Depressive symptoms and sex differences in the risk of post-COVID-19 persistent symptoms: A prospective population-based cohort study
Résumé
Background
After infection with SARS-CoV-2, it is not known why women are more affected than men by persistent and disabling symptoms, frequently referred to as ‘long COVID’ or ‘post-COVID-19 condition’. Since depression is more prevalent in women than men and associated with an increased risk of persistent symptoms after infection with SARS-CoV-2, we hypothesized that depressive symptoms may mediate to some extent the association between sex and the incidence of persistent symptoms after infection with
Methods
In the French population-based CONSTANCES cohort, depressive symptoms were measured with the 9-item Patient Health Questionnaire (PHQ-9) between April 6 and May 4, 2020. Symptoms that emerged from March 2020, lasting for at least 2 months and still present between December 2020 and January 2021 were self-reported. Infection with SARS-CoV-2 was determined according to serology or PCR test results.
Results
Among 2093 infected participants [mean (standard deviation) age, 43.0 years (11.9); 55.3% women], 453 (21.6%) reported at least one incident persistent symptom at follow-up. In binary logistic regression models including age, education, household income, smoking status, body mass index, hypertension, diabetes, and self-rated health, women were more likely than men to have at least one persistent symptom [OR (95%CI): 1.45 (1.17–1.80)]. Further adjusting for PHQ-9, participants in the highest
Limitations
The observational nature of the study prevents causal conclusions.
Conclusions
Sex differences in depressive symptoms may share mechanisms with sex differences in persistent symptoms after infection with SARS-CoV-2. A biopsychosocial model, integrating sex and mental health, is warranted to understand long COVID and inform preventive and therapeutic strategies.