Abstract
BACKGROUND: Many adults with Long COVID experience adverse mental health outcomes, but the long-term persistence of these associations remains unclear. We examined the prospective associations of Long COVID with depressive and anxiety symptoms three years after initial infection. METHODS: We used a population-based cohort of Michigan adults with PCR-confirmed COVID-19, excluding respondents with baseline symptoms (resulting analytic samples: n = 2,431 for depressive symptoms; n = 2,301 for anxiety symptoms). Long COVID was defined as symptoms lasting ≥ 90 days after initial infection, assessed at baseline (median 4.4 months post-infection). Depressive and anxiety symptoms were evaluated 1.5 years (follow-up 1) and 3 years (follow-up 2) after infection. We used modified Poisson regression models to estimate risk ratios (RR) for each outcome and multinomial logistic regression models to examine Long COVID and mental health outcomes measured across two follow-up periods. RESULTS: Long COVID was associated with higher risks of depressive symptoms (aRR:1.86, 95% CI:1.34-2.57) and anxiety symptoms (aRR:1.60, 95% CI:1.18-2.16) after 3 years of follow-up. Adults with Long COVID, compared to adults without Long COVID, had a 2.64 times higher risk of depressive symptoms at follow-up 2 (95% CI:1.60-4.35) relative to no depressive symptoms at either follow-up and a 2.48 times higher risk of anxiety symptoms at both follow-ups (95% CI:1.38-4.47) relative to no anxiety symptoms at either follow-up. CONCLUSION: Our findings that Long COVID is associated with higher depressive and anxiety symptoms after 3 years of follow-up highlight the need to monitor the mental health of adults with Long COVID.