Acute and chronic fatigue after COVID-19 : the impact of depression and somatic distress
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Abstract
Objective
Fatigue is the most frequent and burdensome symptom following COVID-19. The contribution of biopsychosocial factors remains unclear, particularly with respect to symptom duration. This exploratory study investigated the prevalence of acute and chronic fatigue after COVID-19 and examined biopsychosocial correlations.
Methods
Cross-sectional data from 452 participants of the Gutenberg Post-COVID Study were analyzed. All individuals had a previous Sars-CoV-2 infection. Participants were categorized into three groups (1) no fatigue during assessment, (2) fatigue lasting 1–<6 months at assessment, and (3) fatigue lasting 6 months or more at assessment. Fatigue was assessed using the Chalder Fatigue Questionnaire (CFQ) and classified as acute (<6 months) or chronic (≥ 6 months). The modified PHQ-9 (mPHQ-9, excluding the fatigue item) measured depressivity. SSD-12 measured the somatic symptom burden. Associations were examined using multivariable regression analyses.
Results
51.6 % reported no fatigue, 13.9 % showed acute fatigue, 34.5 % displayed chronic fatigue. Vaccination status was not associated with fatigue. The severity of the infection was associated with acute fatigue. No significant associations were observed with chronic fatigue. When psychological variables (mPHQ-9, SSD-12) were introduced, associations with somatic pre-morbid conditions disappeared, except for body mass index. Higher levels of depressiveness and somatic distress increased the likelihood of both forms of fatigue, while lower social status was associated specifically with chronic fatigue.
Conclusion
Depressiveness and somatic distress are strongly linked to post-COVID fatigue, particularly its chronic form. These findings underscore the importance of a biopsychosocial framework and the need for interdisciplinary treatment approaches in post-COVID care.
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Journal of psychosomatic research, 200, Elsevier, Amsterdam, 2025, https://doi.org/10.1016/j.jpsychores.2025.112456