Psychopathologies in post-COVID outpatients differ from a psychosomatic control sample in a cross-sectional study

About 3-6% of individuals infected with SARS-CoV-2 develop post-COVID-19 condition (post-COVID), also known as multisystem disease, which comprises somatic and psychological symptoms. Nevertheless, there is an absence of research findings that differentiate patients with post-COVID from those with psychosomatic problems, for instance with regard to the presence of mental disorders. In addition, a comprehensive understanding of the factors that influence the manifestation of psychological symptoms in these patients is crucial for the development of multimodal interventions and lead to a destigmatization of post-COVID.

A cross-sectional study was conducted at a Clinic for Psychotherapy and Psychosomatics (Dresden University Hospital) to compare the self-reported sociodemographic, clinical, and psychopathological characteristics of post-COVID patients (n = 357), attending a psychosomatic post-COVID outpatient clinic, with those of a group of patients with different psychosomatic disorders, attending a general psychosomatic outpatient clinic (n = 991). Clinical diagnoses were assessed by clinical experts according to the International Classification of Diseases (ICD-10), somatic symptom severity, depressive symptoms and anxiety, using the Patient Health Questionnaire (PHQ-D) (primary outcomes). In addition, in the post-COVID group, the influence of sociodemographic, clinical, and psychopathological variables on primary outcomes and incapacity to work were analyzed. The statistical methods encompassed linear and logistic regression analyses, generalized linear models, Mann-Whitney U-tests and chi-squared tests.

Post-COVID patients demonstrated a greater degree of PHQ-15 somatic symptom severity (B = 1.37, p < .001) and higher levels of somatic and psychological multimorbidity (OR = 1.14, p = .005). At the level of specific disorders, post-COVID patients demonstrated an elevated risk of somatoform disorders (OR = 3.25, p < .001), while the risk of anxiety disorders (OR = .40, p < .001), affective disorders (OR = .52, p < .001) and personality disorders (OR = .11, p < .001) was reduced. In post-COVID, female gender (p = .003), somatic and psychological multimorbidity (p ≤ .025), experience of psychotherapy (p ≤ .031), and stress (p < .001) were associated with increased psychological symptom burden.

Post-COVID patients can be regarded as a specific group, distinguishable from psychosomatic patients and presumably with prevailing somatoform processing mechanisms. In accordance with the recommendations of the German post-COVID guideline, mental disorders should be accorded serious consideration in the treatment of post-COVID, with the objective of averting the risk of chronicity through early intervention.

The present study does not report results of a health care intervention on human participants. Therefore no registration was necessary.