Abstract
Background/ObjectivesLittle is known regarding the prevalence and predictors of prolonged cognitive and psychological symptoms of COVID-19 among community-dwellers. We aimed to quantitatively measure self-reported metrics of fatigue, cognitive dysfunction, anxiety, depression, and sleep and identify factors associated with these metrics among United States residents with or without COVID-19.MethodsWe solicited 1000 adult United States residents for an online survey conducted February 3–5, 2021 utilizing a commercial crowdsourcing community research platform. The platform curates eligible participants to approximate United States demographics by age, sex, and race proportions. COVID-19 was diagnosed by laboratory testing and/or by exposure to a known positive contact with subsequent typical symptoms. Prolonged COVID-19 was self-reported and coded for those with symptoms ≥ 1 month following initial diagnosis. The primary outcomes were NIH PROMIS/Neuro-QoL short-form T-scores for fatigue, cognitive dysfunction, anxiety, depression, and sleep compared among those with prolonged COVID-19 symptoms, COVID-19 without prolonged symptoms and COVID-19 negative subjects. Multivariable backwards step-wise logistic regression models were constructed to predict abnormal Neuro-QoL metrics.ResultsAmong 999 respondents, the average age was 45 years (range 18–84), 49% were male, 76 (7.6%) had a history of COVID-19 and 19/76 (25%) COVID-19 positive participants reported prolonged symptoms lasting a median of 4 months (range 1–13). Prolonged COVID-19 participants were more often younger, female, Hispanic, and had a history of depression/mood/thought disorder (all P < 0.05). They experienced significantly higher rates of unemployment and financial insecurity, and their symptoms created greater interference with work and household activities compared to other COVID-19 status groups (all P < 0.05). After adjusting for demographics, past medical history and stressor covariates in multivariable logistic regression analysis, COVID-19 status was independently predictive of worse Neuro-QoL cognitive dysfunction scores (adjusted OR 11.52, 95% CI 1.01–2.28, P = 0.047), but there were no significant differences in quantitative measures of anxiety, depression, fatigue, or sleep.ConclusionProlonged symptoms occurred in 25% of COVID-19 positive participants, and NeuroQoL cognitive dysfunction scores were significantly worse among COVID-19 positive subjects, even after accounting for demographic and stressor covariates. Fatigue, anxiety, depression, and sleep scores did not differ between COVID-19 positive and negative respondents.
Highlights
Prolonged symptoms of COVID-19 including fatigue, cognitive abnormalities and mood disorders have been reported (Carfi et al, 2020; Tenforde et al, 2020; Al-Aly et al, 2021; Huang et al, 2021; Nalbandian et al, 2021), the prevalence of these symptoms in the general population is not known
76/999 (7.6%, 95% CI 6.0–9.4%) reported having COVID-19, either diagnosed by laboratory test (N = 46/76, 61%, 95% CI 49–72%) or by exposure to a known COVID-19 contact followed by typical symptoms (N = 30/76, 39%, 95% CI 28–51%)
At least one stressor was identified in 676/999 (68%, 95% CI 65–71%) subjects within the last month and 648/999 (65%, 95% CI 62–68%) reported at least one Prolonged COVID-19 symptoms# N = 19
Summary
Prolonged symptoms of COVID-19 including fatigue, cognitive abnormalities and mood disorders have been reported (Carfi et al, 2020; Tenforde et al, 2020; Al-Aly et al, 2021; Huang et al, 2021; Nalbandian et al, 2021), the prevalence of these symptoms in the general population is not known. Community members without COVID-19 may suffer similar symptoms related to social and economic stressors encountered during the global pandemic. Qualitative reports of COVID-19related symptoms are limited in their ability to assess the severity of physical and psychological manifestations. We aimed to estimate the prevalence of symptoms of anxiety, depression, fatigue, sleep abnormalities, and subjective cognitive dysfunction among United States residents with or without the diagnosis of COVID-19 using quantitative NIH PROMIS/NeuroQoL metrics
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