COVID-19 Pandemic
Trajectories of post-traumatic stress disorder symptoms (2003-04 to 2020-21) and risk of long COVID in the World Trade Center Health Registry Julia Sisti* Julia Sisti Samuel Janette Janna
Objective: The etiology of long COVID is not well-understood; however pre-existing mental health conditions have been identified as risk factors. We examined associations between history of post-traumatic stress disorder symptoms (PTSS) and subsequent long COVID among individuals exposed to the World Trade Center disaster.
Methods: Over five waves of follow-up in the World Trade Center Health Registry (2003-04 to 2020-21), we used group-based trajectory modeling to identify five PTSS trajectories (resilient, low-stable, remitted, delayed onset, and chronic-high). Among enrollees who responded to five wave surveys, completed two COVID-19 focused surveys (2021-22 and 2022-23), and reported ever having a COVID-19 infection (N=5,363), we used modified Poisson regression to estimate adjusted RRs and 95% CI for associations of PTSS trajectories with self-report of long COVID symptoms (any vs. none).
Results: In 2022-23, 41% of enrollees reported experiencing any long COVID symptoms. In models adjusted for sociodemographic characteristics and self-reported diagnosed physical health conditions and depression, associations with long COVID were observed for all trajectories compared to the resilient trajectory, which was characterized by very low PTSS at all points. RRs were similar among the three trajectory groups characterized by a high lifetime prevalence (>90%) of probable PTSD (RRremitted=1.82, 95% CI=1.63, 2.03; RRdelayed =1.86, 95% CI=1.67, 2.06; RRchronic=1.80, 95% CI=1.59, 2.03). Risk of long COVID was also elevated among individuals in the low-stable trajectory group, who had a lower lifetime prevalence of probable PTSD (18%) (RR=1.46, 95% CI=1.35, 1.58).
Conclusion: Risk of long COVID is elevated among individuals with a history of elevated PTSS, including among those whose symptoms have improved. Populations at high risk of PTSD, including those exposed to traumatic events, may benefit from targeted screening to identify those with long COVID.