Publication date: Sep 15, 2025

This study explores differences in the co-distribution of anxiety and depression symptoms and sleep quality scores between survivors of COVID-19 and comparison groups, nearly two years after COVID-19 diagnosis. Individuals enrolled at primary healthcare centers of Matosinhos were selected and grouped according to hospitalization and SARS-CoV-2 infection between March 2020 and February 2021: group#1, hospitalized due to COVID-19 (n = 96); group#2, hospitalized, uninfected (n = 81); group#3, infected, non-hospitalized (n = 205); group#4, uninfected, non-hospitalized (n = 236). Groups #2 and #4 were matched to groups #1 and #3, respectively, in a ratio of 1:1, by age, sex and level of care. They were evaluated between July 2022 and October 2023 with the Hospital Anxiety and Depression Scale (subscales HADS-A, anxiety, and HADS-D, depression) and the Pittsburgh Sleep Quality Index (PSQI). Partition clustering centered on the median of HADS-A, HADS-D, and PSQI scores was used to identify two clusters. Logistic regression was used to compute adjusted Odds Ratios (aOR) and 95 % confidence intervals (CI) of the associations between the study group and the two clusters. The cluster of worse mental health (n = 338) presented scores mostly above five, while the best mental health cluster (n = 280) presented scores up to five. Participants infected with SARS-CoV-2 during the first year of the pandemic were more likely to have worse mental health (aOR, 95%CI: 1. 46, 1. 03-2. 05). Survivors of COVID-19 of the first year of the pandemic may require a special clinical attention to ensure that care is provided to improve mental health and prevent a worsening of anxiety and depression symptoms, and sleep problems.

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