Background Mental burden due to the SARS-CoV-2 pandemic has been widely reported for the general public and specific risk groups like healthcare workers and different patient populations. We aimed to assess its impact on mental health during the early phase by comparing pandemic with prepandemic data and to identify potential risk and protective factors. Methods For this systematic review and meta-analyses, we systematically searched PubMed, PsycINFO, and Web of Science from January 1, 2019 to May 29, 2020, and screened reference lists of included studies. In addition, we searched PubMed and PsycINFO for prepandemic comparative data. Survey studies assessing mental burden by the SARS-CoV-2 pandemic in the general population, healthcare workers, or any patients (eg, COVID-19 patients), with a broad range of eligible mental health outcomes, and matching studies evaluating prepandemic comparative data in the same population (if available) were included. We used multilevel meta-analyses for main, subgroup, and sensitivity analyses, focusing on (perceived) stress, symptoms of anxiety and depression, and sleep-related symptoms as primary outcomes. Results Of 2429 records retrieved, 104 were included in the review (n = 208,261 participants), 43 in the meta-analysis (n = 71,613 participants). While symptoms of anxiety (standardized mean difference [SMD] 0.40; 95% CI 0.15–0.65) and depression (SMD 0.67; 95% CI 0.07–1.27) were increased in the general population during the early phase of the pandemic compared with prepandemic conditions, mental burden was not increased in patients as well as healthcare workers, irrespective of COVID-19 patient contact. Specific outcome measures (eg, Patient Health Questionnaire) and older comparative data (published ≥5 years ago) were associated with increased mental burden. Across the three population groups, existing mental disorders, female sex, and concerns about getting infected were repeatedly reported as risk factors, while older age, a good economic situation, and education were protective. Conclusions This meta-analysis paints a more differentiated picture of the mental health consequences in pandemic situations than previous reviews. High-quality, representative surveys, high granular longitudinal studies, and more research on protective factors are required to better understand the psychological impacts of the SARS-CoV-2 pandemic and to help design effective preventive measures and interventions that are tailored to the needs of specific population groups.

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In view of disease-related threats, containment measures, and disrupted healthcare, individuals with pre-existing mental illness might be vulnerable to adverse effects of the COVID-19 pandemic. Previous reviews indicated increased mental distress, with limited information on peri-pandemic changes. In this systematic review, we aimed to identify longitudinal research investigating pre- to peri-pandemic and/or peri-pandemic changes of mental health in patients, focusing on the early phase and considering specific diagnoses. PsycINFO, Web of Science, the WHO Global literature on coronavirus disease database, and the Cochrane COVID-19 Study Register weresearched through 31 May 2021. Studies were synthesized using vote counting based on effect direction. We included 40 studies mostly from Western, high-income countries. Findings were heterogeneous, with improving and deteriorating mental health observed compared to pre-pandemic data, partly depending on underlying diagnoses. For peri-pandemic changes, evidence was limited, with some suggestion of recovery of mental distress. Study quality was heterogeneous; only few studies investigated potential moderators (e.g., chronicity of mental illness). Mental health effects on people with pre-existing conditions are heterogeneous within and across diagnoses for pre- to peri-pandemic and peri-pandemic comparisons. To improve mental health services amid future global crises, forthcoming research should understand medium- and long-term effects, controlling for containment measures.

Beruf Pflegekräfte 283 (43,5) Ärztliches Personal 223 (34,3) Rettungsfachkräfte 127 (19,5) Anderer Beruf 17 (2,6) Arbeitsstätte COVID-19-Klinik a 67 (10,3) Regelversorger 64 (9,8) Universitätsklinik 308 (47,4) Arbeitsstätte im ambulanten Bereich 26 (4,0) Präklinische Notfallmedizin 159 (24,5) Sonstiges 26 (4,0) Fachbereich Konservativer Fachbereich 177 (27,2) Notfallmedizin 159 (24,5) Chirurgischer Fachbereich 120 (18,5) Anästhesie 71 (10,9) Psychiatrie oder Psychosomatik 62 (9,5) Andere 61 (9,3)

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is posing a global public health burden. These consequences have been shown to increase the risk of mental distress, but the underlying protective and risk factors for mental distress and trends over different waves of the pandemic are largely unknown. Furthermore, it is largely unknown how mental distress is associated with individual protective behavior. Three quota samples, weighted to represent the population forming the German COVID-19 Snapshot Monitoring study (24 March and 26 May 2020, and 9 March 2021 with >900 subjects each), were used to describe the course of mental distress and resilience, to identify risk and protective factors during the pandemic, and to investigate their associations with individual protective behaviors. Mental distress increased slightly during the pandemic. Usage of cognitive reappraisal strategies, maintenance of a daily structure, and usage of alternative social interactions decreased. Self-reported resilience, cognitive reappraisal strategies, and maintaining a daily structure were the most important protective factors in all three samples. Adherence to individual protective behaviors (e.g., physical distancing) was negatively associated with mental distress and positively associated with frequency of information intake, maintenance of a daily structure, and cognitive reappraisal. Maintaining a daily structure, training of cognitive reappraisal strategies, and information provision may be targets to prevent mental distress while assuring a high degree of individual protective behaviors during the COVID-19 pandemic. Effects of the respective interventions have to be confirmed in further studies.

Psychiatric inpatient treatment, an important pillar of mental health care, is often of longer duration in Germany than in other countries. The COVID-19 pandemic called for infection prevention and control measures and thereby led to shifts in demand and inpatient capacities. The Germany-wide COVID Ψ Psychiatry Survey surveyed department heads of German psychiatric inpatient institutions. It assessed changes in utilization during the first two high incidence phases of the pandemic (spring 2020 and winter 2020/21) and also consequences for care, telemedicine experiences, hygiene measures, treatment of patients with mental illness and co-occuring SARS-CoV-2, and coercive measures in such patients. A total of n = 71 psychiatric departments (of 346 contacted) participated in the survey. The results showed a median decrease of inpatient treatment to 80% of 2019 levels and of day hospital treatment to 50% (first phase) and 70% (second phase). Reductions were mainly due to decreases in elective admissions, and emergency admissions remained unchanged or increased in 87% of departments. Utilization was reduced for affective, anxiety, personality, and addiction disorders but appeared roughly unaffected for psychotic disorders. A lack of integration of patients into their living environment, disease exacerbations, loss of contact, and suicide attempts were reported as problems resulting from reduced capacities and insufficient outpatient treatment alternatives. Almost all departments (96%) treated patients with severe mental illness and co-occurring SARS-CoV-2 infection. The majority established special wards and separate areas for (potentially) infectious patients. Telephone and video consultations were found to provide benefits in affective and anxiety disorders. Involuntary admissions of persons without mental illness because of infection protection law violations were reported by 6% of the hospitals. The survey showed high adaptability of psychiatric departments, which managed large capacity shifts and introduced new services for infectious patients, which include telemedicine services. However, the pandemic exacerbated some of the shortcomings of the German mental health system: Avoidable complications resulted from the lack of cooperation and integrated care sequences between in- and outpatient sectors and limited options for psychiatric hospitals to provide outpatient services. Preventive approaches to handle comparable pandemic situations in the future should focus on addressing these shortcomings.

Zusammenfassung Hintergrund Zur Erreichung einer flächendeckenden Immunität gegen COVID-19 in der Bevölkerung ist entscheidend, wie sich die Impfbereitschaft bislang Ungeimpfter entwickelt. Schlüsselrolle dabei spielt das medizinische Personal, welches die Gesundheitsversorgung während der Pandemie gewährleistet und vielen Menschen als Informationsquelle zu Impfungen dient. Die allgemeine Impfbereitschaft wird u. a. negativ beeinflusst durch Verschwörungsannahmen und die Verbreitung von Desinformationen. Ziele Es wurden Impfbereitschaft und verschiedene Einflussgrößen bei Klinikpersonal in Deutschland untersucht, um Hinweise auf eine mögliche Steigerung der Impfbereitschaft zu erlangen. Methoden Im Rahmen des vom Bundesministerium für Bildung und Forschung geförderten egePan-Verbundprojekts des nationalen Netzwerkes Universitätsmedizin wurden zwischen Januar und Juni 2021 in einer freiwilligen, anonymen Onlinebefragung die Impfbereitschaft, individuelle Sozialmerkmale, Zustimmung zu Verschwörungsannahmen und Fragen zur Kommunikation in deutschen Kliniken erhoben. Ergebnisse Insbesondere Ärzt*innen und wissenschaftliches Personal gaben eine erhöhte Impfbereitschaft im Vergleich zur Gesamtbevölkerung an. Verschwörungsannahmen waren kaum verbreitet, am häufigsten jedoch unter dem Verwaltungs- und Pflegepersonal. Verschwörungsannahmen waren negativ assoziiert mit der Impfbereitschaft. Prädiktoren für eine höhere Impfbereitschaft waren die empfundene Sicherheit und Effektivität von Impfungen sowie ein höheres Alter. Diskussion Da sich empfundene Sicherheit und Effektivität von Impfungen positiv auf die Impfbereitschaft auswirkten, könnten eine dahingehende Aufklärungsarbeit und transparente Informationsvermittlung der Verbreitung von Verschwörungsannahmen entgegenwirken und die Impfraten unter Krankenhauspersonal erhöhen.