Background Long COVID is increasingly recognised as public health burden. Ongoing inflammatory processes have been found to underlie the post-acute sequalae, as in other viral infections. Psychological stress can trigger increases in circulating markers of inflammation, with higher inflammation in turn associated with a greater propensity for developing chronic illness. However, research on risk factors for long COVID has focused almost entirely on demographic and infection-related characteristics, to the exclusion of psychosocial predictors such as stress immediately preceding the index infection. Research on whether stressors predict the development of specific long COVID symptoms is also needed, because some long COVID symptoms may be more debilitating than others and have different risk factors.

Methods Data from 1,962 UK adults who had previously been infected with COVID-19 and who took part in the UCL COVID-19 Social Study were analysed. The number of adverse experiences (e.g., job loss) and the number of adversity worries measured within the two months prior to COVID-19 infection were used to predict the development of self-reported long COVID and the presence of three specific long COVID symptoms (difficulty with mobility, cognition, and self-care). Logistic regression analyses controlled for a range of COVID-19 infection characteristics, socio-demographics, and health-related factors.

Results One in five who had been infected with COVID-19 had either been diagnosed with or believed themselves to have had long COVID. Odds of self-reported long COVID increased by 1.31 (95% confidence interval [CI]: 1.04 to 1.64) for each additional worry about adversity in the two months prior to COVID-19 infection. The number of adversity experiences corresponded with increased odds of difficulty with self-care (e.g., dressing, washing all over) by 1.68 (95% CI: 1.08 to 2.61).

Discussion Results suggest a central role of stress in the time preceding the acute COVID-19 infection for the development of long COVID and point to the importance of prioritising and monitoring COVID-19 patients who have been affected by stress for ongoing care and prevention. A more comprehensive understanding of whether psychosocial circumstances in the time period leading up to infection could aid in identifying early in the disease who is most likely to be negatively impacted due to ongoing symptoms.