Long COVID as a pandemic legacy: Psychological symptoms, psychosocial factors, and consequences

The Covid-19 pandemic has imposed a major chronic burden on individuals, and those who have been infected with SARS-CoV-2 may experience additional consequences, including long Covid-19 or post-acute sequelae of Covid-19 (PASC). PASC appears to be a consequence of the pandemic that will continue to affect some people well beyond the official end of the pandemic. Therefore, it is important to study it thoroughly to determine how it differs from pandemic sequelae in people who were not infected with Covid-19, to identify optimal treatments, and to develop interventions and supports for people who are affected by it. PASC occurs in 5 to 20% of Covid-19 patients. The most common symptoms include physiological (e.g., coughing, shortness of breath, fatigue, discomfort after exercise, chest pain, joint pain) and psychological symptoms (e.g., depression or other mood disturbances, cognitive impairment). PASC symptoms significantly reduce the quality of life and limit the ability of the affected individuals to function in a variety of life domains, particularly in the workplace. Many authors and organizations point out that there is a lack of PASC research and support systems for people with PASC. Understanding the long-term condition after the acute phase of Covid-19 and its consequences for individual functioning is a prerequisite for appropriate diagnosis and establishment of systems in various settings and at various levels of society to support and care for people with PASC. The main goals of the proposed project are to (i) describe the psychological symptoms of PASC in different domains (cognitive, emotional, motivational), examine how they relate to the physical symptoms of PASC, and how they differ from the general population's responses to a pandemic, (ii) identify psychological and social risk factors and protective factors of PASC, (iii) examine the impact of PASC on the functional abilities and quality of life of persons with PASC, and the responses of the social environment and social support to persons with PASC; and (iv) based on the empirical results, identify possible approaches for secondary and tertiary prevention of PASC in Slovenia. In the proposed project, we will develop a comprehensive psychosocial model of symptoms, factors, and consequences of PASC and use it as a basis for developing guidelines for psychodiagnostics, psychological treatment, and support measures for people with PASC. The research questions will be addressed through empirical research in which we will use a variety of research designs and methods that will contribute to a more comprehensive insight into the psychological symptoms of PASC and their relationship to various factors and consequences, as well as to greater credibility of our conclusions. We will use both cross-sectional and longitudinal research designs that will allow us to derive causal conclusions about the relationships among the variables under study. Rigorous quantitative research methods will be complemented by qualitative methods that will provide deeper insight into individuals' subjective experiences with PASC. The validity of self-report measures will be tested through the concurrent use of objective tests of cognitive abilities. The proposed project will comprehensively examine the psychological aspects of PASC using a nationally representative sample, which - to our knowledge - is the first such research endeavor. In-depth and valid conclusions will form the basis for the development of prevention programs and guidelines for psychodiagnostics, clinical treatment, and psychological interventions. Thus, the proposed research project makes an important contribution not only to science but also to the profession, as the guidelines will provide systematic psychological treatment for individuals with PASC symptoms and will provide employers with starting points for making appropriate adjustments of work requirements for individuals with PASC.