Long COVID-19 can upend people’s lives for months or years, but experts have yet to pin down which traits are linked to developing the condition.

New research published in the journal JAMA Psychiatry suggests psychological distress might play a significant role.

A study of 3,000-plus people who contracted COVID-19 finds those with psychological distress prior to infection had a 32-46% increased risk of developing long COVID-19.

That’s a stronger link than occurs with physical risk factors like obesity, asthma and hypertension.

Symptoms like depression, anxiety and loneliness also correlated to 15–51% greater risk of daily life impairment from long COVID-19.

Previous studies have connected mental illness to greater severity and duration in other respiratory infections, as well as Lyme disease, chronic fatigue syndrome and fibromyalgia, which have symptoms similar to long COVID-19.