O'Connor, D.B., Greenwood, D.C. orcid.org/0000-0001-7035-3096, Mansoubi, M. et al. (18 more authors) (Accepted: 2025) Daily stress and worry are additional triggers of symptom fluctuations in individuals living with Long COVID: Results from an intensive longitudinal cohort study. Annals of Behavioral Medicine. ISSN: 0883-6612 (In Press)
Abstract
Background: Recent research has shown that exertion in physical, cognitive, social and self-care activities trigger symptom severity in individuals with Long COVID.
Purpose: The current study aimed to investigate whether daily emotional exertions (stress, worry, rumination) were associated with symptom exacerbation, over and above influences of effortful daily activities, in individuals with Long COVID.
Methods: 376 participants were recruited from UK Long COVID clinics and community settings and completed daily assessments of activity and severity of 8 core symptoms every 3 hours for up to 24 days. 155 participants completed daily assessments of stress, worry and rumination for at least seven consecutive days.
Results: Days with higher stress scores were associated with increased severity of all symptoms on the same day, after adjusting for activities, demographic and medical factors (p-values ≤ 0.007). Days with higher stress scores also predicted more severe anxiety and depression symptoms 1-day later (p<0.001) and more severe anxiety (p<0.001) and dizziness symptoms (p=0.003) 2-days later. Days with higher worry scores were associated with increased fatigue (p<0.001), anxiety (p<0.001), depression (p<0.001) and cognitive dysfunction (p=0.002) on the same day, but decreased anxiety (p=0.003) and depression (p=0.002) symptoms 1-day later and less severe pain (p=0.002) symptoms 2-days later. Daily rumination was only associated with two symptoms.
Conclusions: Daily stress and worry are distinct factors linked to fluctuations in same-day and next day Long COVID symptoms, with daily stress showing the strongest association—consistent with patterns of post-exertional symptom exacerbation. These findings highlight the importance of considering stress and worry as potential therapeutic targets and integrating their management into self-care programmes.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | This is an author produced version of an article accepted for publication in Annals of Behavioral Medicine made available under the terms of the Creative Commons Attribution License (CC-BY), which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited. |
Keywords: | Post-Covid condition, Stress, Physical exertion; Mental exertion; Symptoms; Ecological momentary assessment |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) |
Funding Information: | Funder Grant number NIHR National Inst Health Research COV-LT2-0016 |
Date Deposited: | 07 Oct 2025 10:32 |
Last Modified: | 08 Oct 2025 05:12 |
Status: | In Press |
Publisher: | Oxford University Press |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:232563 |