Psychiatric symptoms of long COVID among adults: observational case-control study in Johannesburg, South Africa

BJPsych Open. 2026 Jul 14;12(4):e184. doi: 10.1192/bjo.2026.12049.

ABSTRACT

BACKGROUND: Growing research has underscored the elevated prevalence and burden of psychiatric morbidity among adults living with long COVID. The severity of acute SARS-CoV-2 infection may predict the prevalence and severity of psychiatric symptoms in long COVID. Although Global South countries have faced among the highest incidence rates and burden of COVID-19, little is known about the psychiatric symptoms of long COVID in these regions, especially in Sub-Saharan Africa.

AIMS: This study aimed to (a) compare the prevalence of long-term psychiatric symptoms between acute COVID-19 infection groups, (b) estimate the associations between COVID-19 severity and long-term psychiatric symptoms, (c) determine the association between long COVID symptoms and psychiatric symptoms, and (d) test the potential mediating effect of long COVID symptoms in the association between acute COVID-19 infection and psychiatric symptoms.

METHOD: This case-control study took place in Johannesburg, South Africa, between August 2022 and July 2023. A total of 360 adults were categorised into one of four case groups based on initial COVID-19 symptoms: asymptomatic, symptomatic, admitted to hospital and vaccinated controls.

RESULTS: Prevalence rates of post-traumatic stress disorder (21.1%) and somatic symptoms (22.9%) were elevated. Individuals with symptomatic COVID-19 exhibited the greatest psychiatric morbidity out of all groups, exhibiting the highest levels of depression, suicidality, anxiety, post-traumatic stress disorder, bipolar disorder and somatisation. Acute COVID-19 severity was associated with worse symptoms of depression, somatisation and physical fatigue. Severity of long COVID symptoms was directly associated with psychiatric sequelae.

CONCLUSIONS: These results call attention to the long-term psychiatric sequelae of SARS-CoV-2 infection and early identification and management of emerging psychiatric symptoms in high-risk COVID-19 survivors.

PMID:42444199 | DOI:10.1192/bjo.2026.12049