Pre-pandemic lifestyle patterns and mental health outcomes among people reporting post-acute sequelae of COVID-19 : evidence from a Slovenian population-based sample

Zager Kocjan, Gaja (author), Verdnik, Jana (author), Manfreda, Jure (author), Komidar, Luka (author), Lep, Žan (author), Kobal Grum, Darja (author), Hacin Beyazoglu, Kaja (author), Podlesek, Anja (author), Babnik, Katarina (author)

Background: The long-term consequences of COVID-19, or post-acute sequelae of SARS-CoV-2 infection (PASC), represent a major public health concern. Beyond persistent physical symptoms, PASC profoundly affects mental health and daily functioning. Despite growing international evidence, little is known about how pre-pandemic lifestyle patterns shape vulnerability to PASC and how its psychological burden extends beyond distress to deficits in well-being. While national settings may shape prevalence estimates and symptom reporting, this study focuses on group differences within a single country—Slovenia, characterized by universal healthcare, high physical activity, strict containment measures, and low institutional trust. Methods: Data were drawn from a representative sample of working-age Slovenian adults (N = 3,048), surveyed in early 2023. Participants reported infection history, symptom persistence, pre-pandemic lifestyle patterns, and mental health outcomes. PASC was defined following WHO criteria, with an added requirement of functional impairment. Analyses employed chi-squared tests for categorical variables and ANOVAs for differences across ill-being and well-being indicators. Results: Nearly one-third of infected individuals (29.5%) met PASC criteria. Fatigue, decreased physical performance, and cognitive difficulties were the most prevalent and persistent symptoms, often lasting close to a year. PASC was more common among women, younger adults, those facing financial hardship, and individuals with higher education. Lifestyle patterns showed mixed associations: BMI was unrelated, smoking displayed a paradoxically lower risk, while physical activity reduced infection risk but was modestly linked to greater PASC likelihood post-infection. Crucially, PASC was associated with significantly elevated stress, anxiety, and depression, alongside reduced well-being across all domains. Conclusions: These findings highlight the enduring burden of PASC and its dual impact on distress and well-being, underscoring the need for integrated, system-level planning that links primary care, rehabilitation, and mental health services to mitigate long-term consequences and support recovery.

• Language: English
• Keywords: post-acute sequelae of COVID-19 (PASC), lifestyle patterns, mental health outcomes, Slovenian national study, COVID-19, post-COVID-19 conditions, sequelae
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: FF - Faculty of Arts
• Publication status: Published
• Publication version: Version of Record
• Year: 2025
• Number of pages: 17 str.
• Numbering: Vol. 25, art. 4083
• PID: 20.500.12556/RUL-176272
• UDC: 159.9:616-036.22
• ISSN on article: 1471-2458
• DOI: 10.1186/s12889-025-25466-2
• COBISS.SI-ID: 258750211
• Publication date in RUL: 26.11.2025

Record is a part of a journal

• Title: BMC public health
• Shortened title: BMC Public Health
• Publisher: BioMed Central
• ISSN: 1471-2458
• COBISS.SI-ID: 2446356

Licences

• License: CC BY-NC-ND 4.0, Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
• Link: http://creativecommons.org/licenses/by-nc-nd/4.0/
• Description: The most restrictive Creative Commons license. This only allows people to download and share the work for no commercial gain and for no other purposes.

Secondary language

• Language: Slovenian
• Keywords: COVID-19, dolgotrajni covid, posledice, življenjski slog, izidi na področju duševnega zdravja, slovenska nacionalna raziskava

Projects

• Funder: ARIS - Slovenian Research and Innovation Agency
• Project number: J5-4591
• Name: Dolgotrajni covid kot zapuščina pandemije: psihološki simptomi, psihosocialni dejavniki in posledice