# Symptoms of Depression and Anxiety After COVID-19 Despite Systematic Telemedical Care: Results From the Prospective COVID-SMART Study

## TL;DR

This study found that telemedical care during the acute phase of COVID-19 did not reduce long-term symptoms of depression and anxiety in at-risk patients.

## Contribution

The study is the first randomized trial to assess telemedical care's impact on Long-COVID mental health outcomes.

## Key findings

- 40.8% of participants reported Long-COVID symptoms after 12 months.
- 36.5% of participants experienced symptoms of depression and 40.5% anxiety.
- Telemedical support did not reduce depression or anxiety symptoms at follow-up.

## Abstract

Background: Long-COVID has attracted increased attention with rising numbers of affected patients and high individual symptom burden. Prior studies have described its prevalence, course of disease, and severity. Yet, the influence of intensive care, including telemedical support for patients at risk for a severe course of the initial COVID-19 disease, on the occurrence of Long-COVID and its associated symptoms is studied to a lesser extent.

Methods: Here, we report the long-term results of the COVID-SMART study, which randomized at-risk COVID-19 patients to either smartwatch-based monitoring with telemedical support or standard care. We investigate Long-COVID symptoms, including symptoms of depression and anxiety after 12 months.

Findings: Between October 2020 and May 2022, we enrolled 607 patients in the COVID-SMART study. Complete 12-month follow-up was available for 573 patients, with 288 patients randomized to the intervention group and 285 to the control group. Overall, 234 participants (40.8%) reported COVID-related symptoms, with a high prevalence of symptoms of depression (209 participants, 36.5%) and anxiety (232 participants, 40.5%). However, telemedical support did not reduce these symptoms at follow-up. Multivariable regression analysis identified sex, active smoking, and pre-existing asthma as significant predictors of both outcomes.

Interpretation: COVID-SMART is the first prospective, randomized clinical trial to systematically assess the impact of telemedical care on the development of Long-COVID associated risk of depression and anxiety. We identify in part modifiable risk factors for these outcomes. However, telemedical support does not appear to be beneficial in reducing symptoms of anxiety and depression and should hence be focused to the acute infection phase.

Trial Registration: ClinicalTrials.gov identifier: NCT04471636