A clinical survey of 85 pediatric long-COVID patients in Bavaria, Germany, reveals high levels of fatigue, loss of motivation, difficulty concentrating and maintaining attention, worsened mood, and greater anxiety. A

To holistically describe long-COVID symptoms and identify risk factors for post-infection neurocognitive and emotional problems, University of Regensburg researchers analyzed clinical data from COVID-19 survivors aged 12 to 17 years who had symptoms for at least 4 weeks. The average patient age was 12.5 years, 61.2% were girls, and the average interval from infection to examination was 5.7 months. 

From December 2021 to June 2023, the children were given a neuropsychological evaluation made up of infection-specific interviews, psychopathologic exams, questionnaires on emotional well-being and behavioral problems, and computerized tests measuring concentration, attention, and memory. Participants also underwent neurologic, pneumological, gastrointestinal, and cardiac testing.

The findings were published yesterday in BMC Infectious Diseases.

84% had abnormal psychological results

Most children had elevated levels of fatigue (82.4%), loss of motivation (72.9%), impaired concentration and attention (71.8%), and worsened mood (53%), and 31.8% reported more anxiety. The most common diagnoses were post-COVID adjustment disorder (38.8%) and post-COVID attention-deficit disorder (23.5%). Disturbances in attention and memory, drive and psychomotor activity, affect, circadian disturbances, and worries and compulsions were common.

The psychopathological examination resulted in 83.5% of patients being rated as abnormal, therefore clearly surmounting the point prevalence of mental illness among children and adolescents (15%).

Over half of the adolescents (54.2%) were strongly advised to undergo further psychiatric assessment, 30.2% were urged to undergo further diagnostic testing, and 12.5% were told to seek other help, such as psychotherapy, further somatic assessment, weight control, and specialized diagnostics for chronic fatigue syndrome or occupational therapy. Few (3.1%) received no recommendations.

In total, 14.1% of participants received no psychiatric diagnosis, while 8.3% had a psychiatric diagnosis unrelated to COVID-19, and 56.5% had a confirmed and 21.1% had a suspected post-COVID psychiatric diagnosis, respectively. 

Depression and social phobia were very rare. Of all participants, 28.2% had a preexisting psychiatric diagnosis. A coexisting psychiatric condition such as attention-deficit hyperactivity disorder (ADHD), depression, or different kinds of phobia before COVID-19 infection was diagnosed in 20% of those with a psychiatric post-COVID diagnosis.

“The psychopathological examination resulted in 83.5% of patients being rated as abnormal, therefore clearly surmounting the point prevalence of mental illness among children and adolescents (15%),” the researchers wrote.

Social isolation predictor of anomalies

Risk factors for abnormal psychopathologic exams were older age and pre-existing medical conditions, while a pre-existing allergy was a risk factor for a post-COVID adjustment disorder, and preexisting mental illness and obesity predisposed to a post-COVID attention-deficit disorder.

To optimize treatment, comprehensive strategies involving both somatic and psychiatric professionals are crucial for addressing the syndrome’s complexity and managing symptoms effectively.

The data suggest that changes in relationships and activity patterns in families (eg, more or fewer conflicts, more or less time spent together) could, together with age, sex, and preexisting health conditions, lead to a greater risk of a post-COVID psychiatric diagnosis. Social isolation during the pandemic was a significant predictor of stronger and/or more psychological anomalies.

“To optimize treatment, comprehensive strategies involving both somatic and psychiatric professionals are crucial for addressing the syndrome’s complexity and managing symptoms effectively,” the authors wrote. “Additionally, changes in family dynamics, isolation, and quality of sleep can have an impact on long-term effects, so providing (therapeutic) help in these areas could help prevent or improve symptoms.”