A recent study by Journal of Neurological Sciences reported that life stressors influence acute symptoms and long-term outcomes after hospitalization for coronavirus 2019 (Covid-19).

Post-acute covid-19 (PASC) sequelae have been observed in 25% to 69% of non-hospitalized patients and 33% to 90% of hospitalized patients. The variable distribution may result from differences in study design, markers, and assessment time. Despite several studies reporting post-Covid-19 sequelae, there are limited data on predictors of long-term quality of life and cognitive and functional outcomes.

Study: Life stressors significantly affect long-term outcomes and post-acute symptoms 12 months after hospitalization for Covid-19.  Image credit: / ShutterstockResearch: Life stressors significantly affect long-term outcomes and post-acute symptoms 12 months after hospitalization for Covid-19.. Image credit: / Shutterstock

About the study

In the current study, researchers examined the effects of demographics, hospital clinical variables, pre-Covid-19 comorbidities, and lifestyle factors on outcome measures at six months and one year post-Covid-19 hospitalization. This observational study was conducted between March 10 and May 20, 2022, among hospitalized patients with COVID-19.

Follow-up interviews were conducted six months and one year after the first Covid-19 diagnosis. Subjects were eligible if they were 18 years of age or older and were hospitalized with SARS-CoV-2 reverse polymerase chain reaction (RT-PCR) testing voluntarily for the follow-up interview. Individuals assessed in an emergency department or outpatient setting were excluded.

Data on demographics, medical/neurological history, new in-hospital neurologic or other complications, and medications used during acute COVID-19 were recorded. Disease severity was assessed based on ventilatory requirements and sequential organ failure assessment (SOFA) results. The Modified Rankin Scale (MRS) was used to assess subjects’ pre-Covid-19 baseline functional status.

Longitudinal assessments were conducted through telephone interviews. Contact was attempted at six and 12 months after the initial Covid-19 diagnosis. Functional and disability status was assessed using mRS; Cognitive outcomes were assessed with the Montreal Cognitive Assessment (t-MoCA).

The Barthel Index was used to assess activities of daily living (ADL), and self-reported quality of life measures of stress, fatigue, sleep, and anxiety were collected using the short forms of Neurological Disorders (NeuroQoL). PASC results are defined as new/persistent symptoms occurring four weeks after exposure to Covid-19.


Follow-up interviews were conducted on 790 and 590 patients at six and 12 months, respectively. Of these, only 382 (48%) and 242 (41%) patients completed interviews at six and 12 months, respectively. Participants who completed only the six-month interview were older than those who completed the 12-month interview (65 years) (median age: 69 years).

No differences were found in sex, education level, race, pre-Covid-19 mRS scores, history of dementia/psychiatric illness, severity of Covid-19, and rate of in-hospital neurologic complications between patients who completed the six-month and 12-month interviews. months. Headache, anxiety, cognitive impairment, depression, fatigue, and sleep disturbances were common neurological symptoms at 12 months.

At six months, 90% of patients and 87% at 12 months showed abnormalities in at least one assessed parameter, with abnormalities in the mRS and t-MoCA being the most common. A small but significant correlation was observed between post-acute Covid-19 symptoms and NeuroQoL stress scores ≥ 60. The authors also found that older age was associated with poorer mRS, t-MoCA scores and Barthel index at both time points and NeuroQoL depression scores at one year.

Female gender was associated with higher stress scores at one year and a poorer Barthel index at six and 12 months. Neurological complications such as hypoxic-ischemic brain injury and toxic metabolic encephalopathy predicted poor Barthel index and mRS at six and 12 months and worse fatigue and depression at one year. Poor couch scores and mechanical ventilation predicted poor Berthel index at six months.

The researchers found no consistent effect of the Covid-19 drugs on the outcome measures. However, more than 50% of participants reported experiencing at least one life stressor in the 12 months prior to follow-up. New personal illness, social isolation, financial insecurity, and illness/death of a close friend were the most common life stressors.

The presence of stressors is strongly associated with post-emergence Covid-19 symptoms and poor neuroQoL outcomes. There was a significant association between food and financial deprivation, new disability/death of an intimate partner, social isolation and personal pain among NeuroQoL measures. In contrast, new disability and personal pain were associated with Barthel Index and mRS.


In conclusion, the authors found independent associations predicting poorer outcomes, such as older age, poorer pre-Covid-19 functional status and disease severity, worse t-MoCA, Barthel Index and mRS scores, and post-acute symptoms. In addition to covid-19, they found that life stressors had a negative impact on measures of acute covid-19 symptoms, depression, fatigue, sleep and disability. Considering life stressors, interventions aimed at addressing life stress are associated with better cognitive, neuropsychiatric, and functional outcomes 12 months after hospitalization with COVID-19.

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