Exploring the influence of long COVID upon self-identity: a systematic literature review

Long COVID (LC) is understood to be a multisystemic illness involving symptoms of an enduring nature. As underlying pathophysiological mechanisms of LC become better understood, attention has turned towards the psychological aspects of LC lived experience. Comparable conditions, such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), are known to significantly impact self-identity. However, no prior review has explored this topic in the LC population. This review sought to offer an original and exploratory narrative of LC patients' experiences connected to self-identity.

A systematic literature review using a Narrative Synthesis approach. Twenty-one qualitative studies (including 613 participants), published between January 2021-March 2025, exploring the influence of LC upon perceptions of self-identity were reviewed. Narrative Synthesis (NS) and PRISMA guidelines were followed.

Four main themes emerged: "Grief and Loss of the Familiar Self", "Reflections of Self, Mirrored by Others", "Threats to Identity", and "Repairing Fractured Identity".

For many, LC ruptures self-narratives that contribute to a stable and continuous sense of self across time. This can bring forth a strong grieving response to perceived losses and the unfamiliarity of self. Despite this, narratives of post-traumatic growth (PTG) were realised. Current guidance lacks direction for psychological interventions targeting LC-related distress. Acknowledgement of identity-based challenges must also be reflected in future guidance, with clear recommendations for clinical practice. Qualitative longitudinal exploration of LC's influence upon self-identity should be prioritised. Similarly, the acceptability and feasibility of interventions targeting identity-transformation work require further investigation.

PROSPERO ID: CRD420251008410.