{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T05:46:36Z","timestamp":1793166396667,"version":"4.5.0"},"reference-count":63,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Psychiatry"],"published-print":{"date-parts":[[2022,11,1]]},"abstract":"<jats:sec id=\"ab-yoi220056-4\"><jats:title>Importance<\/jats:title><jats:p>Few risk factors for long-lasting (\u22654 weeks) COVID-19 symptoms have been identified.<\/jats:p><\/jats:sec><jats:sec id=\"ab-yoi220056-5\"><jats:title>Objective<\/jats:title><jats:p>To determine whether high levels of psychological distress before SARS-CoV-2 infection, characterized by depression, anxiety, worry, perceived stress, and loneliness, are prospectively associated with increased risk of developing post\u2013COVID-19 conditions (sometimes called long COVID).<\/jats:p><\/jats:sec><jats:sec id=\"ab-yoi220056-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This prospective cohort study used data from 3 large ongoing, predominantly female cohorts: Nurses\u2019 Health Study II, Nurses\u2019 Health Study 3, and the Growing Up Today Study. Between April 2020 and November 2021, participants were followed up with periodic surveys. Participants were included if they reported no current or prior SARS-CoV-2 infection at the April 2020 baseline survey when distress was assessed and returned 1 or more follow-up questionnaires.<\/jats:p><\/jats:sec><jats:sec id=\"ab-yoi220056-7\"><jats:title>Exposures<\/jats:title><jats:p>Depression, anxiety, worry about COVID-19, perceived stress, and loneliness were measured at study baseline early in the pandemic, before SARS-CoV-2 infection, using validated questionnaires.<\/jats:p><\/jats:sec><jats:sec id=\"ab-yoi220056-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>SARS-CoV-2 infection was self-reported during each of 6 monthly and then quarterly follow-up questionnaires. COVID-19\u2013related symptoms lasting 4 weeks or longer and daily life impairment due to these symptoms were self-reported on the final questionnaire, 1 year after baseline.<\/jats:p><\/jats:sec><jats:sec id=\"ab-yoi220056-9\"><jats:title>Results<\/jats:title><jats:p>Of 54\u202f960 participants, 38.0% (n\u2009=\u200920\u202f902) were active health care workers, and 96.6% (n\u2009=\u200953\u202f107) were female; the mean (SD) age was 57.5 (13.8) years. Six percent (3193 participants) reported a positive SARS-CoV-2 test result during follow-up (1-47 weeks after baseline). Among these, probable depression (risk ratio [RR], 1.32; 95% CI\u2009=\u20091.12-1.55), probable anxiety (RR\u2009=\u20091.42; 95% CI, 1.23-1.65), worry about COVID-19 (RR, 1.37; 95% CI, 1.17-1.61), perceived stress (highest vs lowest quartile: RR, 1.46; 95% CI, 1.18-1.81), and loneliness (RR, 1.32; 95% CI, 1.08-1.61) were each associated with post\u2013COVID-19 conditions (1403 cases) in generalized estimating equation models adjusted for sociodemographic factors, health behaviors, and comorbidities. Participants with 2 or more types of distress prior to infection were at nearly 50% increased risk for post\u2013COVID-19 conditions (RR, 1.49; 95% CI, 1.23-1.80). All types of distress were associated with increased risk of daily life impairment (783 cases) among individuals with post\u2013COVID-19 conditions (RR range, 1.15-1.51).<\/jats:p><\/jats:sec><jats:sec id=\"ab-yoi220056-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>The findings of this study suggest that preinfection psychological distress may be a risk factor for post\u2013COVID-19 conditions in individuals with SARS-CoV-2 infection. Future work should examine the biobehavioral mechanism linking psychological distress with persistent postinfection symptoms.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamapsychiatry.2022.2640","type":"journal-article","created":{"date-parts":[[2022,9,7]],"date-time":"2022-09-07T15:02:18Z","timestamp":1662562938000},"page":"1081","source":"Crossref","is-referenced-by-count":375,"title":["Associations of Depression, Anxiety, Worry, Perceived Stress, and Loneliness Prior to Infection With Risk of Post\u2013COVID-19 Conditions"],"prefix":"10.1001","volume":"79","author":[{"given":"Siwen","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luwei","family":"Quan","sequence":"additional","affiliation":[{"name":"Department of Environmental Health, Harvard T.H. 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