Predictors of persistent fatigue one year after severe COVID-19: A prospective cohort study on depression and lung function

Published Nov 20, 2025Clinics (Sao Paulo, Brazil)

Depression and lung function linked to ongoing fatigue one year after severe COVID-19

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Abstract

Half of the participants reported fatigue one month after being discharged from the hospital.

50% of participants experienced fatigue one month after hospital discharge, decreasing to 36% by the end of one year.
The fatigue group had a median age of 58 years, was mostly women, and included many non-white individuals with a body mass index over 30 kg/m.
No significant changes in physical performance were observed in the fatigue group over time, while lung capacity improved significantly by 12 months.
Anxiety and depression levels were significantly higher in the fatigue group throughout the year.
Depressive symptoms and impaired lung function within the first month may predict long-term fatigue.

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BACKGROUND: Fatigue is among the most enduring symptoms of long COVID. However, the relationship between persistent fatigue and factors such as physical performance, lung function, anxiety, and depression in severe cases of COVID-19 remains underexplored.

OBJECTIVES: To assess the prevalence of fatigue and its association with these factors in patients one year after severe COVID-19 hospital discharge.

METHODS: This cohort comprised participants aged 18-years and older diagnosed with COVID-19. Evaluations were conducted at one, four, six-, and twelve-months following hospital discharge. Clinical data were collected, which included assessments of fatigue - Functional Assessment of Chronic Illness Therapy Fatigue subscale, lung capacity ‒ Spirometry, physical performance - 1-minute Sit to Stand Test, psychological aspects - Hospital Anxiety and Depression Scale, and functional capacity - Barthel index.

RESULTS: Of the 162 participants, 50 % experienced fatigue one-month post-discharge and this prevalence gradually decreased to 36 % by the end of one-year period. The fatigue group had a median age of 58-years. It was predominantly composed of women, with a majority identifying as non-white and having a body mass index greater than 30 kg/m. Physical performance assessments within the fatigue group showed no significant changes over time, whereas lung capacity demonstrated significant improvement only at the 12-month mark. Additionally, anxiety and depression levels were significantly higher in the fatigue group over time (p < 0.05). 2

CONCLUSIONS: Fatigue persisted in 36 % of participants one-year post-hospital discharge. The potential predictors of long-term fatigue were depressive symptoms and impaired lung function observed within the first month after hospital discharge. Therefore, the authors highlight the importance of screening and monitoring these aspects in order to enable early intervention in this population.

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Predictors of persistent fatigue one year after severe COVID-19: A prospective cohort study on depression and lung function

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