IntroductionThe current COVID-19 pandemic has resulted in high rates of infection and death, as well as widespread social disruption and a reduction in access to healthcare services and support. There is growing concern over how the pandemic, as well as measures put in place to curb the pandemic, will impact people with mental disorders. We aim to study the effect of pandemics and epidemics on mental health outcomes for people with premorbid mental disorders.Methods and analysisWith our predefined search strategy, we will search five databases for studies reporting on mental health outcomes in people with pre-existing mental disorders during pandemic and epidemic settings. Search dates are planned as follows: 5 May 2020 and 23 July 2020. The following databases will be searched: MEDLINE/PubMed, CINAHL, PsycINFO, MedRxiv and EMBASE. Data will be screened and extracted in duplicate by two independent reviewers. Studies involving non-clinical populations or patients diagnosed with a mental disorder during a pandemic/epidemic will be excluded. We will include data collected from all pandemics and epidemics throughout history, including the present COVID-19 pandemic. If possible, study findings will be combined in meta-analyses, and subgroup analyses will be performed. We hope that this review will shed light on the impact of pandemics and epidemics on those with pre-existing mental disorders. Knowledge generated may inform future intervention studies as well as healthcare policies. Given the potential implications of the current pandemic measures (ie, disruption of healthcare services) on mental health, we will also compile a list of existing mental health resources.Ethics and disseminationNo ethical approval is required for this protocol and proposed systematic review as we will only use data from previously published papers that have themselves received ethics clearance and used proper informed consent procedures.Systematic review registrationPROSPERO registration number: CRD42020179611.

ace and gender-based disparities in health care leadership 1-4 may negatively affect the health of marginalized patients. 5,6 Diverse leadership is an integral step in establishing equitable health care institutions that serve the needs of all community members. 7 Many barriers prevent racialized people, women and gender nonbinary individuals from attaining leadership positions, including reduced access to networking opportunities, 8-10 discrimination from patients and colleagues 2,11-13 and an institutional culture that views white, male leaders as most effective. 14,15 The intersectional effects of discrimination may intensify these barriers for racialized women and nonbinary people. 16,17 Fundamentally, diversity and inclusion in our institutions is important on the basis of basic human rights for all people. 18 Health care leadership in Europe and the United States is thought to lack gender and racial diversity. [19][20][21][22] The degree to which these imbalances exist across Canadian health care institutions is not clear. Despite past evidence that men hold a disproportionate number of health care leadership positions in Canada, 23,24 a recent study noted gender parity among leaders of provincial and terri torial ministries of health. 25 Among university faculty 26,27 and administration, 28 racialized individuals appear to be under-represented, suggesting that a similar trend may exist in health care leadership.Race and gender can be studied in many ways. 29 Perceived race is a measure of "the race that others believe you to be," and these assessments "influence how people are treated and form the basis of racial discrimination including nondeliberate actions