# Daily stress and worry are additional triggers of symptom fluctuations in individuals living with Long COVID: results from an intensive longitudinal cohort study

## TL;DR

Daily stress and worry can worsen Long COVID symptoms, even after accounting for physical and mental exertion.

## Contribution

This study identifies emotional stressors as new triggers of symptom fluctuations in Long COVID patients.

## Key findings

- Higher stress scores were linked to increased same-day symptom severity and worsened anxiety and depression the next day.
- Worry was associated with immediate increases in fatigue and cognitive dysfunction but reduced anxiety and depression the following day.
- Stress showed stronger and broader associations with symptom exacerbation compared to worry or rumination.

## Abstract

Recent research has shown that exertion in physical, cognitive, social, and self-care activities triggers symptom severity in individuals with Long COVID.

The current study aimed to investigate whether daily emotional exertions (stress, worry, rumination) were associated with symptom exacerbation, over and above influences of effortful daily activities, in individuals with Long COVID.

In total, 376 participants were recruited from UK Long COVID clinics and community settings and completed daily assessments of activity and severity of 8 core symptoms every 3 hours for up to 24 days; 155 participants completed daily assessments of stress, worry, and rumination for at least 7 consecutive days.

Days with higher stress scores were associated with increased severity of all symptoms on the same day, after adjusting for activities, demographic and medical factors (P-values ≤ .007). Days with higher stress scores also predicted more severe anxiety and depression symptoms 1 day later (P < .001) and more severe anxiety (P < .001) and dizziness symptoms (P = .003) 2 days later. Days with higher worry scores were associated with increased fatigue (P < .001), anxiety (P < .001), depression (P < .001), and cognitive dysfunction (P = .002) on the same day, but decreased anxiety (P = .003) and depression (P = .002) symptoms 1 day later and less severe pain (P = .002) symptoms 2 days later. Daily rumination was only associated with 2 symptoms.

Daily stress and worry are distinct factors linked to fluctuations in same-day and next-day Long COVID symptoms, with daily stress showing the strongest association—consistent with patterns of postexertional symptom exacerbation. These findings highlight the importance of considering stress and worry as potential therapeutic targets and integrating their management into self-care programs.