Predictors of Anxiety, Depression, and Stress in Long COVID: Systematic Review of Prevalence
Abstract
1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Database | Search Strategy |
---|---|
MEDLINE | ((((((((((((“Post-acute COVID-19 syndrome”) OR (“Long-COVID”)) OR (“Post-COVID-19 syndrome”)) OR (“Long Haul Syndrome COVID-19”)) OR (“long-haul COVID”)) OR (“post-acute COVID syndrome”)) OR (“persistent COVID-19”)) OR (“long COVID”)) OR (“long haul COVID”)) OR (“chronic COVID syndrome”))) OR (“COVID survivor”)) AND ((((((Anxiety) OR (Anxiousness)) OR (Depression)) OR (“Depressive Symptoms”)) OR (((((“Stress Disorders, Traumatic”) OR (“Stress Disorders, Post-Traumatic”)) OR (“Traumatic Stress Disorder”)) OR (“Stress, Psychological”)) OR (“Psychological Stress”)))) |
Web of Science | (ALL = (“Post-acute COVID-19 syndrome”) OR ALL = (“Long-COVID”) OR ALL = (“Post-COVID-19 syndrome”) OR ALL = (“Long Haul Syndrome COVID-19”) OR ALL = (“long-haul COVID”) OR ALL = (“post-acute COVID syndrome”) OR ALL = (“persistent COVID-19”) OR ALL = (“long COVID”) OR ALL = (“long haul COVID”) OR ALL = (“chronic COVID syndrome”) OR ALL = (“COVID survivor”)) AND (ALL = (Anxiety) OR ALL = (Anxiousness) OR ALL = (Depression) OR ALL = (“Depressive Symptoms”) OR ALL = (“Stress Disorders, Traumatic”) OR ALL = (“Stress Disorders, Post-Traumatic”) OR ALL = (“Traumatic Stress Disorder”) OR ALL = (“Stress, Psychological”) OR ALL = (“Psychological Stress”)) |
Scopus | ((TITLE-ABS-KEY (“Post-acute COVID-19 syndrome”) OR TITLE-ABS-KEY (“Long-COVID”) OR TITLE-ABS-KEY (“Post-COVID-19 syndrome”) OR TITLE-ABS-KEY (“Long Haul Syndrome COVID-19”) OR TITLE-ABS-KEY (“long-haul COVID”) OR TITLE-ABS-KEY (“post-acute COVID syndrome”) OR TITLE-ABS-KEY (“persistent COVID-19”) OR TITLE-ABS-KEY (“long COVID”) OR TITLE-ABS-KEY (“long haul COVID”) OR TITLE-ABS-KEY (“chronic COVID syndrome”) OR TITLE-ABS-KEY (“COVID survivor”))) AND ((TITLE-ABS-KEY (anxiety) OR TITLE-ABS-KEY (anxiousness) OR TITLE-ABS-KEY (depression) OR TITLE-ABS-KEY (“Depressive Symptoms”) OR TITLE-ABS-KEY (“Stress Disorders, Traumatic”) OR TITLE-ABS-KEY (“Stress Disorders, Post-Traumatic”) OR TITLE-ABS-KEY (“Traumatic Stress Disorder”) OR TITLE-ABS-KEY (“Stress, Psychological”) OR TITLE-ABS-KEY (“Psychological Stress”))) |
Embase | (‘post-acute COVID-19 syndrome’ OR ‘long-COVID’ OR ‘long COVID’ OR ‘post-COVID-19 syndrome’ OR ‘long haul syndrome COVID-19’ OR ‘long-haul COVID’ OR ‘post-acute COVID syndrome’ OR ‘persistent COVID-19’ OR ‘long haul COVID’ OR ‘chronic COVID syndrome’ OR ‘COVID survivor’) AND (anxiety OR ‘anxiety disorder’ OR anxiousness OR depression OR ‘depressive symptoms’ OR ‘posttraumatic stress disorder’ OR ‘stress disorders, traumatic’ OR ‘stress disorders, post-traumatic’ OR ‘traumatic stress disorder’ OR ‘mental stress’ OR ‘stress, psychological’ OR ‘psychological stress’) |
LILACS, BDENF and IBECS via VHL | ((“Síndrome pós-COVID-19”) OR (“Síndrome pós-aguda de COVID-19”) OR (“COVID longa”) OR (“Síndrome de longo curso COVID-19”) OR (“COVID-19 persistente”) OR (“COVID de longa duração”) OR (“síndrome de COVID crônica”) OR (“sobrevivente de COVID”) OR (“Post-Acute COVID-19 Syndrome”) OR (“Long-COVID”) OR (“Post-COVID-19 syndrome”) OR (“Long Haul Syndrome COVID-19”) OR (“long-haul COVID”) OR (“post-acute COVID syndrome”) OR (“persistent COVID-19”) OR (“long COVID”) OR (“long haul COVID”) OR (“chronic COVID syndrome”) OR (“COVID survivor”)) AND ((mh:(Ansiedade)) OR (Ansiedade) OR (Angústia) OR (mh:(Depressão)) OR (Depressão) OR (“Sintomas Depressivos”) OR (mh: (“Estresse Psicológico”)) OR (“Estresse Psicológico”) OR (Estresse) OR (Anxiety) OR (Anxiousness) OR (Depression) OR (“Depressive Symptoms”) OR (“Stress Disorders, Post-Traumatic”) OR (“Stress Disorders, Traumatic”) OR (“Stress Disorders, Post-Traumatic”) OR (“Traumatic Stress Disorder”) OR (“Stress, Psychological”) OR (“Stress, Psychological”) OR (“Psychological Stress”)) |
Author, Year, Periodical | Objective | Country | Design and Sample | Assessment Time Assessment Tool | Outcome (Prevalence) and Predictor |
---|---|---|---|---|---|
Sykes DL et al. [21]. 2021 Lung | Report the lasting burden of symptoms in patients admitted with COVID-19 | England | Observational N = 134 Male: 65.7% Mean age: 59.6 Treated in wards: 80% Intensive Care Unit (ICU): 20% | 113 days after hospital discharge Standardized Assessment Form and 5-level EuroQol-5 Dimension (EQ-5D-5L) | Anxiety (47.8%) and depression (37.3%) Predictors: Being female There were no significant differences in symptom duration based on level of care, maximum oxygen, or respiratory support received |
Huang et al. [22]. 2021 Lancet | Describe the long-term consequences in patients with COVID-19 who have been discharged from hospital | China | Cohort N = 1733 Male: 52% Mean age: 57.0 | 6 months after the onset of symptoms Self-reported symptoms questionnaire, EQ-5D-5L questionnaire, and EuroQol Visual Analogue Scale (EQ-VAS) | Anxiety or depression (23%) Predictors: Being female, disease severity, use of supplemental oxygen |
Mazza et al. [23]. 2020 Brain Behav Immun. | Investigate the psychopathological impact on COVID-19 survivors | Italy | Cross-sectional N = 402 Male: 56.7% Mean age: 57.80 | One month after hospital treatment Impact of Events Scale-Revised (IES-R), Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), Zung Self-Rating Depression Scale (ZSDS), 13-item Beck’s Depression Inventory (BDI-13), and State-Trait Anxiety Inventory form Y (STAI-Y) | Anxiety (42%), depression (28%), and post-traumatic stress disorder (28%). Predictors: Being female, previous psychiatric diagnosis, home treatment |
Huang et al. [24]. 2021 Lancet | Compare outcomes between 6 months and 12 months after symptom onset among hospital survivors with COVID-19 | China | Cohort 1276 Median age 59.0 years (IQR 49.0–67.0) 681 (53%) were men | 6 months and 12 months after symptom onset Modified British Medical Research Council (mMRC) score and HRQoL | 6 months Anxiety or depression (23%) 12 months Anxiety or depression (26%) Predictors: Being female, infection severity |
Taquet et al. [25]. 2021 PLoS Med | Estimate the incidence, occurrence, and evolution of COVID-19 6 months after diagnosis | USA | Retrospective cohort N = 273,618 Female: 55.6% Mean age: 46.30 | 6 months after COVID-19 diagnosis. TriNetX Analytics to analyze demographics, diagnoses, and measurements | Anxiety or depression (15.49%) Predictor: Young adults |
Vanichkachorn et al. [26]. 2021 Mayo Clin Proc. | Describe the characteristics of prolonged symptoms after COVID-19 infection | USA | Cohort N = 100 Female: 68% Mean age: 45.40 | 93 days after infection Electronic Health Records, EQ-5D-5L, EuroQol Visual Analogue Scale | Depression or anxiety (34%) |
Miranda et al. [27]. 2022 Trans R Soc Trop Med Hyg. | Analyze the profile and symptoms suggestive of Long COVID | Brazil | Longitudinal N = 646 Female: 53.9% Mean age: 50.26 | Up to 14 months Questionnaire and electronic medical records | Anxiety (7.1%) and depression (2.8%). Predictors: Age, disease severity, presence of comorbidities—high blood pressure, diabetes, heart disease, cancer, chronic obstructive pulmonary disease, chronic kidney disease, smoking, alcoholism |
Bai et al. [28]. 2022 Clin Microbiol Infect | Identify the predictors of Long COVID | Italy | Prospective cohort N = 377 | 44 days Hospital Anxiety and Depression Scale (HADS) and Impact of Event Scale–Revised (IES-R) | Anxiety (18.8%), depression (10.6%), post-traumatic stress disorder (31%) Predictors: Being female and advanced age |
Lamontagne, et al. [29]. 2021 Brain Behavior I. Health | Analyze mood and cognitive functioning after COVID-19 infection | USA Canada | Cohort N = 100 Female: 58.0% Mean age: 30.80 | 1–4 months Beck Depression Inventory-II (BDI-II), the Snaith-Hamilton Pleasure Scale (SHAPS), and the Mood and Anxiety Symptom Questionnaire (MASQ) | Anxiety (33%), perceived stress (23%), and depression (17%). Predictor: Headache in the acute phase |
Tarsitani et al. [30]. 2021 J Gen Intern Med. | Assess the prevalence and risk factors of post-traumatic stress disorder in patients hospitalized for COVID-19 infection | Italy | Cohort N = 115 Male: 54% | 3 months PCL-5 | Post-traumatic stress disorder (10.4%) Predictor: Being female, previous psychiatric diagnosis, obesity |
Study/Assessment Criteria | Were the Criteria for Inclusion in the Sample Clearly Defined? | Were the Study Subjects and the Setting Described in Detail? | Was the Exposure Measured in a Valid and Reliable Way? | Were Objective, Standard Criteria Used to Measure the Condition? | Were Confounding Factors Identified? | Were Strategies to Deal with Confounding Factors Stated? | Were the Outcomes Measured in a Valid and Reliable Way? | Was Appropriate Statistical Analysis Used? | Total |
---|---|---|---|---|---|---|---|---|---|
Sykes DL et al., 2021 [21] | Y | Y | Y | Y | N | N | Y | Y | 6/8 |
Huang et al., 2021 [22] | N | Y | Y | Y | N | N | Y | Y | 5/8 |
Mazza et al., 2020 [23] | Y | Y | Y | Y | N | N | Y | Y | 6/8 |
Huang et al., 2021 [24] | Y | Y | Y | Y | N | N | Y | Y | 6/8 |
Taquet et al., 2021 [25] | Y | Y | Y | Y | N | N | Y | Y | 6/8 |
Vanichkachorn et al., 2021 [26] | Y | Y | Y | Y | N | N | Y | Y | 6/8 |
Miranda et al., 2022 [27] | Y | Y | Y | Y | N | N | Y | Y | 6/8 |
Bai et al., 2022 [28] | Y | Y | Y | Y | N | N | Y | Y | 6/8 |
Lamontagne, et al., 2021 [29] | Y | Y | Y | Y | N | N | Y | Y | 6/8 |
Tarsitani et al., 2021 [30] | Y | Y | Y | Y | N | N | Y | Y | 6/8 |
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Rocha, D.d.M.; Pedroso, A.O.; Menegueti, M.G.; Silveira, R.C.d.C.P.; Sousa, L.R.M.; Gir, E.; Reis, R.K. Predictors of Anxiety, Depression, and Stress in Long COVID: Systematic Review of Prevalence. Int. J. Environ. Res. Public Health 2025, 22, 867. https://doi.org/10.3390/ijerph22060867
Rocha DdM, Pedroso AO, Menegueti MG, Silveira RCdCP, Sousa LRM, Gir E, Reis RK. Predictors of Anxiety, Depression, and Stress in Long COVID: Systematic Review of Prevalence. International Journal of Environmental Research and Public Health. 2025; 22(6):867. https://doi.org/10.3390/ijerph22060867
Chicago/Turabian StyleRocha, Daniel de Macêdo, Andrey Oeiras Pedroso, Mayra Gonçalves Menegueti, Renata Cristina de Campos Pereira Silveira, Laelson Rochelle Milanês Sousa, Elucir Gir, and Renata Karina Reis. 2025. "Predictors of Anxiety, Depression, and Stress in Long COVID: Systematic Review of Prevalence" International Journal of Environmental Research and Public Health 22, no. 6: 867. https://doi.org/10.3390/ijerph22060867
APA StyleRocha, D. d. M., Pedroso, A. O., Menegueti, M. G., Silveira, R. C. d. C. P., Sousa, L. R. M., Gir, E., & Reis, R. K. (2025). Predictors of Anxiety, Depression, and Stress in Long COVID: Systematic Review of Prevalence. International Journal of Environmental Research and Public Health, 22(6), 867. https://doi.org/10.3390/ijerph22060867