Mental health of Adolescents in the Pandemic: Long-COVID19 or Long-Pandemic Syndrome?

Abstract

Backround
Post-COVID19 complications such as pediatric inflammatory multisystem syndrome (PIMS) and Long-COVID19 move increasingly into focus, potentially causing more harm in this age group than the acute infection. To better understand the symptoms of long-COVID19 in adolescents and to distinguish infection-associated symptoms from pandemic-associated symptoms, we conducted a Long-COVID19 survey, comparing responses from seropositive and seronegative adolescents. To our knowledge, data of Long-COVID19 surveys with seronegative control groups have not been published yet.
Methods
Since May 2020 students grade 8-12 in fourteen secondary schools in Eastern Saxony were enrolled in the SchoolCovid19 study. Seroprevalence was assessed via serial SARS-CoV-2 antibody testing in all participants. Furthermore, during the March/April 2021 study visit all participants were asked to complete a 12 question Long-COVID19 survey regarding the occurrence and frequency of difficulties concentrating, memory loss, listlessness, headache, abdominal pain, myalgia/ arthralgia, fatigue, insomnia and mood (sadness, anger, happiness and tenseness).
Findings
1560 students with a median age of 15 years participated in this study. 1365 (88%) were seronegative, 188 (12%) were seropositive. Each symptom was present in at least 35% of the students within the last seven days before the survey. However, there was no statistical difference comparing the reported symptoms between seropositive students and seronegative students. Whether the infection was known or unknown to the participant did not influence the prevalence of symptoms.
Interpretation
The lack of differences comparing the reported symptoms between seropositive and seronegative students suggests that Long-COVID19 might be less common than previously thought and emphasizing the impact of pandemic-associated symptoms regarding the well-being and mental health of young adolescents.
Funding
This study was supported by a grant by the Federal State of Saxony. M.K.W. was supported by the Else Kroener-Fresenius Center for Digital Health (EKFZ), TU Dresden, Germany.

Full text

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Mental health of Adolescents in the Pandemic: Long-COVID19 or Long-Pandemic Syndrome?
Judith Blankenburg1, MD, Magdalena K. Wekenborg2, PhD, Jörg Reichert1, PhD, Carolin Kirsten1,
Elisabeth Kahre1, MD, Luise Haag1, MD, Leonie Schumm1, MD, Paula Czyborra1, MD, Reinhard
Berner1, MD, Jakob P. Armann1, MD
Affiliations:
1 Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische
Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany;
2 Biological Psychology, Institute of Psychology, Technische Universität Dresden, Zellescher Weg 19,
01069 Dresden, Germany
Corresponding Author: Jakob P. Armann, Department of Pediatrics, University Hospital and Medical
Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden,
Germany; email: jakob.armann@uniklinikum-dresden.de; telephone: +49 351 458 18568
Clinical Trial Registration: SchoolCoviDD19: Prospektive Erfassung der SARS-CoV-2 Seropositivität bei
Schulkindern nach Ende der unterrichtsfreien Zeit aufgrund der Corona-Schutz-Verordnung (COVID-
19), DRKS00022455,
https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022455
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NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

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Abstract
Backround
Post-COVID19 complications such as pediatric inflammatory multisystem syndrome (PIMS) and Long-
COVID19 move increasingly into focus, potentially causing more harm in this age group than the
acute infection. To better understand the symptoms of long-COVID19 in adolescents and to
distinguish infection-associated symptoms from pandemic-associated symptoms, we conducted a
Long-COVID19 survey, comparing responses from seropositive and seronegative adolescents. To our
knowledge, data of Long-COVID19 surveys with seronegative control groups have not been published
yet.
Methods
Since May 2020 students grade 8-12 in fourteen secondary schools in Eastern Saxony were enrolled
in the SchoolCovid19 study. Seroprevalence was assessed via serial SARS-CoV-2 antibody testing in all
participants. Furthermore, during the March/April 2021 study visit all participants were asked to
complete a 12 question Long-COVID19 survey regarding the occurrence and frequency of difficulties
concentrating, memory loss, listlessness, headache, abdominal pain, myalgia/ arthralgia, fatigue,
insomnia and mood (sadness, anger, happiness and tenseness).
Findings
1560 students with a median age of 15 years participated in this study. 1365 (88%) were
seronegative, 188 (12%) were seropositive. Each symptom was present in at least 35% of the
students within the last seven days before the survey. However, there was no statistical difference
comparing the reported symptoms between seropositive students and seronegative students.
Whether the infection was known or unknown to the participant did not influence the prevalence of
symptoms.
Interpretation
The lack of differences comparing the reported symptoms between seropositive and seronegative
students suggests that Long-COVID19 might be less common than previously thought and
emphasizing the impact of pandemic-associated symptoms regarding the well-being and mental
health of young adolescents.
Funding
This study was supported by a grant by the Federal State of Saxony. M.K.W. was supported by the
Else Kröner-Fresenius Center for Digital Health (EKFZ), TU Dresden, Germany.
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is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 11, 2021. ; https://doi.org/10.1101/2021.05.11.21257037doi: medRxiv preprint

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Abbreviations:
COVID-19 Coronavirus disease 2019
ELISA enzyme-linked immunosorbent assay
IgG Immunoglobulin G
IQR Interquartile Range
PCR Polymerase Chain Reaction
SARS-CoV-2 severe acute respiratory syndrome coronavirus type 2
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Introduction:
Since the identification of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as the
cause of COVID-19 1 in December 2019 and the beginning of the SARS-CoV-2 pandemic in Germany in
March 2020 nearly 490.000 cases in children and adolescents have been reported by the Robert-
Koch-Institute (RKI)2. In contrast to adults, children and adolescents usually have mild disease
courses with a low rate of hospitalization3–5. Therefore, post-COVID19 complications such as pediatric
inflammatory multisystem syndrome (PIMS) and Long-COVID19 - with persisting symptoms 4 – 12
weeks and more than 12 weeks after an acute SARS-CoV-2infection6 move into focus, potentially
causing more harm in this age group than the acute infection.
While multiple studies and registers have provided reliable data on epidemiology, clinical
presentation, disease course and treatment options on PIMS7–9 to date no comparable data exists for
Long-COVID19 in children and adolescents. A cross-sectional study from Italy10 in 123 children
diagnosed with a SARS-CoV-2 infection found that more than 50% of participants had at least one
persisting symptom 120 days after their infection, with Insomnia, pain, fatigue, and concentration
difficulties being the most commonly reported ones. An April 2021 Office for National Statistics (ONS)
report from the UK11 similarly provided data that symptoms in children persisted at least 12 weeks
after their SARS-CoV-2 infection.
These numbers are concerning and require attention; however, currently they merely show a
temporal connection and not a causal relationship. In order to better understand the epidemiology
and clinical manifestations of Long-COVID19 in children and adolescents and differentiate infection-
associated symptoms from pandemic-associated symptoms, we conducted a Long-COVID19 survey in
more than 1500 students participating in the SchoolCoviDD19 study in March and April 2021.
Methods:
Study Design
Since May 2020 students grade 8-12 in fourteen secondary schools in Eastern Saxony are enrolled in
the SchoolCoviDD19study. Two of these 14 schools are vocational schools. Seroprevalence is
assessed via serial SARS-CoV-2 antibody assessment in all participants. During the March/April 2021
study visit all participants were asked to complete a Long-COVID19 survey. Vaccinated Students (n=7)
were excluded from the analysis.
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Survey Details
The Survey included besides sociodemographic variables (i.e., age, sex) twelve questions on the
occurrence and frequency of relevant neurocognitive, pain and mood symptoms, namely difficulties
concentrating, memory loss, listlessness, headache, abdominal pain, myalgia/arthralgia, fatigue,
insomnia and mood (sadness, anger, happiness and tenseness) within the last seven days before the
survey.
The questions were taken from the Symptom Checklist-90-R (SCL-90-R)12, the Somatic Symptom Scale
(SSS-8)13 and a questionnaire about stress and stress management in children and adolescents (SS KJ
3-8 R)14. All questionnaires are validated in adolescents.
Answers were coded on a categorical scale – “never”, “once”, “multiple times” for insomnia and all
mood questions; “not at all”, “a little bit”, “quite”, “severe” and “very severe” for the remaining
questions.
In addition, a self-generated item was used to assess the overall level of mental distress on a scale
from 0 (“not at all”) to 10 (“total”).
Laboratory Analysis
We assessed anti-SARS-CoV-2 IgG antibodies in all samples using a commercially available
chemiluminescence immunoassay (CLIA) technology for the quantitative determination of anti-S1
and anti-S2 specific IgG antibodies to SARS-CoV-2 (Diasorin LIAISON® SARS-CoV-2 S1/S2 IgG Assay).
Antibody levels > 15·0 AU/ml were considered positive and levels between 12·0 and 15·0 AU/ml were
considered equivocal.
All samples with a positive or equivocal LIAISON® test result, as well as all samples from participants
with a reported personal or household history of a SARS-CoV-2 infection, were re-tested with two
additional serological tests. These were a chemiluminescent microparticle immunoassay (CMIA)
intended for the qualitative detection of IgG antibodies to the nucleocapsid protein of SARS-CoV-2
(Abbott Diagnostics® ARCHITECT SARS-CoV-2 IgG ) (an index (S/C) of < 1·4 was considered negative
whereas one >/= 1·4 was considered positive) and an ELISA detecting IgG against the S1 domain of
the SARS-CoV-2 spike protein (Euroimmun® Anti-SARS-CoV-2 ELISA) (a ratio < 0·8 was considered
negative, 0·8–1·1 equivocal, > 1·1 positive).
Participants whose positive or equivocal LIAISON® test result could be confirmed by a positive test
result in at least one additional serological test were considered seropositive. Participants with a
negative LIAISON® test result, but positive results in both additional serological tests were also
considered positive.
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Statistical Analysis
Results for continuous variables are presented as medians with interquartile ranges (IQR) and
categorical variables as numbers with percentages, unless stated otherwise.
Fisher’s exact test was used to determine categorical variables for the statistical analysis. Thereby,
the answers to the items assessing neurocognitive, pain and mood symptoms, were dummy-coded,
enabling a comparison of the answer category “none” (coded 0) against the answer categories “a
little bit”/ “quite”/ “severe”/ “very severe” and “once”/ “multiple times” (coded 1), respectively.
Furthermore, data distributions of the neurocognitive, pain and mood symptoms were tested for
normality using the Kolmogorov-Smirnov (K-S) test. Data with distributions significantly different (p<
0·05) from normal were either transformed to ranks to allow parametric statistics or analyzed using
non-parametric statistics.
In order to examine associations between sociodemographic variables (i.e., age, sex) and the
neurocognitive and pain symptoms, bivariate correlation analyses were conducted.
In a second step, partial correlation analyses were conducted between serostatus and the
neurocognitive and pain symptoms, adjusting for age and sex.
Analyses were performed using IBM SPSS 27.0 or Microsoft Excel 2010. All statistical tests were
conducted with α < 0.05.
Approval
The SchoolCoviDD19 study was approved by the Ethics Committee of the Technische Universität (TU)
Dresden (BO-EK-156042020) and has been assigned clinical trial number DRKS00022455.
Role of the funding source
The funder of the study had no role in the study design, data collection, data analysis, data
interpretation, or writing of the report and in the decision to submit the paper for publication.
Results:
1560 students with a median age of 15 years participated at the study visit in March/April 2021 and
had their serostatus analyzed. Seven already vaccinated students were excluded from the analysis,
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1365 (88%) were seronegative and 188 (12%) were seropositive. Median age, sex and household size
did not differ significantly between seropositive and seronegative participants (table 1).
Long-COVID19 survey was answered by at least 1504 (96·8%) of the participants. Each symptom,
regardless of the expression, was present in at least 35% of the students within the last seven days
before the survey, most commonly happiness (98·7%) followed by tenseness (86·4%), listlessness
(80·7%) and difficulties concentrating (79·3%). Myalgia/arthralgia (35·6%) and fatigue (37·8%) were
reported least commonly. (see table 2 for full results).
Fisher’s exact test did not reveal any significant differences between seropositive and seronegative
students regarding the prevalence of any of the neurocognitive and pain symptoms reported (figure
1).
To avoid underestimation of seropositive individuals due to our relatively strict definitions of
seropositivity, we also analyzed the data if only the LIAISON® test result was taken into consideration
for the decision on seropositivity. This resulted in 204 (13%) LIAISON®-seropositive and 1342 (86%) -
seronegative students. There was no statistical difference (Fisher’s exact test) in the occurrence of
any neurocognitive, pain or mood symptoms between these LIAISON®-seropositive and –
seronegative students either (see Supplementals - figure 1).
Spearman correlation analyses revealed that age was positive correlate with nearly all
neurocognitive and pain symptoms, except for insomnia, sad mood and angry mood (table 3). In
addition, females reported a consistently higher prevalence of neurocognitive and pain symptoms
compared to men, except for Myalgia Arthralgia where there was no significant association with sex.
Partial correlation analyses, which were performed to test for age and sex independent effects of the
analysed serostatus on rank-transformed neurocognitive and pain symptoms revealed differences
only with respect to sadness; with being seronegative was associated with an increased prevalence
of sadness (table 4).
104 out 188 seropositive students (55%) had previously been tested positive for SARS-CoV-2 and/ or
reported a confirmed SARS-CoV-2 positive household member and were therefore considered as
known SARS-CoV2 infections. Compared to those with an unknown infection (84/188 (45%)) Fisher’s
exact test did not reveal any significant differences regarding the prevalence of any of the
neurocognitive and pain symptoms reported either (table 5).
The median score of self-reported mental distress was 4 and did not differ between seropositive and
seronegative participants.
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Discussion:
The data presented in our study clearly shows a high rate of neurocognitive, pain and mood
symptoms in the surveyed group of adolescents, with every item being present in at least one third
of the students within the last seven days before responding to the survey. This is consistent with
previous studies and surveys on the prevalence of Long-COVID19 symptoms10 or psychosomatic
symptoms during the SARS-CoV-2 pandemic15 in this age group. Furthermore the prevalence is
considerably higher compared to pre-pandemic data.15
Our study can know provide a control group to SARS-CoV-2 infected adolescents by comparing the
responses of seropositive individuals to those of their seronegative peers which has not been
published so far.
The differentiation between infection-associated and pandemic-associated symptoms is important
because the approach to mediate these symptoms will be different. While strict lock-down measures
including school closures will prevent SARS-CoV-2 transmissions in this age group and thereby
prevent long-term infection related illnesses, these measures will also further restrict social contact,
self-determination, education and development of the affected children and adolescents and
thereby amplify pandemic- or lockdown-associated symptoms.
The equal prevalence of neurocognitive, pain and mood symptoms in seronegative and seropositive
adolescents in our study does not negate the existence of Long-COVID19 symptoms in general or in
the pediatric population. However, it does suggest that they occur less frequently than previously
assumed – at least in children and adolescents with only mild to asymptomatic courses of disease –
as were investigated by this study.
Furthermore, it confirms the negative effects of lockdown measures on mental health and well-being
of children and adolescents16. These effects – affecting this whole age group – need to be balanced
with the risk of Long-COVID19 in infected individuals. This balancing act will be a difficult task for
public health officials and political officials. Nevertheless, it will be a necessary one when aiming to
improve mental health in adolescents.
While self-reported symptoms cannot be equated with the diagnosis of an illness, a prevalence of at
least 35% for each symptom is a concerning screening result that requires further investigation. In
addition, validated, reliable tests are needed to evaluate symptom severity in affected individuals.
The fact that self-reported overall mental distress did not differ significantly between seropositive
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and seronegative individuals does not suggest though that infection-associated symptoms are
necessarily more severe than pandemic associated symptoms. The interpretation of the negative
correlation of sadness and positive serostatus in the partial correlation analyses is difficult and
should be but not the overstated given the fact that the group (none vs. any) comparison did not
yield significant results and the fact, that this was an exploratory study design. Nevertheless, this
finding warrants further investigation.
As a positive takeaway the fact that happiness is by far the most common response in our survey is
reassuring und clearly points to the resilience of this age group.
There are several limitations to our study. The sample size of around 180 infected individuals is not
large enough to detect rare symptoms and a screening questionnaire cannot reliably compare the
severity of symptoms in affected individuals. Furthermore, our questionnaire concentrated on
neurocognitive, general pain and mood symptoms. Symptoms like a persistent sore throat, persistent
cough or chest tightness and an altered sense of smell/ taste were not included.
However, our survey covers a variety of symptoms reported in the context of Long-COVID19 and
having a control group of age-matched peers who never had a SARS-CoV-2 infection adds valuable
information to the Long-COVID19 discussion that is urgently needed.
Conclusion:
In our cohort of adolescents more than one third reported the presence of at least one
neurocognitive, pain or mood symptom with tenseness, listlessness and difficulties concentrating
being reported most commonly. However, there was no statistical difference comparing the reported
symptoms between seropositive students - with mild to asymptomatic courses of SARS-CoV-2
infections - and seronegative students. Leading to the conclusion that symptoms of Long-COVID19
might be less common than previously assumed and emphasizing on the impact of pandemic-
associated symptoms regarding the well-being and mental health of young adolescents.
Research in context
Evidence before this study
We searched PubMed for articles published between January 1, 2020, and May 1, 2021, using the
search terms ("Long-Covid19") AND ("adolescent") AND (“children”). We identified 1 relevant cross
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sectional study and 1 case series. Persisting symptoms up to 120 days after the SARS-CoV-2 infection
were reported in at least 50% of children and adolescents.
Added value of this study
By adding a control group this study documents that there is no significant difference in the
prevalence of neurocognitive, pain and mood symptoms in seropositive compared to seronegative
adolescents. This suggests that pandemic- and lockdown-associated factors affect the mental health
of adolescents more than infection-associated factors.
Implications of all the available evidence
These findings add relevant new data that will help to inform scientists, public health authorities and
policy makers in regard to future policy measures in an ongoing pandemic.
Acknowledgements:
We thank the Federal State of Saxony for supporting this study by a financial grant.
We thank J. Schneider for her support and excellent organization of the study visit March/ April 2021.
We thank J. Herrmann and K. Jackisch for their great support in collecting all samples.
Declaration of interests: Reinhard Berner and Jakob P. Armann report grants from the Federal State
of Saxony during the conduct of the study. The other authors have no conflicts of interest to disclose.
Contributors:
J.A and R.B. designed the study and wrote the protocol. J.A., J.B., M.W., J.R. and R.B. designed the
Long-COVID19 Survey. J.A., J.B., C.K., L.H., E.K., L.S., P.C. collected samples. J.A., J.B. and M.W.
analyzed and verified the data. J.A. , J.B. and M.W. wrote the manuscript. M.W., R.B., C.K., L.H., E.K.,
L.S., P.C. reviewed the manuscript.
All corresponding authors had full access to all the data in the study and had final responsibility for
the decision to submit for publication.
Data Sharing:
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Deidentified individual participant data will be made available, in addition to study protocols, the
statistical analysis plan, and the informed consent form. The data will be made available upon
publication to researchers who provide a methodologically sound proposal for use in achieving the
goals of the approved proposal. Proposals should be submitted to corresponding author
(jakob.armann@uniklinikum-dresden.de).
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Table 1) Demographic data and serostatus of the participating students at study visit in March/ April
2021; IQR – Interquartile range
Seronegative Students
Seropositive Students
Age (median/IQR), (range)
15 (14-16), (10 - 38)
15 (14-17), (10 - 35)
Female (n/%)
762 (56)
104 (55)
Houshold size (median/IQR)
4 (3-5)
4 (4-5)
Table 2) All answers of seronegative (-) and seropositive (+) participants to the Long-COVID19-survey
Not at all
A little bit
Quite
Severe
Very severe
Serostatus
Item
-
+
-
+
-
+
-
+
-
+
Difficulty
concentrating
278
(20·9)
34
(19·1)
710
(53·5)
98
(55·1)
230
(17·3)
23
(12·9)
88
(6·6)
19
(10·7)
21
(1·6)
4
(2·2)
Memory loss
709
(53·4)
87
(48·9)
478
(36·0)
60
(33·7)
104
(7·8)
18
(10·1)
28
(2·1)
12
(6·7)
9
(0·7)
1
(0·6)
Listlessness
251
(18·9)
39
(21·9)
500
(37·7)
64
(36·0)
329
(24·8)
36
(20·2)
178
(13·4)
30
(16·9)
68
(5·1)
9
(5·1)
Headache
598
(45·1)
69
(38·8)
387
(29·2)
51
(28·7)
233
(17·6)
38
(21·3)
83
(6·3)
19
(10·7)
25
(1·9)
1
(0·6)
Abdominal
pain
794
(59·8)
96
(53·9)
317
(23,9)
43
(24·2)
152
(11·5)
26
(14·6)
52
(3·9)
7
(3·9)
12
(0·9)
6
(3·4)
Myalgia/
Arthralgia
851
(64·1)
116
(65·2)
312
(23,5)
37
(20·8)
124
(9·3)
18
(10·1)
34
(2·6)
6
(3·4)
7
(0·5)
1
(0·6)
Fatigue
831
(62·6)
107
(60·1)
334
(25,2)
44
(24·7)
121
(9·1)
19
(10·7)
32
(2·4)
8
(4·5)
9
(0·7)
0
(0)
Never
Once
Multiple
times
Serostatus
Item
-
+
-
+
-
+
Insomnia
450
(34·0)
66
(37·1)
418
(31,6)
53
(29·8)
456
(34·4)
59
(33·1)
Mood - Sad
447
(33·7)
75
(42·1)
428
(32,2)
51
(28·7)
453
(34·1)
52
(29·2)
Mood - Angry
422
(31·8)
59
(33·1)
506
(38,1)
73
(41·0)
399
(30·1)
46
(25·8)
Mood - Happy
15
(1·1)
4
(2·2)
88
(6,6)
8
(4·5)
1225
(92·2)
166
(93·3)
Mood - tense
181
(13·6)
23
(12·9)
498
(37,5)
72
(40·4)
648
(48·8)
83
(46·6)
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is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 11, 2021. ; https://doi.org/10.1101/2021.05.11.21257037doi: medRxiv preprint

Table 3) Spearman-Rho bivariate correlations between age, sex, and the reported neurocognitive, pain and mood symptoms (n = 1553, * significant at level 0·05,
** significant at level 0·01 (one-tailed test))
Variable
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(1) Age
(2) sex
-·05
(3) Distress
·23**
·25**
(4) Concentration
·08**
·14**
·35**
(5) Memory
·10**
·07**
·24**
·47**
(6) Listlessness
·17**
·08**
·36**
·52**
·32**
(7) Headache
·10**
·27**
·30**
·30**
·23**
·27**
(8) Abdominal Pain
·05*
·21**
·26**
·21**
·20**
·23**
·28**
(9) Myalgia Arthralgia
-·07*
·05
·15**
·24**
·21**
·20**
·21**
·26**
(10) Fatigue
·11**
·10**
·26**
·32**
·25**
·29**
·28**
·27**
·35**
(11) Insomina
·04
·20**
·30**
·28**
·23**
·22**
·29**
·18**
·18**
·24**
(12) Sad
·04
·38**
·48**
·35**
·27**
·33**
·30**
·28**
·18**
·27**
·37**
(13) Angry
-·04
·12**
·24**
·23**
·20**
·22**
·17**
·18**
·14**
·16**
·23**
·33**
(14) Happy
-·05*
·06*
-·11*
-·17**
-·12**
-·17**
-·06*
-·05*
-·07**
-·11**
-·12**
-·11**
-·06*
(15) Tense
·14**
·16**
·33**
·29**
·23**
·30**
·20**
·20**
·14**
·23**
·25**
·36**
·28**
-.07**
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is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 11, 2021. ; https://doi.org/10.1101/2021.05.11.21257037doi: medRxiv preprint

Table 4) Partial correlations between serostatus and neurocognitive, pain and mood symptoms (rank-transformed), controlling for age and sex (n = 1553, *
significant at level 0·05, ** significant at level 0·01 (one-tailed test))
Variable
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(1) Serostatus
(2) Mental Distress
-·01
(3) Concentration
·02
·33**
(4) Memory
·05
·22**
·47**
(5) Listlessness
-·01
·34**
·51**
·31**
(6) Headache
·05
·24**
·27**
·21**
·24**
(7) Abdominal Pain
·05
·22**
·18**
·18**
·22**
·23**
(8) Myalgia Arthralgia
<-·01
·16**
·23**
·21**
·20**
·20**
·26**
(9) Fatigue
·02
·23**
·31**
·24**
·27**
·25**
·25**
·35**
(10) Insomina
-·02
·26**
·26**
·22**
·20**
·25**
·14**
·18**
·23**
(11) Sad
-·06*
·44**
·32**
·25**
·32**
·22**
·22**
·17**
·25**
·32**
(12) Angry
-·02
·22**
·22**
·20**
·21**
·15**
·18**
·13**
·15**
·22**
·31**
(13) Happy
·01
-·12**
-·17**
-·12**
-·17**
-·07**
-·07*
-·08**
-·11**
-·13**
-·14**
-·07*
(14) Tense
-·02
·28**
·27**
·22**
·28**
·16**
·17**
·15**
·21**
·22**
·31**
·27**
-·07**
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is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 11, 2021. ; https://doi.org/10.1101/2021.05.11.21257037doi: medRxiv preprint

Table 5) Answers of seropositive participants to the Long-COVID19-survey – known vs. previously
unknown infection (Fisher’s exact test: n = 1553, * significant at level 0·05)
None
Any
p
known
infection
unknown
infection
known
infection
unknown
infection
Difficulty
concentrating
22 (22·5)
12 (15·0)
76 (77·6)
68 (85·0)
NS
Memory loss
47 (48·0)
40 (50·0)
51 (52·0)
40 (50·0)
NS
Listlessness
21 (21·4)
18 (22·5)
77 (78·6)
62 (77·5)
NS
Headache
40 (40·8)
29 (36·3)
58 (59·2)
51 (63·8)
NS
Abdominal pain
55 (56·1)
41 (51·2)
43 (43·9)
39 (48·8)
NS
Myalgia/Arthralgia
64 (65·3)
52 (65·0)
34 (34·7)
28 (35·0)
NS
Fatigue
61 (62·2)
46 (57·5)
37 (37·8)
34 (42·5)
NS
Never
At least once
p
known
infection
unknown
infection
known
infection
unknown
infection
Insomnia
35 (35·7)
31 (38·8)
63 (64·3)
49 (61·3%)
NS
Mood - Sad
41 (41·8)
34 (42·5)
57 (58·2)
46 (57·58)
NS
Mood - Angry
30 (30·6)
29 (36·3)
68 (69·4)
51 (63·8)
NS
Mood – Happy
1 (1·0)
3 (3·8)
97 (99·0)
77 (96·3)
NS
Mood - Tense
11 (1·22)
12 (15·0)
87 (88·8)
68 (85·0)
NS
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is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 11, 2021. ; https://doi.org/10.1101/2021.05.11.21257037doi: medRxiv preprint

Figure 1) Prevalence of neurocognitive, pain and mood symptoms in seronegative and seropositive
study participants (Fisher’s exact test: n = 1553, * significant at level 0·05)
0,0 10,0 20,0 30,0 40,0 50,0 60,0 70,0 80,0 90,0 100,0
Mood - Tense
Mood - Happy
Modd- Angry
Mood - Sad
Insomnia
Fatigue
Myalgia/ Arthralgia
Abdominal Pain
Headache
Litslessness
Memory loss
Difficulty concentrating
Seropositive (%) Seronegative (%)
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is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 11, 2021. ; https://doi.org/10.1101/2021.05.11.21257037doi: medRxiv preprint

Supplementals - Figure 1) Prevalence of neurocognitive, pain and mood symptoms in LIAISON®-
negativ and positive study participants (Fisher’s exact test: n = 1553, * significant at level 0·05)
0,00 10,00 20,00 30,00 40,00 50,00 60,00 70,00 80,00 90,00 100,00
Mood - Tense
Mood - Happy
Modd- Angry
Mood - Sad
Insomnia
Fatigue
Myalgia/ Arthralgia
Abdominal Pain
Headache
Litslessness
Memory loss
Difficulty concentrating
LIAISON®-positive (%) LIAISON®-negativ (%)
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is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 11, 2021. ; https://doi.org/10.1101/2021.05.11.21257037doi: medRxiv preprint