Post-infectious psychiatric symptoms and diagnoses in children and adolescents following COVID-19

The Coronavirus Disease 2019 (COVID-19) pandemic has substantially disrupted the lives of children and adolescents, raising concerns about increased psychiatric morbidity. This study examined post-COVID psychiatric symptoms in a pediatric population and explored associated risk factors.

This follow-up study enrolled 107 children and adolescents (6-18 years) with laboratory-confirmed COVID-19, retrospectively identified from Gülhane Training and Research Hospital records, contacted via telephone, and invited for in-person pediatric examination and Revised Child Anxiety and Depression Scale (RCADS) screening. Participants with T-scores ≥65 were referred to Gazi University for face-to-face psychiatric evaluation by child psychiatrists using DSM-5 criteria. Sociodemographic and clinical variables were analyzed for associations with elevated RCADS scores. Receiver operating characteristic (ROC) analyses were performed using DSM-5-based clinical diagnoses as the reference standard.

The cohort included 62 females (57.9%) and 45 males (42.1%), with a mean age of 12.3±3.1 years. Most participants were symptomatic during infection (90.7%), and 35.5% developed at least one COVID-related complication, most commonly taste loss (29.0%). Post-COVID psychiatric symptoms were reported in 56.1% of cases, predominantly attention difficulties (28.9%) and irritability (23.3%). Approximately half (52.2%) of children without prior history of psychiatric symptoms developed at least one new symptom. Higher anxiety and depression scores were significantly associated with prematurity, birth complications, and pre-existing psychiatric symptoms. In ROC analyses, the parent-reported total anxiety score showed an area under the curve (AUC) of 0.92 with an optimal cut-off of 60 (sensitivity 81.5%, specificity 93.8%), while the child-reported score showed an AUC of 0.90 with an optimal cut-off of 65 (sensitivity 70.4%, specificity 93.8%). Children without psychiatric history had significantly lower scores (p < 0.001).

COVID-19 was linked to increased psychiatric symptoms in children, with prematurity, birth complications, and prior history as key risks. RCADS proved sensitive for screening, emphasizing targeted interventions post-infection.

Not applicable.