Long COVIDStressLoCNCT05652634
Chronic Stress as a Risk Factor for Long COVID
An observational study of Long COVID and Acute COVID-19, run by Medical University of Graz at 1 site in Austria.
Trial summary
The disease caused by the pathogen SARS-CoV-2 is known as coronavirus disease with the acronym COVID-19. The acute phase of this condition typically lasts one to two weeks and usually results in a full recovery. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Long COVID, Acute COVID-19
- How many people
- 380 participants
- Where
- 1 siteAustria
- Study dates
- 9 Feb 2023to 30 Jun 2024
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Study population: After having been tested positive for SARS-CoV-2 and having received the invitation to participate in this study by the local health authority of the City of Graz, or the health authority of the Province of Styria, persons interested can visit the study website and sign in for getting contacted by the study team.
Who may be able to join
- Adults (>18 years); qPCR-test positive for SARS-CoV-2 infection; symptom(s) of acute COVID-19; inclusion within defined timeframe of one week after testing; data collection online, by phone and at study visits feasible
Who cannot join
- Insufficient knowledge of German language; lengths of hair at rear vertex less than 2 cm; pregnancy or postpartum less than 3 months; refusal to give informed consent
Trial locations and contacts
1 site in 1 country.
Austria1 site
Medical University Graz, Division of Medical Psychology, Psychosomatics and Psychotherapy
Graz, Styria, 8036
About this study
The disease caused by the pathogen SARS-CoV-2 is known as coronavirus disease with the acronym COVID-19. The acute phase of this condition typically lasts one to two weeks and usually results in a full recovery. However, in about 10-30% of those affected, the symptoms persist for more than four weeks after the onset of the disease. In this case, there is an ongoing COVID-19 illness known as long COVID. Long COVID can persist for many months and cause significant distress and limitations to those affected due to the long-term health consequences.
The causes of long COVID are still unclear and, accordingly, therapeutic measures are still insufficiently developed. It is assumed that long COVID can in principle affect anyone. Age, gender, obesity and the number of symptoms during an acute COVID-19 illness are discussed as risk factors for long COVID. Another potential risk factor for developing long COVID could be chronic stress, which has been shown to put a strain on the immune system. It is known from infections with other coronaviruses and other viral respiratory diseases that chronic stress can lead to prolonged illness and limited recovery. The aim of this study is to systematically examine chronic stress, as it existed before infection with the coronavirus, as a possible risk factor for long COVID.
For this purpose, 600 people who have been proven to be infected with SARS-CoV-2 and have developed symptoms of COVID-19 will be included in this study.
Read the detailed description
Wider research context / theoretical framework: The pathophysiology leading to symptom persistence after acute COVID-19, defining long COVID, is widely unknown. Chronic stress may be a risk factor for long COVID as it can impair immune regulation and induce exaggerated inflammatory responses. It is known to negatively influence upper respiratory infections and was found to be associated with long-term symptoms following other coronavirus infections (SARS). In addition, chronic stress is an established risk factor for unspecific functional symptoms and mental health impairment. Data on these issues are scanty, however much-needed for developing proper interventions.
Hypotheses/research questions/objectives: The primary aim of the study is to analyze the influence of chronic stress on symptom persistence in COVID-19. The study team hypothesizes that elevated levels of pre-existing self-reported chronic stress measured at the beginning of infection predict a higher proportion of patients with symptom persistence at one month after testing positive for SARS-CoV-2 infection (primary outcome). Secondary aims are to investigate the influence of chronic stress on medium- to long-term mental health outcome. In addition, the researchers longitudinally investigate chronic stress, stress-related biomarkers and allostatic load in patients with symptom persistence as compared to recovered patients.
Approach/methods: This is a longitudinal prospective observational study designed according to STROBE guidelines in persons newly tested positive for SARS-CoV-2 infection by qPCR with symptoms of acute COVID-19. Monitoring of COVID-19-related symptoms and symptom persistence is conducted online, by phone and in outpatient clinic visits. Pre-existing chronic stress is investigated by questionnaires on perceived stress and negative life events and by analysis of hair cortisol concentrations prior to infection. Collection of blood allows measurement of SARS-CoV-2 antibodies, stress-related biomarkers and the calculation of allostatic load. Baseline and longitudinal data collection encompasses comorbidities, regular medication, screening for anxiety, depression, acute stress symptoms, and cognitive function.
Level of originality/innovation: This is the first study prospectively investigating chronic stress as a risk factor for long COVID and associated mental health impairment by a multimodal approach. In addition, the researchers probe for stress-related biomarkers associated with symptom persistence and also investigate the impact of protective factors, such as resilience, psychosomatic competence and social support, on symptom persistence. Two novel bio-psycho-social assessment tools contribute to the results of this study. Results of this project will lead to innovative preventive and treatment interventions targeting symptom persistence and mental health sequelae after acute COVID-19.
Primary researchers: Christian Fazekas (PI), Nandu Goswami, Barbara Hanfstingl, Voyko Kavcic.
- Conditions
- Long COVID, Acute COVID-19
- Keywords
- Chronic stress, Long COVID, Mental health, Cognitive function, Stress-related biomarkers
- Medical subject headings
- Post-Acute COVID-19 Syndrome, Psychological Well-Being
What is being measured
The primary outcome is the main question the study is designed to answer.
Symptom persistence beyond four weeks from the onset of acute symptoms of COVID-19 (subacute/ongoing symptomatic COVID-19).
Application of the Long COVID Symptom Tool and Impact Tool (LC-ST and LC-IT)
Measured: Symptom persistence at one month after having tested positive for SARS-CoV-2 infection (subacute/ongoing symptomatic COVID-19)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted15 Dec 2022
- Study start9 Feb 2023
- Primary completion31 Jan 2024
- Study completion30 Jun 2024
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Long COVIDStudies of the same condition, open and under way.
- More trials run by Medical University of GrazThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 380 participants (actual)
Sponsor and investigators
- Lead sponsor
- Medical University of Graz
- Sponsor type
- University, hospital or other
- Collaborators
- University of Klagenfurt, Wayne State University
- Responsible party
- Principal investigator, Christian Fazekas, Medical University of Graz
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05652634
- Sponsor's protocol ID
- KLI 1100-B
- Acronym
- StressLoC
- Status last verified
- Sep 2025
- First submitted
- 14 Dec 2022
- Last updated
- 16 Sep 2025
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 16 Sep 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Chronic Stress as a Risk Factor for Long COVID
- ClinicalTrials.gov ID
- NCT05652634
- Acronym / sponsor ID
- StressLoC / KLI 1100-B
- Conditions
- Long COVID, Acute COVID-19
- Keywords
- Chronic stress, Long COVID, Mental health, Cognitive function, Stress-related biomarkers
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 380 participants (actual)
- Lead sponsor
- Medical University of GrazUniversity, hospital or other
- Collaborators
- University of Klagenfurt, Wayne State University
- Study start
- 9 Feb 2023 (actual)
- Primary completion
- 31 Jan 2024 (actual)
- Study completion
- 30 Jun 2024 (actual)
- First posted
- 15 Dec 2022 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The disease caused by the pathogen SARS-CoV-2 is known as coronavirus disease with the acronym COVID-19. The acute phase of this condition typically lasts one to two weeks and usually results in a full recovery. However, in about 10-30% of those affected, the symptoms persist for more than four weeks after the onset of the disease. In this case, there is an ongoing COVID-19 illness known as long COVID. Long COVID can persist for many months and cause significant distress and limitations to those affected due to the long-term health consequences.
The causes of long COVID are still unclear and, accordingly, therapeutic measures are still insufficiently developed. It is assumed that long COVID can in principle affect anyone. Age, gender, obesity and the number of symptoms during an acute COVID-19 illness are discussed as risk factors for long COVID. Another potential risk factor for developing long COVID could be chronic stress, which has been shown to put a strain on the immune system. It is known from infections with other coronaviruses and other viral respiratory diseases that chronic stress can lead to prolonged illness and limited recovery. The aim of this study is to systematically examine chronic stress, as it existed before infection with the coronavirus, as a possible risk factor for long COVID.
For this purpose, 600 people who have been proven to be infected with SARS-CoV-2 and have developed symptoms of COVID-19 will be included in this study.
Detailed description
Wider research context / theoretical framework: The pathophysiology leading to symptom persistence after acute COVID-19, defining long COVID, is widely unknown. Chronic stress may be a risk factor for long COVID as it can impair immune regulation and induce exaggerated inflammatory responses. It is known to negatively influence upper respiratory infections and was found to be associated with long-term symptoms following other coronavirus infections (SARS). In addition, chronic stress is an established risk factor for unspecific functional symptoms and mental health impairment. Data on these issues are scanty, however much-needed for developing proper interventions.
Hypotheses/research questions/objectives: The primary aim of the study is to analyze the influence of chronic stress on symptom persistence in COVID-19. The study team hypothesizes that elevated levels of pre-existing self-reported chronic stress measured at the beginning of infection predict a higher proportion of patients with symptom persistence at one month after testing positive for SARS-CoV-2 infection (primary outcome). Secondary aims are to investigate the influence of chronic stress on medium- to long-term mental health outcome. In addition, the researchers longitudinally investigate chronic stress, stress-related biomarkers and allostatic load in patients with symptom persistence as compared to recovered patients.
Approach/methods: This is a longitudinal prospective observational study designed according to STROBE guidelines in persons newly tested positive for SARS-CoV-2 infection by qPCR with symptoms of acute COVID-19. Monitoring of COVID-19-related symptoms and symptom persistence is conducted online, by phone and in outpatient clinic visits. Pre-existing chronic stress is investigated by questionnaires on perceived stress and negative life events and by analysis of hair cortisol concentrations prior to infection. Collection of blood allows measurement of SARS-CoV-2 antibodies, stress-related biomarkers and the calculation of allostatic load. Baseline and longitudinal data collection encompasses comorbidities, regular medication, screening for anxiety, depression, acute stress symptoms, and cognitive function.
Level of originality/innovation: This is the first study prospectively investigating chronic stress as a risk factor for long COVID and associated mental health impairment by a multimodal approach. In addition, the researchers probe for stress-related biomarkers associated with symptom persistence and also investigate the impact of protective factors, such as resilience, psychosomatic competence and social support, on symptom persistence. Two novel bio-psycho-social assessment tools contribute to the results of this study. Results of this project will lead to innovative preventive and treatment interventions targeting symptom persistence and mental health sequelae after acute COVID-19.
Primary researchers: Christian Fazekas (PI), Nandu Goswami, Barbara Hanfstingl, Voyko Kavcic.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- After having been tested positive for SARS-CoV-2 and having received the invitation to participate in this study by the local health authority of the City of Graz, or the health authority of the Province of Styria, persons interested can visit the study website and sign in for getting contacted by the study team.
Key inclusion criteria (1 listed)
- Adults (>18 years); qPCR-test positive for SARS-CoV-2 infection; symptom(s) of acute COVID-19; inclusion within defined timeframe of one week after testing; data collection online, by phone and at study visits feasible
Key exclusion criteria (1 listed)
- Insufficient knowledge of German language; lengths of hair at rear vertex less than 2 cm; pregnancy or postpartum less than 3 months; refusal to give informed consent
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Symptom persistence beyond four weeks from the onset of acute symptoms of COVID-19 (subacute/ongoing symptomatic COVID-19).
Time frame: Symptom persistence at one month after having tested positive for SARS-CoV-2 infection (subacute/ongoing symptomatic COVID-19)
Application of the Long COVID Symptom Tool and Impact Tool (LC-ST and LC-IT)
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 16 Sep 2025.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Long COVID and Acute COVID-19, run by Medical University of Graz at 1 site in Austria.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 16 Sep 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Austria. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Symptom persistence beyond four weeks from the onset of acute symptoms of COVID-19 (subacute/ongoing symptomatic COVID-19). (time frame: Symptom persistence at one month after having tested positive for SARS-CoV-2 infection (subacute/ongoing symptomatic COVID-19)). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Sep 2025.