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Anxiety and Depression Common Among Coronavirus 'Long Haulers'

Analysis  |  By Christopher Cheney  
   September 10, 2021

In addition to physical symptoms such as cough and fatigue, coronavirus 'long haulers' are experiencing a range of behavioral health conditions.

Coronavirus "long haulers" are experiencing several behavioral health conditions, according to an expert at Doctor On Demand.

One of the more mysterious characteristics of COVID-19 is that a significant number of patients who are long haulers experience symptoms for weeks or months after recovering from the acute phase of the illness. Long haulers have a range of physical symptoms, including cough, shortness of breath, constitutional symptoms such as numbness and tingling, cardiac issues, hair loss, and deconditioning.

Coronavirus long haulers are also experiencing behavioral health issues, says Nikole Benders-Hadi, MD, medical director of behavioral health at Doctor On Demand.

"At Doctor On Demand, we are seeing a lot of depression and anxiety among long haulers. Particularly when you experience long-term anxiety symptoms, the condition has the opportunity to differentiate itself into other more specific anxiety disorders such as generalized anxiety disorder, panic disorders, and posttraumatic stress disorder. PTSD is defined as anxiety symptoms related to a trauma that lasts for greater than six months. Unfortunately, we are seeing an uptick in those types of diagnoses now. The impact of those kinds of symptoms are wide and varied. We are seeing people come to us talking about the impact on their relationships, on their work productivity, and on their ability to function day to day," she says.

Coronavirus long haulers are experiencing behavioral health conditions beyond anxiety and depression, Benders-Hadi says. "We are seeing increases in substance abuse disorders. We are also seeing an increase in the prevalence of obsessive-compulsive disorder in people who are overly focused on cleanliness. There was a recent Lancet study that showed increases in diagnoses of psychotic disorders, where people become very paranoid about cleanliness, and it advances to the point where they have delusions."

Addressing behavioral health issues among coronavirus long haulers

Treatments are available for coronavirus long haulers who are experiencing behavioral health conditions, she says.

"Unfortunately, there are not quick solutions to any of these symptoms—there is no magic pill that you can offer. We can provide supportive therapy and cognitive behavioral therapy. CBT has been shown to be effective because CBT specifically works to identify anxiety triggers. The work becomes practicing a different type of response when you feel anxiety rising up. It involves recognizing acute changes in your body and empowering the patient to exhibit more control over their anxiety," Benders-Hadi says.

Many people can provide emotional support to coronavirus long haulers with behavioral health issues, she says. "Being proactive about checking in with friends, loved ones, and co-workers who are experiencing long COVID symptoms is a great first step to making sure that they are getting the support they need. As a clinician, for me it comes down to early intervention being key. We need to offer practical advice on how to counter brain fog, for example. We need to encourage patients to be able to talk to their managers at work if there are work accommodations that are needed."

Increase in patient volume

During the pandemic, Doctor On Demand has seen a dramatic increase in behavioral health visits, including visits with coronavirus long haulers, Benders-Hadi says.

"In 2020, we saw a 140% year-over-year growth in behavioral health visits, and the demand for behavioral health visits remains high. We have seen the demand for medical visits come and go with different coronavirus variants and concern about acute COVID infections, but we have not seen a decrease in the need for behavioral health visits. The depression, anxiety, and other behavioral health conditions that are resulting from the long-term symptoms that patients are experiencing show that COVID is having a continuing impact," she says.

Healthcare providers need to think about coronavirus long haulers in the same way they think about other chronic illness patients, Benders-Hadi says. "We need to pull together research and data. We need to bring together both behavioral health specialists as well as medical and rehabilitation specialists to help treat individuals holistically rather than in isolation. That is going to be key given the widespread impact of both the physical and behavioral health symptoms that COVID long haulers are struggling with."

Related: Coronavirus 'Long Hauler' Care Model

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


Coronavirus "long haulers" who are afflicted by long-term anxiety can develop specific anxiety disorders such as panic disorder and posttraumatic stress disorder.

Cognitive behavioral therapy can be an effective treatment for coronavirus "long haulers" who are experiencing anxiety.

Healthcare providers need to think about coronavirus "long haulers" in the same way they think about other chronic illness patients.

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