Pre-pandemic lifestyle patterns and mental health outcomes among people reporting [PASC]: evidence from a Slovenian population…, 2025, Zager Kocjan+

[SNT Gatchaman]

Pre-pandemic lifestyle patterns and mental health outcomes among people reporting post-acute sequelae of COVID-19: evidence from a Slovenian population-based sample

Spoiler: Authors

Zager Kocjan, Gaja; Verdnik, Jana; Manfreda, Jure; Komidar, Luka; Lep, Žan; Kobal Grum, Darja; Hacin Beyazoglu, Kaja; Podlesek, Anja; Babnik, Katarina

BACKGROUND
The long-term consequences of COVID-19, or post-acute sequelae of SARS-CoV-2 infection (PASC), represent a major public health concern. Beyond persistent physical symptoms, PASC profoundly affects mental health and daily functioning. Despite growing international evidence, little is known about how pre-pandemic lifestyle patterns shape vulnerability to PASC and how its psychological burden extends beyond distress to deficits in well-being. While national settings may shape prevalence estimates and symptom reporting, this study focuses on group differences within a single country—Slovenia, characterized by universal healthcare, high physical activity, strict containment measures, and low institutional trust.

METHODS
Data were drawn from a representative sample of working-age Slovenian adults (N = 3,048), surveyed in early 2023. Participants reported infection history, symptom persistence, pre-pandemic lifestyle patterns, and mental health outcomes. PASC was defined following WHO criteria, with an added requirement of functional impairment. Analyses employed chi-squared tests for categorical variables and ANOVAs for differences across ill-being and well-being indicators.

RESULTS
Nearly one-third of infected individuals (29.5%) met PASC criteria. Fatigue, decreased physical performance, and cognitive difficulties were the most prevalent and persistent symptoms, often lasting close to a year. PASC was more common among women, younger adults, those facing financial hardship, and individuals with higher education. Lifestyle patterns showed mixed associations: BMI was unrelated, smoking displayed a paradoxically lower risk, while physical activity reduced infection risk but was modestly linked to greater PASC likelihood post-infection. Crucially, PASC was associated with significantly elevated stress, anxiety, and depression, alongside reduced well-being across all domains.

CONCLUSIONS
These findings highlight the enduring burden of PASC and its dual impact on distress and well-being, underscoring the need for integrated, system-level planning that links primary care, rehabilitation, and mental health services to mitigate long-term consequences and support recovery.

Web | DOI | PDF | BMC Public Health | Open Access

 

[ScoutB]

From the abstract, I kind of got the impression that people were facing financial hardship *before* they developed PASC, but the questionnaire doesn't really seem to confirm that timing. Could they have financial hardships as a *result* of PASC?

Participants also assessed their financial hardship by answering the question “How much difficulty do you have paying all your financial obligations throughout the month?”

Their finding that

smoking displayed a paradoxically lower risk

reminds me of Parkinsons. OTOH, last time I was reading up on it, sounds like we don't think the smoking-parkinson's-protection thing is due to nicotine, whereas I guess nicotine is something people have theories about with covid.

Appreciate them reporting this despite being surprised by it from the sounds of it

Among individuals who were infected, those who had engaged in at least 30 min of daily physical activity prior to the pandemic had a slightly higher likelihood of developing PASC, whereas those who were not sufficiently active were less likely to develop PASC.

 

[Utsikt]

They acknowledge that there is an overlap between symptoms of being ill and symptoms of anxiety and depression, but it doesn’t seem like they fully catch on to the fact that the questionnaires can flag physically ill but mentally healthy people as mentally ill.

The stronger effects observed for ill-being likely reflect the closer conceptual and experiential link between PASC symptomatology and negative affective states. PASC involves chronic physical symptoms—such as fatigue, pain, and cognitive difficulties—that are inherently distressing and overlap with depressive and anxiety features. By contrast, well-being reflects broader cognitive and social evaluations of one’s life and functioning, which may be partially preserved despite physical and emotional strain.

Of course there is the usual babble about evidence based multidisciplinary rehabilitation and so on..