A Systematic Review of the International Evolution of Online Mental Health Strategies and Recommendations During the COVID-19 Pandemic

Abstract

Introduction: The global health crisis caused by the COVID-19 pandemic, which started at the beginning of 2020, has had a negative impact on mental health (MH). As a response to the pandemic, international agencies and governmental institutions providedan initial response to the population’s needs. As the pandemic evolved, the population circumstances changed, and some of these international agencies, such as the UN or WHO, updated their strategies, recommendations, and guidelines for the populations. However, there is currently a lack of information on the attention given to response strategies by the different countries throughout the beginning of the pandemic. Objectives: To evaluate the evolution of MH online strategies and recommendations developed by governments and related institutions to cope with the impact ofCOVID-19 on MH from the early stages of the COVID-19 pandemic to the vaccination period and to assess their current status. Methodology: An adaptation of the PRISMA guidelines to review online documents was used together with a questionnaire for MH strategies and recommendation assessment. Basic statistics and Student’s t test were used to assess the evolution of the documents, while a two-step cluster analysis was performed to assess the organisation and characteristics of the most recent documents. Results: Statistically significant differences were found both in the number of symptoms and mental disorders and MH strategies and recommendations included in the initial documents and the updated versions generated after vaccines became available. The most recent versionsare more complete in all cases. Regarding the forty-six total documents included in the review, the cluster analysis showed a broaddistribution from wide-spectrum documents to documentsfocusing on a specific topic. Conclusions: Governments and institutions have worked actively but unevenly on updating the MH guidelines, paying attention to actions related to bereavement, telehealth and domestic violence. Significant improvements have been made regarding Mexico’s guideline and the availability of comprehensive resources from England, Australia and the United States of America. The study supports the use of the PRISMA protocol adaptation and questionnaire for MH strategy and recommendation assessments as a standard by which to conduct longitudinal assessments of dynamic documents.