Trajectories of symptoms in the acute phase of COVID-19 infection and their association with anxiety and depression 2 years after infection

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BACKGROUND: The COVID-19 not only affects physical health, but its long-term mental health effects are also receiving increasing attention. While numerous studies have examined the prevalence of post-COVID mental health conditions, critical gaps remain in understanding how distinct trajectories of acute-phase symptoms differentially predict long-term psychiatric outcomes. This study aims to explore the severity, duration, and trajectory patterns of early symptoms of Covid-19 infection and analyze their association with anxiety and depression symptoms 2 years after infection. METHODS: We conducted a retrospective cohort study of 1,038 medical staff infected with COVID-19 at Suqian First People’s Hospital before December 2022 in July and August 2024. Information on early symptoms of infection, as well as anxiety and depression symptoms 2 years after infection were collected through questionnaires. We used 13 COVID-19 symptom checklists to evaluate the presence or absence of early symptoms in patients with COVID-19. We used standardized scales to assess anxiety (Generalized Anxiety Disorder-7[GAD-7]) and depression (Patient Health Questionnaire-9[PHQ-9]), the group-based trajectory model(GBTM) to analyze the trajectory patterns of early symptoms. We use logistic regression model to analyze the relationship between trajectory pattern and anxiety and depression symptoms after 2 years of infection. We first analyze the relationship between them in unadjusted model, and then further adjust the covariates including social demographic and clinical information such as gender, age and complication. RESULTS: The prevalence of anxiety was 23.5% in the Mild group, 46.0% in the Moderate group, and 61.6% in the Serious group. After covariate adjustment, anxiety risk increased progressively across trajectory groups. Compared to the Mild group (reference group), the odds ratio (OR) of anxiety was significantly higher in the Moderate group (OR: 2.81, 95% CI: 1.82–4.45; p < 0.001). Similarly, individuals in the Serious group also had a significantly higher odds of anxiety compared to the Mild group (OR: 4.12, 2.91–5.83; p < 0.001). The prevalence of depression was 22.0% in the Mild group, 45.5% in the Moderate group, and 63.6% in the Serious group. Furthermore, we found a significant association between trajectory groups and depression. Similarly, the adjusted logistic regression analysis showed that the Moderate (OR: 2.92, CI [95%]: 1.88–4.67, p < 0.001) and Serious (OR: 5.83, CI [95%]: 3.50–9.93, p < 0.001) groups showed 192% and 483% higher depression risk respectively versus Mild groups. CONCLUSIONS: In summary, this study reveals the heterogeneity of symptom trajectories in the acute phase of COVID-19 infection and demonstrates significant relationships between acute phase symptoms and long-term anxiety and depressive symptoms. Our findings provide new theoretical support for long-term health management of COVID-19 patients, especially mental health intervention. For the identified high-risk symptom trajectory groups, targeted early screening and continuous monitoring programs are recommended in clinical practice to detect possible anxiety and depression symptoms early.

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