SARS-CoV-2 infection frequency and depressive symptoms in Chinese residents: A moderated mediation model

Coronavirus disease 2019 (COVID-19) is associated with depressive symptoms, with reinfection posing a risk to mental health. However, few studies have examined the impact of the frequency of severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection on perceived stress and depressive symptoms. The present study aimed to examine whether the frequency of SARS-CoV-2 infection is associated with perceived stress and subsequent depressive symptoms and to determine whether socioeconomic status (SES) moderates this mediating effect.

In this cross-sectional study, a total of 30,053 Chinese residents (15,011 males, 49.9 %) aged 19-107 years were recruited between June 20 and August 31, 2023. The participants recalled their frequency of SARS-CoV-2 infection. Perceived stress and depressive symptoms were measured via the Perceived Stress Scale-4 and the Patient Health Questionnaire-9. SES was assessed via a 7-point self-report scale. MANOVA, ANOVA, and conditional indirect effect analysis were performed.

Residents with one SARS-CoV-2 infection experienced fewer depressive symptoms than those with no infections. Perceived stress mediated the association between one case of SARS-CoV-2 infection and reduced depressive symptoms, with higher SESs amplifying this association. Conversely, among individuals with multiple infections, the frequency of SARS-CoV-2 infection was associated with increased depressive symptoms.

In the postpandemic era, repeated SARS-CoV-2 infections still significantly affect residents' mental health. Attention should be paid to the psychological stress and depressive symptoms of high-risk groups, such as individuals with a history of repeated infections.