Illness representation and depression in Long Covid: the role of avoidance strategies

Objectives. Symptoms of COVID-19 can persist long after the acute phase, determining severe psychophysical disability. Among the most frequent and disabling psychological symptoms are depressive symptoms such as asthenia, low mood, and feelings of hopelessness. How patients represent their illness and avoidance strategies may play a role in depressive symptomatology. This study aimed to assess the role of psychological avoidance coping strategies and illness representation in explaining depressive symptoms.

Method. An online survey was conducted among subjects with Long COVID (n = 238). Illness representation was investigated with the Illness Perception Questionnaire (IPQ-R), Avoidance Strategies with the Shortened Version of the Coping Orientations to the Problems Experienced (COPE-NVI-25), and Depressive symptoms with the Patient Health Questionnaire (PHQ-9). A mediation analysis was conducted with an explorative approach by considering the PHQ-9 score as a dependent variable, the IPQ-R scale as an independent variable, and avoidance strategies as a mediator.

Results. Among 238 participants, 70.2% (n = 167) reported moderate to severe depressive symptoms. Avoidance strategies mediate the relationship between timeline cyclical and depressive symptoms, with a proportion of 42.3%, and partially mediate the relationship between illness consequences, emotional representation, and depressive symptoms.

Conclusions. This study confirms the importance of illness representations on psychological adjustment in this clinical population and the role of avoidance strategies as a mediator between certain perceptions of illness (in particular, emotional representations and cyclicality) and depressive symptoms.