The Context of COVID-19 at 18 Months in Relation to Depression, Anxiety, Insomnia: The Emerging Role of Post COVID-19 Symptoms.

Background: The COVID-19 pandemic naturally raised concerns about mental health and wellbeing around the world. As time passed, persisting physical and mental symptoms of post COVID-19, referred to as Post COVID Condition (PCC), have become an increasing concern. The aim of this study was to investigate the stability of symptoms of mental ill health in Sweden in the late phase of the pandemic and the prevalence of persistent symptoms post COVID-19 and interrelations between them. Method: We measured depression, anxiety, and insomnia, through a one-time online survey in Sweden ( Results: Compared to our previous study during the pandemic (May - June 2020), a marginal decrease was found for depression (27% versus 30%), a larger decrease for anxiety (16% vs 24%), and an increase for insomnia (45% vs 38%). Persistent symptoms were frequently reported, with 84.5% reporting at least one symptom, and 49.7% attributing one or more of these to COVID-19 infection. A history of poor mental health and COVID-19 related worry appeared as the strongest risk factors for mental ill health. Persistent symptoms also predicted these outcomes. Conclusions: Based on comparison with pre-pandemic rates, it appears that the pandemic continued to exert a negative impact on mental health in Sweden. Persistent symptoms, associated with COVID-19 exposure, appear common and may represent a vulnerability factor for mental ill health, along with other factors, including history of a mental ill health and specific pandemic worries.