Frequency and correlates of somatic symptom disorder in patients with post COVID-19 condition: Cross-sectional results from the SOMA.COV study

Background Persistent somatic symptoms are common in patients with post COVID-19 condition (PCC). Yet, somatic symptom disorder (SSD) which captures maladaptive symptom-related thoughts, feelings, and behaviors has not been investigated in individuals with PCC using clinical interviews. This study examined SSD frequency and associated biopsychosocial factors in a randomized controlled trial (RCT) sample of patients with PCC. Methods Baseline data from adults with PCC enrolled in a RCT were analyzed. SSD was assessed using a structured DSM-5-based clinical interview. Self-report measures assessed sociodemographic, disease-related, and psychobehavioral variables. Group differences by SSD status and multivariable associations with SSD were analyzed. Results Overall, 256 patients with PCC (85.6% female; mean age = 46.8 years, SD = 11.4) completed the baseline assessment, of whom 65.6% (95% CI 59.6%–71.2%) met SSD criteria. Patients with comorbid SSD reported greater functional impairment, more sick leave, and lower mental health–related quality of life, while somatic symptom and fatigue severity did not differ. In multivariable analyses, anxiety severity (OR = 1.11, 95% CI [1.01–1.22]) and negative symptom expectations (OR = 1.27, 95% CI [1.08–1.50]) were independently associated with SSD status. Conclusions In this sample, SSD was common among patients with PCC and associated with psychological distress and functional impairment rather than somatic symptom severity. Anxiety severity and negative symptom expectations were associated with SSD. Recruitment within a RCT limits the representativeness for the broader PCC population. Routine SSD assessment may help identify a particularly burdened subgroup. Longitudinal studies are needed to clarify temporal relationships and mechanisms.