Life stressors significantly impact long-term outcomes and post-acute symptoms 12-months after COVID-19 hospitalization 2022 Frontera et al

[Andy]

Highlights

• Over 50% of subjects reported significant life stressors at 12-months post COVID-19.
• Life stressors predict worse outcomes 12-months after COVID-19 hospitalization.
• Older age, female sex, baseline disability and COVID severity predict worse outcomes.

Abstract

Background
Limited data exists evaluating predictors of long-term outcomes after hospitalization for COVID-19.

Methods
We conducted a prospective, longitudinal cohort study of patients hospitalized for COVID-19. The following outcomes were collected at 6 and 12-months post-diagnosis: disability using the modified Rankin Scale (mRS), activities of daily living assessed with the Barthel Index, cognition assessed with the telephone Montreal Cognitive Assessment (t-MoCA), Neuro-QoL batteries for anxiety, depression, fatigue and sleep, and post-acute symptoms of COVID-19. Predictors of these outcomes, including demographics, pre-COVID-19 comorbidities, index COVID-19 hospitalization metrics, and life stressors, were evaluated using multivariable logistic regression.

Results
Of 790 COVID-19 patients who survived hospitalization, 451(57%) completed 6-month (N = 383) and/or 12-month (N = 242) follow-up, and 77/451 (17%) died between discharge and 12-month follow-up. Significant life stressors were reported in 121/239 (51%) at 12-months. In multivariable analyses, life stressors including financial insecurity, food insecurity, death of a close contact and new disability were the strongest independent predictors of worse mRS, Barthel Index, depression, fatigue, and sleep scores, and prolonged symptoms, with adjusted odds ratios ranging from 2.5 to 20.8. Other predictors of poor outcome included older age (associated with worse mRS, Barthel, t-MoCA, depression scores), baseline disability (associated with worse mRS, fatigue, Barthel scores), female sex (associated with worse Barthel, anxiety scores) and index COVID-19 severity (associated with worse Barthel index, prolonged symptoms).

Conclusions
Life stressors contribute substantially to worse functional, cognitive and neuropsychiatric outcomes 12-months after COVID-19 hospitalization. Other predictors of poor outcome include older age, female sex, baseline disability and severity of index COVID-19.

Open access, https://www.jns-journal.com/article/S0022-510X(22)00349-5/fulltext

 

[rvallee]

life stressors including financial insecurity, food insecurity, death of a close contact and new disability were the strongest independent predictors of worse mRS

Other predictors of poor outcome included older age (associated with worse mRS, Barthel, t-MoCA, depression scores), baseline disability (associated with worse mRS, fatigue, Barthel scores), female sex (associated with worse Barthel, anxiety scores) and index COVID-19 severity

So, illness. All of those are direct consequences of the illness, or the illness itself. You can even sort of put old age in that category, as it usually means more health problems. I mean, sure, they are happening in life, I guess that's one way to have an argument, just make it fully generic and universal. That's basically the BPS model in a nutshell: stuff that happened in time and can do other stuff, trust us we're experts and definitely don't look up.

It's absolutely incredible that medicine is genuinely incapable of understanding in its full context that illness impacts people. No, it's "life events", even when those "life events" are illness or the consequences of illness.

It's genuinely hard at times not to think whether this is all a sick joke because it's genuinely hard to be this ineptly incoherent on purpose. It's really easy to see why religion dominated so much in culture and politics for most of our history, even scientists can be completely gullible or incapable of telling the truth if it's politically unpopular.

 

[Peter T]

Such studies would only be meaningful if predictive.

Ideally it would be prospective study, assessing a group of people for life stressors, predicting which you consider most likely to be at risk for a consequent illness and then following them up to see if your predictions were accurate.

Though obviously you need to allow for any intervening life stressors, if acute Covid is included as a stressor that renders the results totally [un]interpretable.

Also if previous health conditions are included as life stressors, it is hard to know how these results can be interpreted, given it is a big assumption that pre existing conditions will not physiologically impact on the effects of the acute Covid infections.

[added - There is now evidence suggesting that everyone with MS has had prior exposure to EBV, so if EBV infection is allowed as a life stressor, then by the arguments used in this study MS is invariably cased by prior exposure to life stressors.]

 

[Sean]

Such studies would only be meaningful if predictive.

This.

 

[rvallee]

Such studies would only be meaningful if predictive.

Clearly, studies don't even have to be predictive, they'll be reported as such anyway. There will need to be laws against this, academia is not able to police themselves here. Purely associative studies can be presented as determinant, even when the associations happen after the illness, with cheery quotes from the researchers, who clearly do not understand what is happening with the patients, how they are mistreated and how it's exactly this "holistic" approach that's been failing all along. They see nothing of us, only what they perceive.

The summary went from "significant impact" in the paper to "strongly predictive" in the news reports. This is nearly fraudulent reporting, there is no basis for those claims, but they are very popular and so there would be actual backlash to opposing a rosy but false picture. Medicine is seriously losing the battle to pseudoscience, this is not normal. How in the hell can what is basically "things that happen in time" happening in the future affect the development of symptoms that in most cases are there from the start.

Major Life Stressors 'Strongly Predictive' of Long COVID Symptoms
https://www.medscape.com/viewarticle/984336

After recovery from acute infection with SARS-CoV-2, major stressful life events such as the death of a loved one or financial insecurity can have a significant impact on the development of long COVID symptoms, new research suggests.

Major life stressors in the year after hospital discharge for COVID-19 are "strongly predictive of a lot of the important outcomes that people may face after COVID," lead investigator Jennifer A. Frontera, MD, a professor in the Department of Neurology at NYU Langone Health, New York City, told Medscape Medical News.​

"On the development of symptoms". There is not a single bit of evidence in this paper that allows this language, there is no support for the development of symptoms based on "life stressors" clearly hinting here at worrying and mood, other of course for the fact that one such stressor is illness. If we account for PEM/PESE as stressor, things actually make sense, but is not the case here because they are alluding at anxiety and probably have not even heard of PEM. The impact, including financial, is reattributed as causative, just because.

These outcomes include depression, brain fog, fatigue, trouble sleeping, and other long COVID symptoms.​

"And other symptoms", but the focus is an explicit framing to bring depression into mind for everyone.

Frontera said it's important to realize that "sleep, fatigue, anxiety, depression, even cognition are so interwoven with each other that anything that impacts any one of them could have repercussions on the other."

She added that it "certainly makes sense that there is an interplay or even a bi-directional relationship between the stressors that people face and how well they can recover after COVID."

Therapies that lessen the trauma of the most stress-inducing life events need to be a central part of treatment for long COVID, with more research needed to validate the best approaches, Frontera said.

She also noted that social services or case management resources may be able to help address at least some of the stressors that individuals are under — and it is important to refer them to these resources. Referral to mental health services is also important.

"I think it's really important to take a holistic approach and try to deal with whatever the problem may be," said Frontera.
​

Yeah, let's do that and "try to deal with whatever the problem may be", that will definitely work. Just wing this like a cowboy throwing a lasso. Who cares, right? This definitely sounds like a whole bunch of whatever. As in whatever happens to those people is of no concern to anyone who cares so let's go with the healing crystals and magical cookie therapy, which at the very least would be considered very acceptable and enjoyed.

I'm not sure what it says of this doctor that they are either completely unaware that almost all treatment for LC is exactly this tripe, or that she says so pretending that it's not. I really don't know what this says about them anymore. They have to know that this is what's out there, that the patients are screaming mad about the fact that it's useless. But either they genuinely don't know, putting their competence into question, or don't really care because it's all whimsical and no one of influence even cares about this yet, so there's nothing wrong with saying nonsense that reassures them personally.

But the thing is I don't doubt she actually believes this, wants to help, and is simply unable to see how completely broken this is. This is ideological goggles, they are not seeing reality, are too detached from it. Professionals who genuinely cannot assess the outcome of their work should obviously have no say in the lives of anyone else. This is madness. Our lives are in the hands of people who face a major health disaster and only have kumbaya and yoga as an answer even after all this time.

By many estimates LC will be a multi-trillion dollar disaster affecting tens of millions. And they have freaking yoga for it and they are happy about it. They think they're doing great. This is insane.

 

[Sean]

The summary went from "significant impact" in the paper to "strongly predictive" in the news reports.

This is standard stuff from these clowns. They start with may, could, suggests, etc, and by the end of the paper, or sometimes even just the end of the abstract, it becomes is and does. Minor correlation becomes definite causation with nothing more than a rhetorical sleight of hand.

Ellen Goudsmit was pointing out this tactic 20 years ago. Nothing has changed. I guess because it works so well for them.

 

[bobbler]

Clearly, studies don't even have to be predictive, they'll be reported as such anyway. There will need to be laws against this, academia is not able to police themselves here. Purely associative studies can be presented as determinant, even when the associations happen after the illness, with cheery quotes from the researchers, who clearly do not understand what is happening with the patients, how they are mistreated and how it's exactly this "holistic" approach that's been failing all along. They see nothing of us, only what they perceive.

The summary went from "significant impact" in the paper to "strongly predictive" in the news reports. This is nearly fraudulent reporting, there is no basis for those claims, but they are very popular and so there would be actual backlash to opposing a rosy but false picture. Medicine is seriously losing the battle to pseudoscience, this is not normal. How in the hell can what is basically "things that happen in time" happening in the future affect the development of symptoms that in most cases are there from the start.

Major Life Stressors 'Strongly Predictive' of Long COVID Symptoms
https://www.medscape.com/viewarticle/984336

After recovery from acute infection with SARS-CoV-2, major stressful life events such as the death of a loved one or financial insecurity can have a significant impact on the development of long COVID symptoms, new research suggests.

Major life stressors in the year after hospital discharge for COVID-19 are "strongly predictive of a lot of the important outcomes that people may face after COVID," lead investigator Jennifer A. Frontera, MD, a professor in the Department of Neurology at NYU Langone Health, New York City, told Medscape Medical News.​

"On the development of symptoms". There is not a single bit of evidence in this paper that allows this language, there is no support for the development of symptoms based on "life stressors" clearly hinting here at worrying and mood, other of course for the fact that one such stressor is illness. If we account for PEM/PESE as stressor, things actually make sense, but is not the case here because they are alluding at anxiety and probably have not even heard of PEM. The impact, including financial, is reattributed as causative, just because.

These outcomes include depression, brain fog, fatigue, trouble sleeping, and other long COVID symptoms.​

"And other symptoms", but the focus is an explicit framing to bring depression into mind for everyone.

Frontera said it's important to realize that "sleep, fatigue, anxiety, depression, even cognition are so interwoven with each other that anything that impacts any one of them could have repercussions on the other."

She added that it "certainly makes sense that there is an interplay or even a bi-directional relationship between the stressors that people face and how well they can recover after COVID."

Therapies that lessen the trauma of the most stress-inducing life events need to be a central part of treatment for long COVID, with more research needed to validate the best approaches, Frontera said.

She also noted that social services or case management resources may be able to help address at least some of the stressors that individuals are under — and it is important to refer them to these resources. Referral to mental health services is also important.

"I think it's really important to take a holistic approach and try to deal with whatever the problem may be," said Frontera.
​

Yeah, let's do that and "try to deal with whatever the problem may be", that will definitely work. Just wing this like a cowboy throwing a lasso. Who cares, right? This definitely sounds like a whole bunch of whatever. As in whatever happens to those people is of no concern to anyone who cares so let's go with the healing crystals and magical cookie therapy, which at the very least would be considered very acceptable and enjoyed.

I'm not sure what it says of this doctor that they are either completely unaware that almost all treatment for LC is exactly this tripe, or that she says so pretending that it's not. I really don't know what this says about them anymore. They have to know that this is what's out there, that the patients are screaming mad about the fact that it's useless. But either they genuinely don't know, putting their competence into question, or don't really care because it's all whimsical and no one of influence even cares about this yet, so there's nothing wrong with saying nonsense that reassures them personally.

But the thing is I don't doubt she actually believes this, wants to help, and is simply unable to see how completely broken this is. This is ideological goggles, they are not seeing reality, are too detached from it. Professionals who genuinely cannot assess the outcome of their work should obviously have no say in the lives of anyone else. This is madness. Our lives are in the hands of people who face a major health disaster and only have kumbaya and yoga as an answer even after all this time.

By many estimates LC will be a multi-trillion dollar disaster affecting tens of millions. And they have freaking yoga for it and they are happy about it. They think they're doing great. This is insane.

To be fair the issue is that they think 'therapies that lessen the trauma of' is the issue rather than 'support to minimise the impact of' - which takes things from the realmof common sense in those with empathy and exactly the message you wonder why most of the world won't get, into 'how on earth do you think that adding a therapy of any kind in makes over-exertion less/OK'.

This has always been the crux of the issue with the world for ME - that most people won't give leeway to others, particularly when it means not putting themselves top of the pile for once. And so when faced with a condition that says rather than give someone the bare minimum leeway for them to just about 'perform' ie 'seem to function' you actually need to give support early, to a substantial enough level they are well-below even what they say in order that they really are resting and doing less, for a really decent amount of time - another issue, most people think weeks not years. And really can't process the action/inaction--> consequences issue

not giving someone the say 3 years of proper reduction but thinking a few weeks of being ill, and sneaking liberties at best and only giving the odd little fop at normal isn't adjustments and leads to constant deterioation they never get better from and the world doesn't want to know. They are basically bartering with God/life/us on trying to make reality not reality and people like this offer them something I can't believe they think works but gives them a nice little excuse to pretend they had no idea for a few more years, then 'I wasn't to know' when the consequences hit.

Which is why noone cares how illogical, ridiculous and stupid any of it is as long as it makes their life easy. It's just the same old circuit of clownery because laypersons are as bad as anyone for playing politics on us, our health etc and if there isn't a strong scientific contingent telling them to stop it sadly their natural default is to do what they can ge away with and blag morally