Work

Depression, anxiety, and stress at different time frames in relation to COVID-19 disease course: a Flemish observational study

Year: 2026

Type: article

Abstract: Introduction: Psychological distress can impact the course of viral infections such as COVID-19. This study aimed to examine how depression, anxiety, and stress, which occurred before and during COVID-19 infection, are associated with COVID-19 disease course (number of symptoms and duration of symptoms) in Flemish outpatients. Methods: In early 2022, a two-wave web-based survey was administered to 3,025 adults who had a positive COVID-19 PCR test. Psychological distress was assessed using the Depression, Anxiety, and Stress Scale-21 (DASS-21) and COVID-19 disease course with a set of self-constructed items. Generalized linear models were used to evaluate the associations. Several control variables were included in the analysis, such as vaccination status, comorbidities, and previous SARS-CoV-2 infection. Results: Across all time frames, psychological distress showed consistent, statistically significant associations with both aspects of the COVID-19 disease course (with the exception of psychopharmaceutical use 3 years before COVID-19 infection and duration of symptoms), albeit with small to moderate effect sizes typical of psychological research. Across all time frames, anxiety during infection showed the largest point estimates with number of symptoms (IRR: 1.20, 95% CI 1.16 to 1.23) and duration of symptoms (OR: 1.79, 95% CI 1.55 to 2.07). However, there was no statistical evidence that these associations differed in magnitude from other types of distress. When focusing on psychological distress before COVID-19 infection, anxiety short-term before infection had the largest point estimate for number of symptoms (IRR: 1.13, 95% CI 1.09 to 1.16) and duration of symptoms (OR: 1.40, 95% CI 1.22 to 1.61), although we did not find evidence of differences in effects across types of distress. Conclusion: All measures of psychological distress were significantly associated with worse COVID-19 outcomes, except for the association between psychopharmaceutical use 3 years before COVID-19 infection and duration of symptoms. The magnitude of effects showed a consistent trend whereby anxiety short-term before and during COVID-19 infection showing the strongest associations, though not significantly different. This observational survey study has a few notable limitations associated with measurement and casual inferences, including those related to recall bias and self-report of both independent and outcome variables. Further research is needed to clarify these associations in a causal and mechanistic framework.

Source: Frontiers in Psychology

DOI: 10.3389/fpsyg.2026.1765017