Persistent physical symptoms after COVID-19 infection and the risk of Somatic Symptom Disorder

J Psychosom Res. 2023 Mar;166:111172. doi: 10.1016/j.jpsychores.2023.111172. Epub 2023 Jan 25.


Objective: Evidence shows that many patients with COVID-19 present persistent symptoms after the acute infection. Some patients may be at a high risk of developing Somatic Symptom Disorder (SSD), in which persistent symptoms are accompanied by excessive and disproportionate health-related thoughts, feelings and behaviors regarding these symptoms. This study assessed the frequency of persistent physical symptoms and SSD and their associated factors in patients with confirmed COVID-19.

Methods: We conducted a longitudinal retrospective study after the first two French lockdowns at the Lille University Hospital (France), including all patients with confirmed COVID-19. Persistent physical symptoms and excessive preoccupations for these symptoms were measured 8 to 10 months after the onset of COVID-19. The combination of the Patient Health Questionnaire-15 and the Somatic Symptom Disorder-B Criteria Scale was used to identify the individuals likely to present with SSD. Two linear regression models were performed to identify sociodemographic and medical risk factors of SSD.

Results: Among the 377 patients with a laboratory-confirmed diagnosis, 220 (58.4%) completed the questionnaires. Sixty-five percent of the 220 included patients required hospitalization, 53.6% presented at least one persistent physical symptom and 10.4% were considered to present SSD. Female sex, older age, infection during the second wave and having probable PTSD were significantly associated with the severity of SSD and SSD was associated with a significantly higher healthcare use.

Conclusions: The identification of SSD should encourage clinicians to move beyond the artificial somatic/psychiatric dualism and contribute to a better alliance based on multi-disciplinary care.

Keywords: COVID-19; Long COVID, post-acute sequelae of COVID-19; Post-COVID condition; Post-traumatic stress disorder; Somatic Symptom Disorder.

MeSH terms

  • COVID-19*
  • Communicable Disease Control
  • Female
  • Humans
  • Medically Unexplained Symptoms*
  • Retrospective Studies
  • Somatoform Disorders / diagnosis
  • Somatoform Disorders / epidemiology
  • Somatoform Disorders / etiology