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Depression, worry, and loneliness are associated with subsequent risk of hospitalization for COVID-19: a prospective study

Published online by Cambridge University Press:  19 May 2022

Siwen Wang*
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
Luwei Quan
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Ming Ding
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Jae H. Kang
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Karestan C. Koenen
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA Psychiatric Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
Laura D. Kubzansky
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Westyn Branch-Elliman
Department of Medicine, VA Boston Healthcare System, Boston, MA, USA Harvard Medical School, Boston, MA, USA
Jorge E. Chavarro
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Andrea L. Roberts
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Author for correspondence: Siwen Wang, E-mail:



Pre-pandemic psychological distress is associated with increased susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but associations with the coronavirus disease 2019 (COVID-19) severity are not established. The authors examined the associations between distress prior to SARS-CoV-2 infection and subsequent risk of hospitalization.


Between April 2020 (baseline) and April 2021, we followed 54 781 participants from three ongoing cohorts: Nurses' Health Study II (NHSII), Nurses' Health Study 3 (NHS3), and the Growing Up Today Study (GUTS) who reported no current or prior SARS-CoV-2 infection at baseline. Chronic depression was assessed during 2010–2019. Depression, anxiety, worry about COVID-19, perceived stress, and loneliness were measured at baseline. SARS-CoV-2 infection and hospitalization due to COVID-19 was self-reported. Relative risks (RRs) were calculated by Poisson regression.


3663 participants reported a positive SARS-CoV-2 test (mean age = 55.0 years, standard deviation = 13.8) during follow-up. Among these participants, chronic depression prior to the pandemic [RR = 1.72; 95% confidence interval (CI) 1.20–2.46], and probable depression (RR = 1.81, 95% CI 1.08–3.03), being very worried about COVID-19 (RR = 1.79; 95% CI 1.12–2.86), and loneliness (RR = 1.81, 95% CI 1.02–3.20) reported at baseline were each associated with subsequent COVID-19 hospitalization, adjusting for demographic factors and healthcare worker status. Anxiety and perceived stress were not associated with hospitalization. Depression, worry about COVID-19, and loneliness were as strongly associated with hospitalization as were high cholesterol and hypertension, established risk factors for COVID-19 severity.


Psychological distress may be a risk factor for hospitalization in patients with SARS-CoV-2 infection. Assessment of psychological distress may identify patients at greater risk of hospitalization. Future work should examine whether addressing distress improves physical health outcomes.

Original Article
Copyright © The Author(s), 2022. Published by Cambridge University Press

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