Depression as a moderator and mediator of functional status in patients with Long COVID: a cross-sectional and longitudinal observational study from the PERCEIVE cohort in Australia.
| Title: | Depression as a moderator and mediator of functional status in patients with Long COVID: a cross-sectional and longitudinal observational study from the PERCEIVE cohort in Australia. |
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| Authors: | Seboka BT; Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia.; Imaging Research Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.; Smith J; Imaging Research Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.; Whitmore K; Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia.; Imaging Research Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.; Baranow B; Imaging Research Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.; Howden E; Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia.; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.; Kulkarni J; Monash Alfred Psychiatry Research Centre, Melbourne, Victoria, Australia.; Huynh QL; Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia quan.huynh@baker.edu.au.; Imaging Research Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.; H Marwick T; Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia.; Imaging Research Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia. |
| Source: | BMJ open [BMJ Open] 2025 Nov 21; Vol. 15 (11), pp. e099776. Date of Electronic Publication: 2025 Nov 21. |
| Publication Type: | Journal Article; Observational Study |
| Language: | English |
| Journal Info: | Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: [London] : BMJ Publishing Group Ltd, 2011- |
| MeSH Terms: | COVID-19*/psychology ; COVID-19*/complications ; COVID-19*/epidemiology ; COVID-19*/physiopathology ; Depression*/epidemiology; Tasmania/epidemiology ; Victoria/epidemiology ; Humans ; Male ; Female ; Cross-Sectional Studies ; Longitudinal Studies ; Middle Aged ; Adult ; SARS-CoV-2 ; Aged ; Severity of Illness Index ; Post-Acute COVID-19 Syndrome |
| Abstract: | Background: In patients with post-acute sequelae of COVID-19 (PASC), depression has been associated with symptom severity, the duration since infection and ongoing functional impairment. However, the interconnections between these factors remain inadequately understood.; Objectives: This study aimed to explore the roles of depressive symptoms in moderating and mediating the relationships between post-COVID-19 conditions and functional capacity.; Methods: The PERCEIVE study recruited 1794 participants from Victoria and Tasmania through online advertisements based on possible PASC for a cross-sectional study. Of these, 461 participated in the longitudinal study. Post-COVID-19 duration and symptoms were recorded, and depressive symptoms and functional capacity were self-reported using the 9-item Patient Health Questionnaire and the Duke Activity Status Index (DASI), respectively. The association of depression with functional capacity was explored using ordinary least squares (OLS) regression, with companion OLS models, Sobel-Goodman tests and 1000 bootstrap iterations to assess mediation. Longitudinal data were analysed to assess changes in functional capacity and depressive symptoms over time, with mediation analysis using mixed models to explore depression as a mediator.; Results: Participants had a mean DASI score of 35 (SD 21). Fatigue (18%), shortness of breath (11%) and chest pain (6%) were common symptoms, with severe depression linked to fatigue (93%) and shortness of breath (66%). The severity of post-COVID-19 symptoms was associated with severe depression (β=6.31, 95% CI 5.42 to 7.21) and reduced functional capacity (β=-6.40, 95% CI -9.20 to -3.61), with depression mediating 36% of the association between post-COVID-19 symptom severity and functional capacity. PASC was associated with higher depression scores (β=2.06, 95% CI 1.15 to 2.97) and lower functional capacity (β=-3.99, 95% CI -6.21 to -1.77), with depression mediating 51% of the association between PASC and reduced functional capacity. The longitudinal analysis suggested that depression is associated with the relationship between PASC and changes in functional capacity over time (unstandardised estimate=-5.16, p |
| Competing Interests: | Competing interests: None declared. |
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| Contributed Indexing: | Keywords: COVID-19; Cardiac Epidemiology; Depression & mood disorders; Post-Acute COVID-19 Syndrome |
| Entry Date(s): | Date Created: 20251121 Date Completed: 20251121 Latest Revision: 20251216 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC12658530 |
| DOI: | 10.1136/bmjopen-2025-099776 |
| PMID: | 41271424 |
| Database: | MEDLINE |
Journal Article; Observational Study