Schäfer, Isabel Cecil, Krehbiel, Johannes, Adler, Werner et al. · International journal of environmental research and public health · 2024 · DOI
Researchers followed 265 Post-COVID patients for about 5 months to understand how mental health symptoms changed over time. They found that most patients still had severe Post-COVID symptoms, with nearly 9 in 10 reporting extreme fatigue and about half experiencing depression. Importantly, while depression and anxiety improved somewhat over time, fatigue and post-exertional malaise (getting worse after activity) stayed at very high levels and did not improve.
This study provides crucial longitudinal evidence that fatigue and post-exertional malaise—hallmark features of ME/CFS—persist unchanged at severe levels in Post-COVID patients, challenging assumptions that these symptoms naturally resolve. Understanding which factors predict worse mental health outcomes helps clinicians identify high-risk patients early and informs service planning for the substantial patient population experiencing long-term disability.
This study does not establish causation or definitively separate Post-COVID from ME/CFS, as it lacks a control group and cannot prove that observed factors directly cause worse mental health outcomes rather than being associated with them. The findings are limited to clinic-attending patients and may not represent the broader Post-COVID population, particularly those too disabled to access care or those who recovered.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Schäfer, Isabel Cecil, Krehbiel, Johannes, Adler, Werner, Borho, Andrea, Herold, Regina, Greiner, Brigitte, et al. (2024). Three-Month Follow-Up of the Post-COVID Syndrome after Admission to a Specialised Post-COVID Centre-A Prospective Study Focusing on Mental Health with Patient Reported Outcome Measures (PROMs).. International journal of environmental research and public health. https://doi.org/10.3390/ijerph21081076
BibTeX
@article{mecfsatlas-schfer-2024-three-month,
author = {Schäfer, Isabel Cecil and Krehbiel, Johannes and Adler, Werner and Borho, Andrea and Herold, Regina and Greiner, Brigitte and Reuner, Miriam and Morawa, Eva and Erim, Yesim},
title = {Three-Month Follow-Up of the Post-COVID Syndrome after Admission to a Specialised Post-COVID Centre-A Prospective Study Focusing on Mental Health with Patient Reported Outcome Measures (PROMs).},
journal = {International journal of environmental research and public health},
year = {2024},
doi = {10.3390/ijerph21081076},
note = {PubMed: 39200685},
url = {https://www.mecfsatlas.com/evidence/schfer-2024-three-month},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/schfer-2024-three-month
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