Trajectory of severe COVID anxiety and predictors for recovery in an 18-month cohort.

Background: People with severe COVID anxiety have significant fears of contagion, physiological symptoms of anxiety in response to a COVID stimuli, and employ safety behaviours which are often in excess of health guidelines and at the expense of other life priorities. The natural course of severe COVID anxiety is not known. Methods: This prospective cohort study followed 285 people with severe COVID anxiety in United Kingdom over 18-months. Descriptive statistics and linear regression models identified factors associated with change in COVID anxiety. Results: Most participants experienced major reductions in COVID anxiety over time (69.8% relative cohort mean decrease; p<0.001), but a quarter of people (23.7%, 95% CI 17.8 to 30.1) continued to worry about COVID every day. Increasing age, being from an ethnic background which conferred greater risk from COVID-19, and the persistence of high levels of health anxiety and depressive symptoms predicted significantly slower improvements in severe COVID anxiety adjusting for other clinical and demographic factors. Conclusions: For most people severe COVID anxiety significantly improves with time. However established interventions treating depression or health anxiety, and targeting older people and people from at-risk minority groups who appear to recover at slower rates, might be clinically indicated in future pandemics.