COVID-19 Risk Greater if Stressed

Dr Rob Hicks

January 14, 2022

Researchers from University of Nottingham School of Medicine, King’s College London, and the University of Auckland in New Zealand have concluded that COVID-19 infection and symptoms may be more common among those experiencing elevated psychological distress.

In their study, published in the Annals of Behavioural Medicine , the researchers point out that it has been previously identified that stress, social support, and other psychological factors are "associated with greater susceptibility to viral illnesses and more severe symptoms".

Prof Trudie Chalder, Professor of Cognitive Behavioural Psychotherapy from King’s College London, said, "Previous work has shown a clear relationship between distress and the development of viral infections indicating a vulnerability."

The researchers wanted to investigate whether the same applied to COVID-19 infection.

First Time Psychological Distress Effect on COVID-19 Infection Demonstrated

To examine the relationship between psychological factors and the risk of COVID-19 self-reported infection, and the number and severity of COVID-19 related symptoms, the researchers recruited participants through social media, such as Facebook and Twitter, and a mainstream media campaign. They performed a large prospective cohort study with 1,087 participants completing surveys of psychological wellbeing during April 2020 and self-reported incidence of COVID-19 infection and symptom experience across the pandemic through to December 2020. Of the participants 85% were female, the mean age was 50 years old, and 42% were key-workers.

The authors said that as far as they were aware "this is the first study to demonstrate a small but significant effect of psychological distress on both the likelihood of reporting COVID-19 infection and the symptom experience".

Mental Health Aspects of COVID-19 Pandemic Debate Turned on Its Head

The authors discuss how who gets COVID-19 and who doesn’t, and for those who do get the infection how severe their symptoms are, may be related to psychological distress, which in their study they say has been "operationalised as a constellation of increased stress, anxiety, and depression and low levels of positive mood". In turn they question whether a person’s response to COVID-19 vaccination, that is, how effective the vaccine is, may also be influenced by the person’s psychological wellbeing.

Prof Kavita Vedhara from the School of Medicine at the University of Nottingham, who led the study, said, "The significance of the work is in that it turns the debate regarding the mental health aspects of the pandemic on its head." 

He added that their findings show that "increased stress, anxiety and depression are not only consequences of living with the pandemic but may also be factors that increase our risk of getting SARS-CoV-2 too".

In their study the authors highlighted how their findings also raise the question as to whether having either high, or low, levels of worry related to COVID-19 may be associated with a greater risk of COVID-19 infection. However, they commented that further research was needed to disentangle these findings.

Prof Trudie Chalder said: "Previous work has shown a clear relationship between distress and the development of viral infections indicating a vulnerability. Our study found that distress was associated with self-reported COVID-19 infection and the next step is to investigate whether this association is found in those with confirmed infection."

"Further work is now needed to determine whether and how public health policy should change to accommodate the fact that the most distressed people in our communities appear to be at greatest risk of COVID-19 infection," said Prof Vedhara.

Kieran Ayling, PhD, Ru Jia, MSc, Carol Coupland, PhD, Trudie Chalder, PhD, Adam Massey, PhD, Elizabeth Broadbent, PhD, Kavita Vedhara, PhD, Psychological Predictors of Self-reported COVID-19 Outcomes: Results From a Prospective Cohort Study, Annals of Behavioral Medicine, 2022;, kaab106,


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