Depressive symptoms and gender differences in the risk of post-COVID-19 persistent symptoms: a prospective population-based cohort study

Abstract Women are unexplainedly more affected than men by post-COVID-19 persistent symptoms. Depressive symptoms may partially explain these gender differences. In the French population-based CONSTANCES cohort, depressive symptoms were measured with the 9-item Patient Health Questionnaire (PHQ-9) between April 6 and May 4, 2020. Between December 2020 and January 2021, among 2093 infected participants [mean (SD) age, 43.0 years (11.9); 55.3% women], 453 (21.6%) reported ≥1 new persistent symptom that emerged from March 2020. Accounting for several confounders, women were more likely than men to have ≥1 symptom [OR (95%CI): 1.45 (1.17-1.80)]. Further adjusting for PHQ-9, participants in the highest (versus the lowest) quartile were more likely to have ≥1 symptom [2.97 (2.09-4.23)], while the association with female gender substantially dropped [1.28 (1.02-1.60)]. Depressive symptoms mediated 38.6% of this association. A biopsychosocial model, integrating gender and mental health, is warranted to understand long COVID and inform preventive and therapeutic strategies.