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

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.