# Beyond COVID-19 Infection: Cognitive and Emotional Pathways Between Posttraumatic Stress, Rumination, and Quality of Life in Hospitalized Patients

## TL;DR

Hospitalized COVID-19 patients experience long-term quality of life issues linked to stress, rumination, and cognitive decline, with effects varying by sex and time since discharge.

## Contribution

This study identifies cognitive and emotional pathways linking posttraumatic stress and rumination to quality of life in post-COVID-19 patients, with sex and time since discharge as moderators.

## Key findings

- PTSS and rumination reduce quality of life via psychological morbidity, cognitive impairment, loneliness, and reduced posttraumatic growth.
- Rumination has strong direct and indirect effects on multiple mediators of quality of life.
- Sex and time since discharge moderate the relationship between loneliness and mental quality of life.

## Abstract

Background: Hospitalization during the COVID-19 pandemic has been linked with increased psychological distress, cognitive impairment, and reduced quality of life (QoL). Posttraumatic stress symptoms (PTSS) and rumination may significantly influence QoL outcomes, yet the mechanisms underlying these effects remain poorly understood. Based on the Cognitive Aging Model, this study examines the mediating effects of cognitive and emotional functioning, loneliness, and posttraumatic growth (PTG) on the connection between PTSS/rumination and QoL among patients hospitalized with COVID-19, including the moderator effect of sex, time since discharge, and admission to the intensive care unit (ICU). Methods: A cohort of 258 patients previously hospitalized with COVID-19 as the primary or secondary diagnosis was assessed 6 to 24 months post-discharge. Participants completed validated self-report and neuropsychological assessments of PTSS, rumination, cognitive function, psychological morbidity (depression and anxiety), loneliness, PTG, and QoL. Path analysis and multigroup analysis were employed to assess mediating and moderating effects. Results: PTSS and rumination were associated with reduced physical and mental QoL, primarily via increased psychological morbidity, impaired cognitive functioning, loneliness, and reduced PTG. Rumination showed strong direct and indirect effects on multiple mediators. Only sex and time since discharge significantly moderated pathways, with women showing a strong association between rumination and cognitive impairment/loneliness, while the association between loneliness and mental QoL was significant only in men and in recently discharged patients. Conclusions: PTSS and rumination contribute negatively to QoL in post-discharged patients with COVID-19 through emotional, cognitive, and social pathways, influenced by sex and duration since discharge. The findings underscore the significance of comprehensive long-term care methods focused on cognitive rehabilitation, psychosocial sT, and social reintegration for COVID-19 survivors.