Social support, distress and well-being in individuals experiencing Long-COVID: a cross-sectional survey study

Sociodemographic and psychosocial correlates of fatigue and chronic fatigue: A cross-sectional study from a South East London community survey

OBJECTIVE

A better understanding of fatigue and chronic fatigue symptoms in the community may lead to better targeted preventative interventions. This study aims to estimate the prevalence of fatigue and chronic fatigue and explore relationships with sociodemographic and psychosocial factors in a representative community population survey in London, UK.

METHODS

The first wave of the South East London Community Health study (2008 to 2010) surveyed face-to-face 1698 individuals aged 16 years and over from 1075 randomly selected households in the boroughs of Southwark and Lambeth. Self-reported fatigue and/or chronic fatigue was determined using the Chalder fatigue scale. Ordinal and binary logistic regression analyses were undertaken to assess the association of sociodemographic and psychosocial factors with higher levels of fatigue symptoms.

RESULTS

The point prevalence of fatigue was 23.5 % (95 % CI 21.5-25.7). After adjusting for age and sex, higher levels of fatigue were substantially associated with impacts on work and other activities due to physical (OR: 4.87 (95 % CI 3.44-6.88)) or emotional symptoms (OR: 4.52 (95 % CI, 3.16-6.48)). Higher levels of fatigue were also associated with seeking emotional help from professionals (OR: 2.73 (95 % CI, 1.91-3.92) or family or friends (OR: 2.37 (95 % CI,1.68-3.34) and reporting less perceived instrumental (OR: 2.01 (0.75-5.37)) and emotional support (OR: 3.76 (1.46-9.68)).

CONCLUSION

Our findings highlight the high prevalence of fatigue and chronic fatigue in a representative urban community sample. Higher levels of fatigue were significantly associated with greater disability and formal and informal help-seeking. The quality of perceived social support is an important protective factor.

Clair-Sullivan N, Chan Carusone S, Thomson C, McCorkell L, Wei H, Goulding S, O’Hara M, Roche N, Stokes R, Kelly M, Cheung AM, Erlandson KM, Harding R, Vera JH, Bergin C, Robinson L, Avery L, Bannan C, Torres B, O’Donovan I, Malli N, Solomon P. Episodic disability framework in the context of Long COVID: Findings from a community-engaged international qualitative study

BACKGROUND

Increasing numbers of adults are living with the health-related consequences of Long COVID. The Episodic Disability Framework (EDF), derived from perspectives of adults living with HIV, characterizes the multi-dimensional and episodic nature of health-related challenges (disability) experienced by an individual. Our aim was to determine the applicability of the Episodic Disability Framework to conceptualize the health-related challenges experienced among adults living with Long COVID.

METHODS

We conducted a community-engaged qualitative descriptive study involving online semi-structured interviews. We recruited adults who self-identified as living with Long COVID via collaborator community organizations in Canada, Ireland, United Kingdom, and United States. We purposively recruited for diversity in age, gender identity, ethnicity, sexual orientation, and time since initial COVID-19 infection. We used a semi-structured interview guide informed by the EDF to explore experiences of disability living with Long COVID, specifically health-related challenges and how challenges were experienced over time. We conducted a group-based content analysis.

RESULTS

Of the 40 participants, the median age was 39 years; and the majority were white (73%), women (63%), living with Long COVID for ≥ 1 year (83%). Consistent with the Episodic Disability Framework, disability was described as multi-dimensional and episodic, characterized by unpredictable periods of health and illness. Experiences of disability were consistent with the three main components of the Framework: A) dimensions of disability (physical, cognitive, mental-emotional health challenges, difficulties with day-to-day activities, challenges to social inclusion, uncertainty); B) contextual factors, extrinsic (social support; accessibility of environment and health services; stigma and epistemic injustice) and intrinsic (living strategies; personal attributes) that exacerbate or alleviate dimensions of disability; and C) triggers that initiate episodes of disability.

CONCLUSIONS

The Episodic Disability Framework provides a way to conceptualize the multi-dimensional and episodic nature of disability experienced by adults living with Long COVID. The Framework provides guidance for future measurement of disability, and health and rehabilitation approaches to enhance practice, research, and policy in Long COVID.

Exploring social determinants of health and their impacts on self-reported quality of life in long COVID-19 patients

This study explores the health-related quality of life (HRQoL) experienced by patients with Long COVD-19 using data from British Columbia's post-COVID-19 Recovery Clinics. A retrospective cohort of 3463 patients was analyzed to assess HRQoL through the EQ-5D-5L questionnaire which includes five dimensions (mobility, self-care, usual activities, physical health, and mental health) administered to patients; responses were analyzed using the Visual Analogue Score (VAS). Notably, 95% of participants reported HRQoL scores below 90, with 50% scoring under 60, indicating significant impacts on their well-being. The analysis revealed that HRQoL is significantly influenced by various social determinants of health (SDoH), including age, sex, employment status, and ethnicity, each showing distinct correlations with HRQoL dimensions and overall VAS scores. Specifically, older age was associated with decreased mobility and increased pain/discomfort but less anxiety and depression, highlighting varying impacts across the age spectrum. The study highlights the multifaceted impacts of Long COVID on the lives of patients and underscores the necessity of targeted strategies to improve HRQoL among diverse groups, considering specific SDoH. Such a comprehensive approach could lead to more equitable health outcomes and support the development of tailored public health policies aimed at the recovery and rehabilitation of Long COVID sufferers.

Parallel Mediating Effects of Sleep Quality, Psychological Distress, and Self-Stigma in the Associations Between Long COVID Symptoms and Quality of Life Among Taiwanese Individuals With Mental Health Illness

BACKGROUND

Long COVID symptoms (i.e., experiencing symptoms of COVID-19 for 3 months post-COVID-19) affect individuals' health and their quality of life (QoL). However, the pathways through which it does so are not fully known.

AIM

The present study examined the mediating roles of sleep quality, psychological distress, and self-stigma in the associations between long COVID symptoms and QoL among individuals with mental illness.

METHOD

Individuals with mental illness (n = 333) were recruited from a psychiatric center in southern Taiwan to participate in the study. Data were collected regarding sleep quality, psychological distress, self-stigma, and QoL. Independent t-tests, Pearson correlations, and regression with Hayes' Process Macro were used to compare groups, examine relationships, and parallel mediation models, respectively.

RESULTS

Participants with long COVID symptoms had significantly worse sleep quality, psychological distress, physical QoL, and psychological QoL compared to those without symptoms. There were significant relationships between sleep quality, psychological distress, self-stigma, and QoL. Sleep quality significantly mediated the associations between long COVID symptoms and physical and social QoL. Psychological distress significantly mediated the associations between long COVID symptoms and all domains of QoL, but not self-stigma.

CONCLUSION

There are alternative pathways (e.g., sleep quality and psychological distress) through which long COVID symptoms may affect the QoL of individuals with mental illness. The findings suggest that individuals with long COVID symptoms have a higher chance of having poor QoL. Therefore, there may be the need for counseling and possible therapy for those who contract COVID-19, especially among individuals who already have mental illness.

Psychosocial Aspects of the Lived Experience of Long COVID: A Systematic Review and Thematic Synthesis of Qualitative Studies

BACKGROUND

Despite increasing recognition of long COVID, the psychosocial impacts of the lived experience on individuals remain underexplored. This systematic review sought to fill this gap by identifying key themes that describe the psychosocial dimensions of long COVID.

OBJECTIVE

The aim of this study is to identify key themes illustrating the psychosocial aspects of individuals' lived experience of long COVID.

SEARCH STRATEGY

Searches were conducted in multiple databases and grey literature sources for qualitative studies published between November 2019 and June 2024.

INCLUSION CRITERIA

Eligible studies involved adult participants self-reporting long COVID. The studies needed to provide qualitative data that could be synthesised thematically.

DATA EXTRACTION AND SYNTHESIS

Data extraction and thematic synthesis were conducted by at least two independent reviewers at each stage. Quality appraisal was performed using the Critical Appraisal Skills Programme tool.

RESULTS

The review included 34 studies. Thematic synthesis yielded five themes: 'Debilitation', 'Uncertainty', 'Sources of Support', 'Meaning Making: Adjusting to a New Normal' and 'Experiences with Healthcare Services'. Individuals with long COVID reported experiencing physical, economic, and social challenges. Uncertainty and scepticism from others caused anxiety. Support from healthcare services, friends and online groups played an important role. Acceptance and gratitude were found to be meaningful in adjusting to the new normal. Experiences with healthcare services varied.

DISCUSSION AND CONCLUSIONS

This review provides valuable insights into the psychosocial impact of long COVID, highlighting the profound changes and challenges that individuals face. Healthcare services should adopt a holistic approach to integrate psychosocial support within their management strategies, to improve overall patient outcomes.

Journey mapping long COVID: Agency and social support for long-hauling

Long COVID, also known as Post COVID-19 condition, is defined by the WHO as the continuation or development of new symptoms three months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least two months with no other explanation. Despite many studies examining the causes and mechanisms of this disease, fewer studies have sought to understand the experience of those suffering from long COVID, or "long-haulers," This study contributes to the understanding of long-haulers (N = 14) by examining the role of agency and social support in shaping their journeys with long COVID. Drawing on a combination of interviews, questionnaires, and video diaries over a three-month period, journey mapping was used to document the participants' experiences, including symptoms, coping strategies, and lifestyle changes. Analysis of these journey maps resulted in a framework with four clusters demonstrating the importance of social support and patient agency shaping participants' Long COVID trajectory; the study contributes valuable insights into the daily lives and challenges individuals face with long COVID, informing the development of targeted support programs.