A study in JAMA Network Open finds that while US adults with long COVID have a higher rate of psychiatric conditions such as depression and anxiety and are just as likely to receive treatment, many cite cost as a reason for not seeking care.
A team led by University of British Columbia researchers parsed data on 25,122 US adults with and without long COVID (or post-COVID condition [PCC]) from the 2022 National Health Interview Survey, a nationally representative interview-based survey, from October 2023 to February 2024.
The researchers used the Patient Health Questionnaire-8 to gauge depression symptoms and the General Anxiety Disorder-7 instrument to assess anxiety. Participants were considered treated if they received counseling or psychiatric medications for their symptoms. The median participant age was 46 years, half were women, and 3.4% were experiencing long COVID.
"The experiences of individuals who were unable to access care due to costs, stigma, or other reasons are important to consider when developing PCC-focused mental health supports," the researchers wrote. "Adults with mental illness frequently experience barriers to care and may be underserved—a problem that was exacerbated during the COVID-19 pandemic."
Similar rates of receiving treatment
Relative to participants without long COVID, those who had the condition were about twice as likely to experience depression (weighted prevalence [wPr], 16.8% vs 7.1%; adjusted odds ratio [aOR], 1.96), anxiety (wPr, 16.7% vs 6.3%; aOR, 2.21), sleep difficulties (wPr, 41.5% vs 22.7%; aOR 1.95), cognitive problems (wPr, 35.0% vs 19.5%; aOR, 2.04), and disabling fatigue (wPr, 4.0% vs 1.6%; aOR, 1.85).
People with PCC may have more difficulty paying for counseling or therapy due to lost employment wages and greater costs of managing complications from COVID-19, or they may experience challenges obtaining health plan authorization for these supports.
Having current long COVID was tied to female sex, White race, having multiple chronic conditions, and not having received a COVID-19 vaccine.
Of adults with depression or anxiety, those with long COVID (wPr, 28.2% vs 34.9%; aOR, 1.02) were similarly likely as those without the condition to not receive treatment in the previous year (wPr, 37.2% vs 23.3%; AOR, 2.05). But participants currently experiencing long COVID were twice as likely to report cost as a barrier to getting counseling (aOR, 2.12).
"People with PCC may have more difficulty paying for counseling or therapy due to lost employment wages and greater costs of managing complications from COVID-19, or they may experience challenges obtaining health plan authorization for these supports," the researchers wrote.
Screening may counter reluctance to seek care
The authors said that the US Department of Health and Human Services is helping healthcare systems create care pathways specific to long COVID.
"These pathways can integrate mental health services by, for example, incorporating routine mental health screening in follow-up for individuals recovering from COVID-19 and including mental health professionals in multidisciplinary PCC clinics," they wrote. "In contexts in which mental health services are sparse, telehealth and group-based programs could be leveraged."
But these programs should recognize that long-COVID patients with or without psychiatric conditions may hesitate to seek care.
"These individuals have described experiencing stigma and medical gaslighting from clinicians, sometimes being told that their physical symptoms are psychosomatic," they wrote. "Standardized screening strategies for psychiatric symptoms in PCC clinics may help normalize mental health assessments for this population."
