旨在综合当前关于可能与长新冠相关的心理因素以及生活质量等疾病相关结局的证据。
在这项系统评价和荟萃分析中，检索了MEDLINE、PsycINFO和Cochrane系统评价数据库，以查找2019年至2024年1月2日期间以英文发表的同行评审研究。纳入提供至少一个心理变量与长新冠的存在（主要结局）或疾病相关次要结局（症状严重程度、功能损害、生活质量和医疗保健利用）之间关联的横断面或纵向数据的研究。在有对照组的横断面研究的随机效应荟萃分析中，将至少有五次比较的心理结构合并为分类数据的优势比（OR）和连续数据的标准化均值差（SMD）。本综述已在PROSPERO注册，注册号为CRD42023408320。
113项研究（n = 312831例长新冠患者）提供了至少一个心理变量的数据，其中63项为横断面组比较，53项为横断面关联，18项为纵向研究。大多数报告的结果与抑郁和焦虑有关，较少与身体活动、创伤后应激障碍、压力和精神疾病史有关。抑郁（OR 2.35；95%CI，1.49 - 3.70）和焦虑（OR 2.53；95%CI，1.76 - 3.61）与长新冠显著相关，且在受影响患者中高于对照组（抑郁：SMD 0.88；95%CI，0.66 - 1.11；焦虑：SMD 0.74；95%CI，0.50 - 0.99），而身体活动和压力的结果不显著。在大多数前瞻性研究中，所调查的心理结构显著预测了长新冠。
有证据表明抑郁和焦虑是长新冠的并发现象和预测因素。未来的研究应前瞻性地调查情绪调节或功能失调的症状预期等心理结构，这些是其他医疗状况中持续性躯体症状的已知风险因素和治疗靶点，但在长新冠中迄今研究较少。
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