The association between commonly reported symptoms following SARS-CoV-2 infection and subjective well-being

In a recent study published in Epidemiology and Infectionresearchers evaluated the association between SWB (subjective well-being) and post-COVID-19 (coronavirus disease 2019) symptoms.

Study: Associations Between Reported Post-COVID-19 Symptoms and Subjective Well-Being, Israel, July 2021 -April 2022. Image Credit: ANDREI_SITURN/Shutterstock


Symptoms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections have been reported persistent beyond the acute period of infection or arise in the post-acute phase after recovery. The global burden of post-acute health implications of SARS-CoV-2 infections could probably be enormous; however, the impact of post-acute COVID-19 symptoms on SWB is not clear.

About the study

In the present study, researchers determined the relationship between common post-COVID-19 symptoms and SWB for assessing the effects of symptoms experienced beyond the acute phase of COVID-19 in the long term.

The team analyzed documented symptoms and SWB from 2,295 individuals (of which 576 reported a history of SARS-CoV-2 infections) who were a part of an ongoing longitudinal cohort study conducted in Israel. They estimated changes in SWB associated with documented symptoms after three to six months, after six to 12.0 months, and after 12 to 18 months post-COVID-19 among individuals reporting prior SARS-CoV-2 infections. The participants were different at every follow-up assessment.

The participants were regularly (every three to four months) asked to answer questions concerning their physical, mental and psychosocial health and well-being using the ISARIC (international severe acute respiratory and emerging infection consortium) questionnaires. They documented symptoms experienced during the acute COVID-19 period and within seven days preceding filling out the survey.

The SWB division of the questionnaire was based on the WHO-5 (five-item World Health Organization well-being index). The participating individuals were to fill out the SWB division concerning the previous two weeks and provide NRS (numeric rating scale) scores for fatigue experienced on the previous day.

Invitations comprising the survey links were sent by SMS (short message system) to all individuals who underwent RT-PCR (reverse transcription polymerase chain reaction) SARS-CoV-2 testing between July 2021 and April 2022 in either of the governmental hospitals in Israel, including Galilee medical center, Baruch Padeh Poriya medical center, and Ziv medical center.

The survey was available in four commonly spoken languages ​​in Israel: Arabic, Hebrew, Arabic, English, and Russian. Participants were invited to participate at three points: July 2021, November 2021, and March 2022. Generalized linear regression analysis was performed, and data adjustments were made for the main demographic factors.

Individuals documenting symptoms within 3.0 months or beyond 18 months of COVID-19 or those providing incomplete data were excluded from the analysis. Variables considered were participant sex, age, the status of COVID-19 vaccination, follow-up period, time of filling out the survey questionnaires, and symptoms documented when the questionnaires were filled out.


Out of 95,604 individuals invited, 6,500 individuals filled out the questionnaires (seven percent). After excluding individuals with missing information and ineligible individuals, 2,295 individuals (two percent of invitees) were considered for the final analysis. Among 2,295 participants, 57% (n=1,319) were female, 92% (n=2,112) had been vaccinated, and 75% (n=1,719) had no prior COVID-19 history.

Out of 576 individuals previously infected with SARS-CoV-2, 32% (n=186) did not document any COVID-19 symptoms during filling out the questionnaires, and 68% (n=390) documented ≥1.0 symptoms experienced in the post -acute period during filling out the questionnaires. A median value of 260.0 days was obtained for the duration between COVID-19 and completing the questionnaires.

Individuals with post-COVID-19 symptoms showed a greater likelihood of being unvaccinated and female. Among 526 participants with prior COVID-19 history, the symptoms most frequently documented included fatigue (42%, n=243), muscular weakness (26%, n=153), pain in muscles (23%, n=134), sleep difficulties (21%, n=121), and concentration difficulties/confusion (22%, n=126).

SWB scores by individuals with prior history of SARS-CoV-2 infections previously who reported no symptoms in the post-COVID-19 period were identical to those by individuals with no prior COVID-19 history (74% for both groups).

In comparison to individuals who did not document any symptoms, individuals documenting unspecific symptoms such as sleep difficulties, concentration difficulties/confusion, and fatigue showed the most significant SWB reductions of 12, 12, and 8.0 pp (percent points), respectively. The effect of individual post-acute COVID-19 symptoms developed on SWB differed at each time point.

While fatigue resulted in a statistically non-significant eight pp reduction in SWB among individuals documenting fatigue at three to six months post-COVID-19, among individuals documenting fatigue during the 12-month to 18-month time point, the reduction in SWB related to fatigue was significant (13 pp).

Concentration difficulties significantly reduced the SWB scores when documented at three to six months or 12 to 18 months post-infection. However, sleep difficulties significantly affected the SWB at three to six months and six to 12 months but not at 12 to 18 months post-infection.

Musculoskeletal symptoms such as pain and weakness in the muscles did not show any significant association with SWB at any time point except for an SWB reduction among individuals documenting pain in the muscles during the six-month to 12-month follow-up period post-COVID. -19. Among 553 SARS-CoV-2-infected individuals with complete NRS data, those documenting fatigue had significantly greater NRS scores (7.1, more fatigue) than those who didn’t (4.1).


Overall, the study findings showed that post-acute COVID-19 symptoms were associated with a significant reduction in SWB ≤18.0 months after initial infection.


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