Depressive symptoms and sex differences in the risk of post-COVID-19 persistent symptoms: a prospective population-based cohort study

Abstract

Women are unexplainedly more affected than men by post-COVID-19 persistent symptoms. Depressive symptoms may partially explain these sex differences. In the French population-based CONSTANCES cohort, depressive symptoms were measured with the nine-item Patient Health Questionnaire between April 6 and May 4, 2020. Between December 2020 and January 2021, among 2,093 infected participants (mean (s.d.) age, 43.0 years (11.9); 55.3% women), 453 (21.6%) reported ≥1 new persistent symptom that emerged from March 2020. Accounting for several confounders, women were more likely than men to have ≥1 symptom (odds ratio (95% confidence interval), 1.45 (1.17–1.80)). Further adjusting for the nine-item Patient Health Questionnaire, participants in the highest (versus lowest) quartile were more likely to have ≥1 symptom (2.97 (2.09–4.23)), while the association with female sex substantially dropped (1.28 (1.02–1.60)). Depressive symptoms mediated 41.5–45.4% of this association. A biopsychosocial model, integrating gender and mental health, is warranted to understand long COVID and inform preventive and therapeutic strategies. In this cohort study, the authors find that depressive symptoms at the beginning of the pandemic may partially explain why women participants who had a COVID-19 episode were more likely than their male counterparts to report at least one post-COVID-19 persistent symptom seven to ten months later.