Depression and Long COVID Outcomes in Women: New Data Analysis

Wael Al-Delaimy, MD, PhD, discussed findings from a longitudinal analysis of the Women’s Health Initiative (WHI), a large prospective cohort study with more than 20 years of follow-up, examining the association between preexisting psychiatric disorders and COVID-19 outcomes. The study addressed whether individuals with established mental health conditions prior to the pandemic were at increased risk of COVID-19 infection, long COVID, or COVID-19–related complications.¹

Using repeated measures of depressive and anxiety symptoms collected before the pandemic, the investigators identified women with persistent or severe mental illness, defined primarily by comorbid depression and anxiety. The analytic sample consisted of older women, with a mean age of approximately 80 years, a population already at elevated risk for both medical and psychosocial vulnerability. Models were adjusted for multiple potential confounders, including age, comorbid chronic diseases, living situation, and other sociodemographic factors.

The study found that women with severe preexisting mental illness had a significantly higher risk of developing long COVID. Those with both depression and anxiety demonstrated an approximately 78% increased risk compared with women without these conditions. Notably, preexisting mental illness was not associated with higher risk of acute COVID-19 infection itself. Although, participants with mental health symptoms were less likely to engage in mitigation behaviors such as masking, handwashing, and social distancing, this did not translate into higher infection rates, but rather into greater risk of post-acute complications.

These findings suggested that mechanisms beyond exposure risk may underlie the association between chronic mental illness and long COVID, including potential biological pathways or the effects of social isolation, loneliness, and cumulative stress. Al-Delaimy emphasized that the results highlighted the importance of identifying older adults with longstanding depression and anxiety as a high-priority group during pandemics.

For psychiatrists and other clinicians, the study underscored the need for proactive outreach, coordination with primary care, and preventive strategies for patients with chronic mental illness, particularly among socially isolated older adults.² Future research was suggested to evaluate similar associations in younger populations and to clarify biological mechanisms contributing to long COVID vulnerability.

Dr Al-Delaimy is a professor and researcher at the University of California, San Diego.

References

1. Al-Delaimy WK, Bruno W, Shadyab A, et al. Psychological symptoms predict long coronavirus disease 2019: a prospective analysis from the Women’s Health Initiative. Menopause. 2026;10:1097.

2. Doraiswamy S, Mamtani R, Ameduri M, et al. Respiratory epidemics and older people. Age Ageing. 2020;49(6):896-900.