# Trajectory of severe COVID anxiety and predictors for recovery in an 18-month UK cohort

## TL;DR

Severe COVID anxiety generally decreases over 18 months, but some people continue to experience high levels, especially those with depression, health anxiety, or from high-risk minority groups.

## Contribution

Identifies long-term trajectory and predictors of recovery for severe COVID anxiety in a UK cohort.

## Key findings

- Most participants experienced significant reductions in severe COVID anxiety over 18 months.
- 23.7% of participants continued to worry about COVID daily, and 13% had severe symptoms post-restrictions.
- Older age, minority ethnic background, health anxiety, and depression predicted slower recovery.

## Abstract

People with severe COVID anxiety have significant fears of contagion, physiological symptoms of anxiety in response to a COVID stimulus and employ often disproportionate safety behaviours at the expense of other life priorities.

To characterise the long-term trajectory of severe COVID anxiety, and the factors that influence recovery.

This prospective cohort study followed 285 people with severe COVID anxiety in the UK over 18 months. A nested randomised feasibility trial tested an online cognitive–behavioural therapy (CBT)-based intervention (no. ISRCTN14973494). Descriptive statistics and linear regression models identified factors associated with change in COVID anxiety over 18 months.

Most participants experienced major reductions in COVID anxiety over time (69.8% relative cohort mean decrease, P < 0.001), but a quarter of people (23.7%, 95% CI: 17.8–30.1) continued to worry about COVID every day, and for 13% symptoms remained severe even after the ending of all public health restrictions. Increasing age, being from a minority ethnic background that confers greater risk from COVID-19, and the persistence of high levels of health anxiety and depressive symptoms, predicted slower improvements in severe COVID anxiety after adjusting for other clinical and demographic factors. Neither a trial CBT-based intervention, nor contextual factors including daily case rates, vaccination status or having contracted COVID-19, appeared to affect the trajectory of severe COVID anxiety.

For most people severe COVID anxiety improves significantly with time. However, interventions treating depression and health anxiety, and targeting older people and those from greater-risk minority backgrounds, warrant further investigation in future pandemics.