Graduation Semester and Year
Spring 2026
Language
English
Document Type
Dissertation
Degree Name
Doctor of Nursing Practice
Department
Nursing
First Advisor
Ann Eckhardt
Second Advisor
Paul Fidel
Third Advisor
Daisha Cipher
Fourth Advisor
Surendra Barshikar
Abstract
Importance Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), remains a major global health concern. Recovery may result in persistent symptoms known as post-acute sequelae of SARS-CoV-2 (PASC), or long COVID. Most studies focus on individuals with laboratory-confirmed infection; however, some patients with COVID-like illness and negative tests also develop persistent symptoms. Testing status should not delay appropriate interventions or specialist referrals. Early, symptom-based care is essential to improve outcomes.
Objective To compare patient-reported outcomes and demographics between long COVID patients who tested positive versus negative during their initial illness.
Design, Setting, and Participants This secondary cross-sectional analysis included 267 adults (>18 years) seen at a single metropolitan long COVID clinic between January 2021 and October 2022. Eligible participants had symptomatic illness suggestive of COVID-19 and completed the Patient Health Questionnaire-9 (PHQ-9) and Satisfaction With Life Scale (SWLS) at their initial visit.
Main Outcomes and Measures Outcomes included SWLS and PHQ-9 scores.
Results The sample (N = 267) was predominantly female (73%) and non-Hispanic White (69.3%); 86.9% initially tested positive. Symptoms often developed without corresponding pre-existing comorbidities, suggesting new multisystem involvement. Neurological (74.9%) and constitutional (68.5%) symptoms were most common; fatigue (65.2%) and brain fog (47.6%) were hallmark features. Nearly half reported at least moderate depressive symptoms (PHQ-9, 49.8%). Life satisfaction varied widely.
After propensity score matching (n = 35 per group), demographic balance was achieved. Positive testers reported higher life satisfaction (p = .014), while depressive severity did not differ (p = .441). Positive testers had higher frequencies of neurological, cardiovascular, and psychological symptoms (p < .05). However, substantial symptom burden was also observed among negative testers.
Conclusion Long COVID patients experience significant multisystem symptoms and reduced quality of life regardless of initial test status. Findings support symptom-based evaluation and comprehensive, multidisciplinary care.
Keywords Long COVID; Post Acute Sequelae of COVID-19; Positive vs negative tests; Demographics; Satisfaction With Life Scale; Patient Health Questionnaire-9
Keywords
Long COVID; Post Acute Sequelae of COVID-19; Positive vs negative tests; Demographics; Satisfaction With Life Scale; Patient Health Questionnaire-9
Disciplines
Family Practice Nursing
License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Recommended Citation
Georgoudiou, Stephanie, "Differences in comorbidities, presenting symptoms, demographics, and patient reported outcomes in long COVID by initial test status" (2026). Nursing Dissertations. 140.
https://mavmatrix.uta.edu/nursing_dissertations/140
Comments
I would like to thank my dissertation committee for their academic support and assistance throughout this journey, especially my committee chair, Dr. Eckhardt.
I gratefully acknowledge the financial support that made the completion of this doctoral program possible. The Rory Meyers Advanced Education Program for Nursing Excellence Scholarship at UT Southwestern, provided foundational and sustained support throughout my doctoral education. This scholarship enabled me to pursue additional coursework, engage in scholarly collaboration with doctoral students across campuses, and fully participate in academic opportunities that significantly enriched my training as a nurse scientist.
I also acknowledge the support of the Ferne Kyba Fellowship Endowment Award from the University of Texas at Arlington College of Nursing and Health Innovation. This fellowship provided essential funding during the final year of my program, including support for data processing and analytic assistance, which contributed directly to the successful completion and rigor of my dissertation research.