Mental and Physical Health Predictors of Return-to-Work Outcomes among Individuals with Long COVID Symptoms

BACKGROUND: Emerging evidence shows that infectious diseases, such as COVID-19, can lead to chronic health conditions. Long COVID symptoms such as fatigue, cognitive impairment, and psychological distress can significantly hinder return-to-work, complicating recovery and rehabilitation. This study explores how these persistent symptoms affect work outcomes to inform clinical and policy interventions supporting affected individuals. METHODS: We conducted a single-site study of patients following acute SARS-CoV-2 infection (N = 206, 128 employed prior to infection). Participants reported symptoms that occurred anytime between COVID-19 infection and survey completion and their work status. A classification decision tree was generated with return-to-work status as an outcome. RESULTS: Among 128 participants, 65% (n = 83) returned to their usual work duties after COVID-19 infection, with a mean recovery time of 21 days. Twenty percent (n = 25) resumed work under modified conditions (e.g., reduced hours or remote work) after a mean of 43 days, and 10% (n = 13) were unable to return due to persistent symptoms. The top five important variables that predicted work status post-COVID-19 infection were mental health, physical health, emotional distress, recovery days, and back pain. CONCLUSIONS: Overall, global mental and physical health status are stronger predictors of return-to-work status after COVID-19 infection than most individual long COVID symptoms, with the exceptions of emotional distress and back pain symptoms. Patients who have issues with mental health, physical health, emotional distress, long recovery time, and back pain are a primary group that needs support with transitioning back to work.