Cross-sectional and longitudinal comparison of health-related quality of life and mental well-being between persons with and without post COVID-19 condition

Abstract

Background: Still little is known about the impact of post COVID-19 condition (PC) on health-related quality of life (HRQOL) and mental well-being. We compared participants with PC with three groups: an acute COVID-19 infection (AC) only, at least one chronic condition (CC) but no COVID-19, or no condition at all, healthy (PH). Between these disease groups, we also estimated and compared HRQOL and mental well-being change over time.

Methods: Participants from six countries (Greece, Italy, Netherlands, Sweden, United Kingdom and United States) completed two web-based questionnaires (T1 = April-May 2020 and T2 = April-June 2022). Primary outcomes were HRQOL, measured by EQ-5D-5L and EQ VAS, and mental well-being (measured by World Health Organisation-Five (WHO-5) Well-Being Index, Patient Health Questionnaire (PHQ)-9 and General Anxiety Disorder (GAD)-7). All analyses were stratified by the disease groups.

Results: In total, 4,999 participants filled out both surveys: 240 were in PC, 107 in AC, 1798 in CC and 2,854 in PH. At T2, the mean EQ-5D-5L index values for the PC, AC, CC and PH groups were 0.70, 0.73, 0.75 and 0.92 (p < .001), respectively. Mean EQ VAS scores were 66, 65, 68 and 81 (p < .001), respectively. Poor mental well-being, depression and anxiety mean values were highest in the PC group (47.7; 9.1; 7.4), followed by the AC group (51.1; 7.7; 5.7), CC group (56.1; 5.2; 4.2) and the PH group (65.6; 2.8; 2.5), respectively (p < .001 between groups). Over time, HRQOL deteriorated in all groups, apart from the PH group. We observed the largest deterioration in the CC (EQ-5D-5L index: Δ0.03, p < .001) and AC group (EQ VAS: Δ6.3, p < .001). For the mental well-being outcomes, deterioration for WHO-5 and PHQ-9 were largest in the AC group (Δ4.8, p = .016; Δ-1.3, p = .012). Rates for GAD-7 improved for the PH and CC groups (PH: Δ1.27, CC: Δ0.56, p < .001).

Conclusions: In the cross-sectional analysis, participants with PC had the worst HRQOL and mental well-being compared to the other groups. In terms of change since the start of the COVID-19 pandemic, HRQOL and mental well-being deterioration was highest among AC participants and had a lower impact among PC participants, most likely due to pre-existing chronic disease.

Keywords: COVID-19; EQ-5D-5L; chronic condition; health-related quality of life; healthy control group; longitudinal; mental well-being; post COVID-19 condition.

Figure 1

Transitions between disease status groups in 2020 (T1) [healthy, chronic condition(s), possible acute or past COVID-19 infection] to 2022 (T2) [healthy, chronic condition(s), acute COVID-19 infection and post COVID-19 condition].

Figure 2

Percentage of respondents per level per EQ-5D-5L dimension in 2020 (T1) and 2022 (T2), by T2 disease status.

Figure 3

Percentage of respondents with poor mental health according to the WHO-5, PHQ-9 and GAD-7 in 2020 (T1) and 2022 (T2), by T2 disease status. The WHO-5 well-being index measures overall mental well-being, whereby poor mental well-being ranges from 0 to 50 points and good mental well-being from 51 to 100 points. The Patient health questionnaire 9 (PHQ-9) measures depression, whereby depression (i.e. “poor PHQ-9”) includes moderate, moderately severe and severe depression, which ranges from 10 to 27. The General anxiety disorder 7-item scale (GAD-7) measures anxiety, whereby having anxiety (i.e. “poor GAD-7”) includes mild, moderate and severe anxiety from the raw score (ranging from 8 to 21), and no anxiety ranges between 0 and 7.

Figure 4

(A–E): Mean and median EQ-5D-5L index value (A), EQ VAS score (B), WHO-5 sum score (C), PHQ-9 sum score (D) and GAD-7 sum score (E) in 2020 (T1) and 2022 (T2), by T2 disease status. The X denotes the mean, the line in the box the median, the box is the interquartile range, and the whiskers are the minimum and maximum points with outliers removed and depicted as dots. For the (A) EQ-5D-5L index values we used the United States value set. EQ-5D-5L index values range from less than 0 (worse than death) to 1. The (B) EQ VAS (Visual analogue scale) ranges from 0 (worst self-rated health) to 100 (best self-rated health). The (C) WHO-5 sum score (WHO-5 Well-being index) ranges from 0 (worst imaginable well-being) to 100 (best imaginable well-being). The (D) PHQ-9 sum score (Patient health questionnaire 9) ranges from 0 to 27 (Mild: 5–9, Moderate: 10–14, Moderately severe: 15–19, Severe: 20–27). The (E) GAD-7 sum score (General anxiety disorder 7-item scale) ranges from 0 to 21 (Mild: 5–9, Moderate: 10–14, Severe: 15–21).

Figure 5

Overlap of poor mental well-being (WHO-5), depression (PHQ-9) and anxiety (GAD-7) at T2 in (A) healthy respondents (n=2854), (B) chronic condition(s) respondents (n = 1798), (C) acute COVID-19 infection respondents (n = 107) and (D) post COVID-19 condition respondents (n = 240).