Black adults living with long COVID pointed to challenges with their physical health – rather than their mental health – when asked to describe their long-COVID symptoms. That is one key finding from our new study, published in the Journal of Racial and Ethnic Health Disparities.

When we examined the data further, however, we found that those living with long COVID in the U.S. had significantly more anxiety, depression, hopelessness, psychosis and suicidal thoughts than those without long COVID.

In other words, while participants clearly explained how long COVID impaired their physical health, they were less likely to attribute their recent mental health struggles to any issues stemming from their experiences of long COVID.

For the study, we asked nearly 500 Black adults in the U.S. to respond to a series of psychological questionnaires measuring various mental health outcomes in the spring of 2022. All participants, regardless of their long-COVID status, provided responses to these survey questions.

Next, we asked study participants to describe their long-COVID symptoms by using their own words to type short phrases or sentences. When analyzing their written responses, we found that participants most often pointed to physical or cognitive health conditions such as chest pain, troubled breathing, prolonged coughing, headaches, memory loss, impaired vision or smell, and sharp bodily pains.

This mismatch between how individuals described their long-COVID symptoms versus what they reported in the survey highlights the importance of collecting multiple forms of data – particularly when studying complex topics such as long COVID among marginalized populations.

We used qualitative and quantitative analysis techniques to identify points of overlap and divergence across the two data sources.

These approaches align with our work as suicide prevention and preventive medicine researchers, where we study topics at the intersection of race, mental health and physical health promotion.

Why it matters

During the early phases of the COVID-19 pandemic, Black Americans were more likely to work in the service industry or in front-line positions, and in turn were at greater risk for COVID-19 exposures and infections.

Research confirms that members of this group also experienced disproportionately higher rates of COVID-19-related hospitalizations and deaths during the earliest waves of the pandemic. Additionally, Black communities across the U.S. faced structural barriers to accessing COVID-19 vaccines once immunizations became available.

One might anticipate that the cumulative impact of these disparate experiences would lead researchers, clinicians and government officials to prioritize the study of long COVID among vulnerable populations.

This, unfortunately, has not been the case. Black Americans’ mental and physical health experiences have gone largely understudied within existing long-COVID research.

What other research is being done

Researchers are currently focused on understanding the underlying biological pathways leading to long COVID, along with potential biological markers that predispose some individuals to long COVID.

Yet much of this work does not account for differences that may emerge either within or across race groups. Amid the rapidly evolving research on long COVID, several scholars are working to understand both the development and progression of long COVID in various communities across the globe.

What still isn’t known

We analyzed surveys from only one point in time and would need to collect multiple surveys over an extended amount of time before being able to determine whether long COVID causes negative mental health outcomes, or vice versa.

As a result, the findings from our study should be understood as correlational, meaning that while there is a statistically relevant relationship between these variables, we cannot rule out the potential influence of other external factors that may also affect Black adults’ mental health during the pandemic. More research is needed to understand how long COVID is linked to psychological outcomes and mental health over time.

While the U.S. COVID-19 public health emergency ended in May 2023, the mental and physical health needs of those living with long COVID are ongoing. We, therefore, plan to continue examining how long COVID is affecting people across different age, gender, economic and other important demographic groups in order to respond to the urgent need for evidence-based research and treatment options.

The Research Brief is a short take on interesting academic work.