Cognitive and emotional predictors of quality of life and functioning after COVID-19

Abstract

Objective: A long-term decline in health-related quality of life (HRQoL) has been reported after coronavirus disease 2019 (COVID-19). Studies with people with persistent symptoms showed inconsistent outcomes. Cognition and emotion are important determinants in HRQoL, but few studies have examined their prognostic significance for HRQoL and functionality in post-COVID patients with persisting symptoms. We aimed to describe QoL, HRQoL, and functioning in individuals post-COVID with varying COVID-19 severities and to investigate the predictive value of cognitive and emotional variables for QoL, HRQoL, and functioning.

Methods: In total, 492 participants (398 post-COVID and 124 healthy controls) underwent a neurobehavioral examination that included assessments of cognition, mood, QoL/HRQoL (WHOQOL-BREF, EQ-5D), and functioning (WHODAS-II). Analysis of covariance and linear regression models were used to study intergroup differences and the relationship between cognitive and emotional variables and QoL and functioning.

Results: The Physical and Psychological dimensions of WHOQoL, EQ-5D, and WHODAS Cognition, Mobility, Life Activities, and Participation dimensions were significantly lower in post-COVID groups compared with a control group. Regression models explaining 23.9%-53.9% of variance were obtained for the WHOQoL-BREF dimensions and EQ-5D, with depressive symptoms, post-COVID symptoms, employment status, income, and mental speed processing as main predictors. For the WHODAS, models explaining 17%-60.2% of the variance were obtained. Fatigue, depressive symptoms, mental speed processing, and post-COVID symptoms were the main predictors.

Interpretation: QoL/HRQoL and functioning after COVID-19 in individuals with persistent symptoms were lower than in non-affected persons. Depressive symptoms, fatigue, and slower mental processing speed were predictors of lower QoL/HRQoL and functioning.

Figure 1

Flowchart for the sample selection. (A) Post‐COVID condition individuals; (B) Health control. Participants were selected from the following hospitals: Consorci Sanitari de Terrassa (Terrassa, Barcelona, Spain); Hospital Sant Joan Despí Moisès Broggi‐Consorci Sanitari Integral (Sant Joan Despí, Barcelona, Spain); Hospital Universitari Arnau de Vilanova (Lleida, Spain); Hospital Universitari de Santa Maria (Lleida, Spain); Consorci Sanitari Alt Penedès‐Garraf (Vilafranca de Penedés, Barcelona, Spain); Hospital Verge de la Cinta, (Tortosa, Tarragona, Spain); Fundació Sant Hospital (La Seu d'Urgell, Lleida, Spain); Consorci Hospitalari de Vic (Vic, Barcelona, Spain); Hospital Universitari Germans Trias i Pujol (Badalona, Barcelona, Spain); Hospital Universitari de Bellvitge (Barcelona, Spain); Hospital Universitari Mútua de Terrassa (Terrassa, Barcelona, Spain); Hospital Clinic de Barcelona (Barcelona, Spain); Hospital Municipal Badalona (Badalona, Barcelona, Spain); Institut d'Assistència Sanitària (Girona, Spain); Hospital de Figueres (Figueres, Girona, Spain); Hospital de Puigcerdà (Puigcerdà, Girona, Spain); Hospital General de la Cruz Roja San José y Santa Adela (Madrid, Spain); Hospital Nostra Senyora de Meritxell (Andorra); Hospitales San Roque (Gran Canaria, Islas Canarias, Spain).

Figure 2

Symptoms reported by people with PCC at time of assessment. The graph illustrates the frequency of symptoms exhibited by the participants. Asterisks denote significant differences (p < 0.05).

Figure 3

Intergroup differences in WHOQoL‐BREF adjusted for age, sex, educational level, comorbidities, income, and employment status change. Bars represent the adjusted mean of the WHOQoL‐BREF dimension scores for each group. Asterisks denote significant differences. The Bonferroni comparisons are shown.

Figure 4

Intergroup differences in WHODAS‐II adjusted for age, sex, educational level, comorbidities, income, and employment status change. Bars represent each group's adjusted mean of the WHODAS Total and dimension scores. Asterisks denote significant differences. The Bonferroni comparisons are shown.