History of trauma linked to risk of long COVID

People who have experienced traumatic stress are more likely to develop persistent symptoms after a COVID-19 infection, according to a recent study in Chronic Stress. This finding may suggest new approaches in treating long COVID and other postviral syndromes, which significantly hinder people's quality of life. 

The study began before the COVID-19 pandemic, with two observations. Dr. Rebecca Hendrickson, a UW Medicine psychiatrist, noticed that many of her patients with post-traumatic stress disorder also had autonomic symptoms, which are commonly associated with changes in autonomic regulation, including high blood pressure, heart palpitations, and chronic nausea. At the same time, Dr. John Oakley, a UW Medicine neurologist, recognized that many of his patients with autonomic symptoms had a history of traumatic stress. 

Hendrickson and Oakley wondered, “Is this just what we’re happening to notice in our clinics or is there something else here?” 

As the pandemic took hold and people began reporting persistent symptoms after their COVID-19 infections, Hendrickson and Oakley realized it was a chance to study whether exposure to traumatic stress and autonomic symptoms were connected.  

Their investigation, part of the larger Seattle RECOVER study, examined whether a history of traumatic stress affected the likelihood and severity of autonomic symptoms and other common persistent symptoms after COVID-19 infections. 

Over 400 participants completed online surveys. This included people with and without a history of COVID-19 infections, and with and without persistent symptoms after those infections. 

The researchers found that having experienced traumatic stress increased the likelihood and severity of autonomic symptoms after COVID-19 infection.  Past traumatic stress appeared to intensify people’s responses to stressors such as a COVID-19 infection, possibly through long-term changes in stress-threat response systems.   

Not everyone with a history of traumatic stress, however, developed long COVID.  

“There’s huge variability,” Hendrickson said. 

Among people who have developed long COVID, she said, “recovery can take a long time, but even when it’s slow, most people really do seem to recover.” 

Hendrickson’s team is now studying whether traumatic stress and infections can change people’s stress-threat response systems with follow-up surveys and physiological tests among a subset of the participants. Understanding those changes and their corresponding symptoms might inform treatments. 

The work has bridged the traditional separation among researchers in mental and physical health. Underscoring the need for cross-department collaboration, Christine Cheah, a UW Medicine research scientist, moved between the departments of neurology and psychiatry during her work on the project to span the expertise of both areas. 

The psychiatric symptoms didn’t cause the autonomic ones, nor vice versa. Rather, Hendrickson suggested, traumatic stress or viral infections likely changed both systems in parallel, and those changes reinforced each other. 

She added, “We should be able to think about how stressful events can impact the autonomic nervous system and physical health, and also how they can impact cognition, mood and anxiety — and hold both of these effects as real at the same time.” 

This work was supported by an Innovation Grant from the Garvey Institute for Brain Health Solutions, a Veterans Affairs Clinical Sciences Research and Development Service Career Development Award (IK2CX001774), and the VA Northwest Network Mental Illness Research, Education and Clinical Center.

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