Changes in depression and anxiety symptoms and their association with healthcare service use after COVID-19

The human mind and body are deeply intertwined, a fact that became impossible to ignore during the global pandemic caused by the SARS-CoV-2 virus. While the initial waves of infection were defined by fever, coughing, and breathing difficulties, a quieter, longer-lasting wave emerged afterward. This phenomenon, often called long COVID, involves symptoms that linger for months or even years after the virus has left the body. Among the most persistent and disruptive of these lingering effects are changes in mental health, specifically feelings of deep sadness and overwhelming worry. Scientists have long known that surviving a severe illness can take a toll on a person's emotional well-being, but the pandemic created a unique opportunity to study this on a massive scale. The critical question for doctors and public health officials became not just whether these feelings occurred, but how they changed over time for individuals who had been infected. Did these feelings fade away as people recovered physically, or did they stick around? And perhaps most importantly for the functioning of hospitals and clinics, did these changing emotional states lead people to seek medical help more often, and if so, what kind of help did they need?

To answer these questions, a team of researchers from the Federal University of Rio Grande in Brazil followed a large group of adults who had tested positive for the virus. They did not just take a single snapshot of these people's lives; instead, they checked in on them twice, first about six months after their infection and again about two years later. This approach allowed the scientists to watch the story of each person's mental health unfold, rather than just guessing what happened between the two points in time. The researchers sorted the participants into four distinct groups based on how their symptoms of depression and anxiety behaved. Some people never had symptoms at either check-in. Some had symptoms at the first check-in but felt better by the second, a pattern known as remission. A third group started with no symptoms but developed them by the second check-in, representing new cases. The final group struggled with symptoms at both times, indicating that their distress had persisted throughout the two-year period. The team then looked at self-reports of these groups to see if their emotional journey influenced how often they visited doctors, emergency rooms, or mental health specialists.

The study involved nearly 1,900 adults who had confirmed cases of the virus. When the researchers looked at the big picture, they found that the majority of people managed to stay free of significant depression and anxiety symptoms throughout the entire two-year follow-up. About three-quarters of the participants did not experience depressive symptoms, and roughly two-thirds remained free of anxiety symptoms. However, for a significant portion of the group, the emotional struggle was real and lasting. Persistent symptoms, where the feeling of sadness or worry lasted from the first check-in to the second, were found in about 15 percent of the participants for depression and 16.6 percent for anxiety. Another group, representing about 6.5 percent for depression and 11.9 percent for anxiety, developed these symptoms only after the initial six-month mark, showing that the impact of the virus on mental health could be delayed.

What made this study particularly valuable was its focus on what happened next: how these different emotional paths affected the way people used healthcare services. The researchers discovered a clear and strong link between the persistence or new onset of these symptoms and the need for medical care. People who developed new symptoms of depression were significantly more likely to visit emergency departments and urgent care centers compared to those who remained symptom-free. They were also far more likely to seek out psychological or psychiatric help. The numbers were even more striking for those whose anxiety symptoms persisted over the two years. These individuals were much more likely to use emergency rooms and urgent care facilities. Most notably, the group with persistent anxiety was more than eleven times as likely to use psychological or psychiatric services compared to those who never had symptoms. This suggests that for many, the mental health toll of the virus was not just a private struggle but a driver of public healthcare demand, pushing people toward specialized care and emergency services.

The study also highlighted that even when symptoms improved, the need for care did not always disappear. People whose anxiety symptoms faded away by the second check-in were still more likely to use mental health services than those who never had symptoms at all. This indicates that the experience of having these symptoms, even if temporary, leaves a mark that leads people to seek professional support. The researchers noted that women were more likely to experience persistent symptoms than men, and that the use of healthcare services was highest among those who reported ongoing mental health struggles. The findings suggest that the burden of long COVID extends beyond physical recovery, creating a sustained demand for medical resources that is heavily concentrated in emergency and mental health sectors.

These results paint a picture of a healthcare system under pressure from a dual crisis: the physical aftermath of the virus and the enduring emotional scars it left behind. The data suggests that emergency rooms and urgent care centers are often the first place people turn when their mental health deteriorates, perhaps because primary care doctors are not always able to identify or manage these complex emotional needs quickly enough. The researchers emphasize that this pattern points to a need for better integration between different levels of care. If doctors in primary care settings could identify and treat these symptoms earlier, it might be possible to reduce the number of people flooding into emergency departments. The study concludes that monitoring mental health over time is essential for understanding the full cost of the pandemic. By recognizing that depression and anxiety can emerge or persist long after the virus is gone, healthcare systems can better prepare to support the millions of people who are still navigating the long road to recovery.