A recent cross-sectional study posted to the medRxiv* preprint server found childhood trauma to be a risk factor for post-coronavirus disease (COVID-19) syndrome or long COVID.
Study: Childhood Trauma Exposure Increases Long COVID Risk. Image Credit: Ann in the uk/Shutterstock
*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been an unprecedented health crisis for the past two years, disrupting everyday life. The long-term effects of COVID-19 are unclear, but it is understood that some COVID-19 survivors experience long COVID with protracted symptoms after several months of acute infection.
The study
In the present study, researchers assessed childhood trauma as a contributory risk to long COVID. Participants were enrolled via online posts on several social media platforms like Facebook, Instagram, and Twitter. Individuals aged 18 years or more with confirmed or suspected COVID-19 and who could complete English questionnaires were eligible.
Participants were surveyed about psychiatric and medical history, symptoms, disease course, and treatment of COVID-19, and post-COVID-19 symptoms. Patient health questionnaire-9 (PHQ-9) and Center for Epidemiology Studies Depression Scale-Revised (CESD-R) were used to evaluate depression. Subsequently, their scores were converted to t-scores according to the conversion chart of the Patient-Reported Outcomes Measurement Information System (PROMIS). Generalized Anxiety Disorder-2 (GAD-2) and post-traumatic stress disorder (PTSD) Checklists for the DSM-5 (PCL-5), respectively, assessed anxiety and PTSD severity.
Traumatic experiences before the age of 17 years, like the death of a loved one, physical exposure to violence, parental divorce, severe injury, and sexual abuse, among others, were investigated based on the Childhood Traumatic Events Scale. Using the Recent Traumatic Events Scale, relationship stressors, sexual assault, non-sexual violence, the death of a loved one, or other traumatic events in the past three years were assessed. Volunteers were asked to mention the age at which these traumas occurred and assign a numerical rating from zero to seven.
Findings
About 455 candidates were recruited initially, and subsequent screening as per the established criteria identified 338 eligible participants. Of these, 158 (47 %) subjects had fully recovered from COVID-19 within 30 days of acute illness, and the remaining candidates (53%) complained of protracted symptoms, namely, long COVID. All subjects were diagnosed with COVID-19 between January 2020 and January 2021. Most participants responded by saying they had excellent (37.6%) or good (51.5%) premorbid health. The authors noted that obese people had higher odds of manifesting long COVID-19, with current smokers more likely to recover completely from the infection.
Long COVID patients exhibited higher rates of premorbid hypertension, migraine, hyperlipidemia, headaches, thyroid disorders, osteoarthritis, and fibromyalgia, with elevated tendencies of Ehlers-Danlos syndrome and food allergies. Between the two cohorts (recovered and long COVID), recovered patients showed a high frequency of bipolar II disorder.
Most COVID-19 patients presented moderate (32.6 %), or mild (40.7 %) disease severity, and around 5% developed severe disease and pneumonia. Among the long COVID cohort, higher rates of hospitalizations and an increased degree of severe disease were observed. Notably, the long COVID subjects had higher frequencies of the following symptoms during the acute illness - brain fog, burning sensation, phantosmia, chest pain, dyspnea, shortness of breath, hypoxia, chanteuse, nausea, constipation, rash, myalgias, headaches, chills, and lymphadenopathy, than recovered individuals.
Premorbid levels of depression and PTSD were similar in the two cohorts but differed significantly post-COVID-19. Depression and generalized anxiety were markedly higher in patients with long COVID than recovered subjects. Long COVID patients exhibited an elevated burden of childhood trauma. Individuals with at least one traumatic childhood event were thrice as likely to develop long COVID upon contracting SARS-CoV-2. Those with a history of two or more traumatic events were 5.6 times more likely to manifest long COVID. No such association was reported for individuals with recent trauma(s) in the past three years. Further analysis identified phantosmia, chest pain, and brain fog during acute illness as predictors of long COVID.
Conclusion
Overall, the authors observed that more than half of the study population had not recovered from COVID-19 infection in three months, with females representing most of these individuals. Some studies posit that the protracted immune response could be the possible mechanism for long COVID-19, particularly in females, as they generate more robust innate and immune responses compared to males.
To summarize, the current findings indicated that long COVID is not uncommon, with females being disproportionately affected and childhood trauma escalating the risk of long COVID.
*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
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