Anxiety, depression, and fear after coronavirus disease 2019 infection and their association with long coronavirus disease symptoms

Ayaka Saito; Shiro Otake; Keiko Ohgino; Shogyoku Bun; Yu Mimura; Daisuke Ito; Naoki Miyazaki; Kengo Nagashima; Hideki Terai; Shotaro Chubachi; Katsunori Masaki; Jun Miyata; Ichiro Kawada; Ho Namkoong; Mizuha Hashiguchi; Junko Kagyo; Tetsuya Shiomi; Keita Masuzawa; Takanori Asakura; Sohei Nakayama; Yusuke Suzuki; Naoto Minematsu; Tadashi Manabe; Takahiro Fukui; Yohei Funatsu; Hidefumi Koh; Koichi Fukunaga

doi:10.3389/fpsyt.2025.1672447

Anxiety, depression, and fear after coronavirus disease 2019 infection and their association with long coronavirus disease symptoms

Front Psychiatry. 2025 Sep 10:16:1672447. doi: 10.3389/fpsyt.2025.1672447. eCollection 2025.

Authors

Ayaka Saito¹, Shiro Otake¹, Keiko Ohgino¹, Shogyoku Bun², Yu Mimura², Daisuke Ito^{3

4}, Naoki Miyazaki⁵, Kengo Nagashima⁵, Hideki Terai¹, Shotaro Chubachi¹, Katsunori Masaki¹, Jun Miyata¹, Ichiro Kawada¹, Ho Namkoong⁶, Mizuha Hashiguchi⁷, Junko Kagyo⁷, Tetsuya Shiomi⁷, Keita Masuzawa⁸, Takanori Asakura^{1

8

9}, Sohei Nakayama⁸, Yusuke Suzuki^{8

9}, Naoto Minematsu¹⁰, Tadashi Manabe¹¹, Takahiro Fukui¹¹, Yohei Funatsu¹¹, Hidefumi Koh¹¹, Koichi Fukunaga¹

Affiliations

¹ Division of Pulmonary Medicine, Keio University School of Medicine, Tokyo, Japan.
² Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
³ Department of Neurology, Keio University School of Medicine, Tokyo, Japan.
⁴ Memory Center, Keio University School of Medicine, Tokyo, Japan.
⁵ Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan.
⁶ Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan.
⁷ Department of Internal Medicine, Keiyu Hospital, Kanagawa, Japan.
⁸ Department of Respiratory Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
⁹ Department of Clinical Medicine (Laboratory of Bioregulatory Medicine), Kitasato University School of Pharmacy, Tokyo, Japan.
¹⁰ Department of Internal Medicine, Hino Municipal Hospital, Tokyo, Japan.
¹¹ Division of Pulmonary Medicine, Department of Internal Medicine, Tachikawa Hospital, Tachikawa, Japan.

Abstract

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has had widespread physical and psychological repercussions. Additionally, long COVID symptoms such as fatigue, dyspnea, and cognitive impairment have been well-documented; however, their associations with mental health symptoms remain unclear. This study investigated the relationships between long COVID and symptoms of anxiety, depression, and COVID-19-related fear using validated psychological assessment tools.

Methods: This nationwide, prospective cohort study enrolled 1,066 individuals who recovered from COVID-19. The participants completed self-report questionnaires at 3, 6, and 12 months after diagnosis. Long COVID symptoms and psychological status were assessed using the Hospital Anxiety and Depression Scale (HADS) and Fear of COVID-19 Scale (FCV-19S). Statistical analyses were used to examine associations between long COVID symptoms and psychological scores while accounting for clinicodemographic factors.

Results: Three months after diagnosis, 20.1% of the participants exhibited high anxiety (HADS-Anxiety [A] score ≥ 8), 23.6% had high depression (HADS-Depression [D] score ≥ 8), and 35.3% reported high levels of COVID-19-related fear (FCV-19S score ≥ 21). High HADS-A and HADS-D scores were significantly associated with younger age, female sex, and mild initial illness severity. Individuals with high HADS scores reported significantly greater long COVID symptoms; headaches and fatigue were associated with high anxiety scores and impaired concentration was associated with high depression scores.

Conclusions: This study highlighted the significant associations between mental health symptoms and long COVID, emphasizing the need for integrated psychological support in post-COVID care. Addressing anxiety, depression, and fear-related concerns may contribute to improved management of long COVID symptoms and enhance overall patient well-being.

Keywords: anxiety; depression; fear; long COVID; mental health; symptoms.

Copyright © 2025 Saito, Otake, Ohgino, Bun, Mimura, Ito, Miyazaki, Nagashima, Terai, Chubachi, Masaki, Miyata, Kawada, Namkoong, Hashiguchi, Kagyo, Shiomi, Masuzawa, Asakura, Nakayama, Suzuki, Minematsu, Manabe, Fukui, Funatsu, Koh and Fukunaga.