Healthcare Consumption and Work Absenteeism [post COVID]: The Role of Cognitive-Behavioural Factors…, 2026, Verveen, Knoop+

[SNT Gatchaman]

Healthcare Consumption and Work Absenteeism of Individuals With and Without Persistent Complaints After COVID-19: The Role of Cognitive-Behavioural Factors, Neuropsychological Functioning and Depressive Symptoms

Spoiler: Authors

Verveen, Anouk; Camper, Eva; Verfaillie, Sander Cj; Visser, Denise; Appelman, Brent; van Heugten, Caroline M; Horn, Janneke; Hulst, Hanneke E; Kuut, Tanja A; van der Maaden, Tessa; van Os, Yvonne Mg; Prins, Maria; Visser-Meily, Johanna Ma; van Vugt, Michele; van den Wijngaard, Cees C; Brouwer, Sandra; Nieuwkerk, Pythia T; van Berckel, Bart; Tolboom, Nelleke; Knoop, Hans

BACKGROUND
To compare healthcare consumption and work absenteeism of individuals with and without persistent complaints after COVID-19 and determine to what extent cognitive-behavioural factors, neuropsychological functioning and depressive symptoms influence this relationship.

METHOD
Individuals with (n = 129) and without (n = 96) persistent fatigue (Checklist Individual Strength (CIS) fatigue ≥ 35) and difficulty concentrating (CIS concentration ≥ 18) at least 3 months (IQR 16–28 months) after SARS-CoV-2 infection were included. Using the Treatment Inventory of Costs in Patients, healthcare consumption (number of visits) and work absenteeism (≥ 3 weeks absent from paid work) in the past 3 months were assessed. Mediation analyses were performed to investigate whether the putative factors indeed influence the relationship between persistent complaints and work absenteeism or healthcare consumption.

RESULTS
Individuals with persistent complaints more often visited a healthcare professional in the past 3 months (3; IQR = 0–11) than participants without persistent complaints (0; IQR = 0–2, p < 0.001). None of the putative factors was associated with healthcare consumption. Work absenteeism (n = 21/85 with paid work) and work disability (n = 27/225) were only reported by participants with persistent complaints, so no mediation analysis could be performed. Within the group with persistent symptoms, worse neuropsychological functioning (attention and executive functioning) and two illness perception subscales were associated with an increased likelihood of work absenteeism.

CONCLUSION
The relationship between reporting persisting symptoms and increased healthcare consumption could not be explained by cognitive-behavioural factors, depressive symptoms or neuropsychological functioning. In participants with persistent complaints, illness perceptions and neuropsychological functioning were associated with work absenteeism.

Web | DOI | PDF | International Journal of Behavioral Medicine | Open Access

 

[SNT Gatchaman]

It remains inconclusive what the addition of perceptions is to the burden of disease. Nevertheless, in post-COVID complaints, associations with illness perceptions have been established, also when taking self-reported severity of symptoms into account. Prospective research is necessary to determine the relation between illness perceptions and health outcomes.

Contrary to what was expected from previous prepandemic research, other cognitive-behavioural factors did not seem to influence work absenteeism in PASC in this cross-sectional study.

the relationship between reporting persisting symptoms and increased healthcare consumption could not be explained by cognitive-behavioural factors, depressive symptoms or neuropsychological functioning.

 

[bobbler]

Healthcare Consumption and Work Absenteeism of Individuals With and Without Persistent Complaints After COVID-19: The Role of Cognitive-Behavioural Factors, Neuropsychological Functioning and Depressive Symptoms

Spoiler: Authors

Verveen, Anouk; Camper, Eva; Verfaillie, Sander Cj; Visser, Denise; Appelman, Brent; van Heugten, Caroline M; Horn, Janneke; Hulst, Hanneke E; Kuut, Tanja A; van der Maaden, Tessa; van Os, Yvonne Mg; Prins, Maria; Visser-Meily, Johanna Ma; van Vugt, Michele; van den Wijngaard, Cees C; Brouwer, Sandra; Nieuwkerk, Pythia T; van Berckel, Bart; Tolboom, Nelleke; Knoop, Hans

BACKGROUND
To compare healthcare consumption and work absenteeism of individuals with and without persistent complaints after COVID-19 and determine to what extent cognitive-behavioural factors, neuropsychological functioning and depressive symptoms influence this relationship.

METHOD
Individuals with (n = 129) and without (n = 96) persistent fatigue (Checklist Individual Strength (CIS) fatigue ≥ 35) and difficulty concentrating (CIS concentration ≥ 18) at least 3 months (IQR 16–28 months) after SARS-CoV-2 infection were included. Using the Treatment Inventory of Costs in Patients, healthcare consumption (number of visits) and work absenteeism (≥ 3 weeks absent from paid work) in the past 3 months were assessed. Mediation analyses were performed to investigate whether the putative factors indeed influence the relationship between persistent complaints and work absenteeism or healthcare consumption.

RESULTS
Individuals with persistent complaints more often visited a healthcare professional in the past 3 months (3; IQR = 0–11) than participants without persistent complaints (0; IQR = 0–2, p < 0.001). None of the putative factors was associated with healthcare consumption. Work absenteeism (n = 21/85 with paid work) and work disability (n = 27/225) were only reported by participants with persistent complaints, so no mediation analysis could be performed. Within the group with persistent symptoms, worse neuropsychological functioning (attention and executive functioning) and two illness perception subscales were associated with an increased likelihood of work absenteeism.

CONCLUSION
The relationship between reporting persisting symptoms and increased healthcare consumption could not be explained by cognitive-behavioural factors, depressive symptoms or neuropsychological functioning. In participants with persistent complaints, illness perceptions and neuropsychological functioning were associated with work absenteeism.

Web | DOI | PDF | International Journal of Behavioral Medicine | Open Access

Have I read that conclusion right?

They’ve actually honestly reported cognitive behavioural factors do not explain the link between symptoms and increased healthcare use?

 

[Eleanor]

other cognitive-behavioural factors did not seem to influence work absenteeism in PASC in this cross-sectional study.

always the slippery language

 

[Trish]

I wish people would use honest language like 'sick leave' or 'sickness absence' not 'absenteeism' which sounds too much like vountary bad behaviour.

Edit: And another one 'illness perceptions' rather than 'symptoms'.
And 'neuropsychological' instead of congitive problems.

All slippery terms suggesting psychosomatic.

 

[Sean]

Work absenteeism (n = 21/85 with paid work) and work disability (n = 27/225) were only reported by participants with persistent complaints, so no mediation analysis could be performed. Within the group with persistent symptoms, worse neuropsychological functioning (attention and executive functioning) and two illness perception subscales were associated with an increased likelihood of work absenteeism.

Sicker people tend to score worse on measures of work capacity.

All of which could easily be explained as being caused by a chronic physical condition.

Cutting edge stuff, isn't it.

 

[Utsikt]

The relationship between reporting persisting symptoms and increased healthcare consumption could not be explained by cognitive-behavioural factors, depressive symptoms or neuropsychological functioning. In participants with persistent complaints, illness perceptions and neuropsychological functioning were associated with work absenteeism.

So the people that report being more sick are less able to work. How surprising.

 

[rvallee]

I've been reading these people's junk for years and I still have no idea what "cognitive-behavioral factor" even means. Even reading them describing it clarifies nothing:

namely fear avoidance (6 items, range 0–24), damage avoidance (5 items, range 0–20) and all-or-nothing behaviour (5 items, range 0–20). Higher scores indicate more avoidance/all-or-nothing behaviour.

None of this means anything or has any relevance to anything in the context of chronic symptoms following an infection. Those are obviously not "cognitive-behavioral factor", but rather very odd and biased concepts that they have been selling for decades by asking odd, leading questions that overlap with completely unrelated concepts.

So the people that report being more sick are less able to work. How surprising.

It really is surprising to them. They are constantly surprised and baffled by this, in fact literally cannot process it. People who are experts in this, somehow forever surprised by the most obvious thing in this context. They will never stop saying so anyway. This is evidence-based medicine, after all, evidence is entirely irrelevant to the process.