Comparison of Mental Health Symptoms Prior to and During COVID-19: Evidence from a Systematic Review and Meta-analysis of 134 Cohorts

Abstract

Objectives: The rapid pace, high volume, and limited quality of mental health evidence being generated during COVID-19 poses a barrier to effective decision-making. The objective of the present report is to compare mental health outcomes assessed during COVID-19 to outcomes prior to COVID-19 in the general population and other population groups. Design: Living systematic review. Data Sources: MEDLINE (Ovid), PsycINFO (Ovid), CINAHL (EBSCO), EMBASE (Ovid), Web of Science Core Collection: Citation Indexes, China National Knowledge Infrastructure, Wanfang, medRxiv (preprints), and Open Science Framework Preprints (preprint server aggregator). The initial search was conducted on April 13, 2020 with ongoing weekly updates. Eligibility criteria for selecting studies: For this report, we included studies that compared general mental health, anxiety symptoms, or depression symptoms, assessed January 1, 2020 or later, to the same outcomes collected between January 1, 2018 and December 31, 2019. We required ≥ 90% of participants pre-COVID-19 and during COVID-19 to be the same or the use of statistical methods to address missing data. For population groups with continuous outcomes for at least three studies in an outcome domain, we conducted restricted maximum-likelihood random-effects meta-analyses. Results: As of March 22, 2021, we had identified 36 unique eligible studies with data from 33 cohorts. All reported COVID-19 outcomes between March and June 2020, and 3 studies also reported outcomes between September and November 2020. Estimates of changes in general mental health were close to zero in the general population (standardized mean difference [SMD] = 0.02, 95% CI -0.11 to 0.16, I2 = 94.6%; 4 studies, N = 19,707) and among older adults (SMD = 0.02, 95% CI -0.11 to 0.16, I2 = 90.4%; 4 studies, N = 5,520) and university students (SMD = -0.01, 95% CI -0.33 to 0.30, I2 = 92.0%; 3 studies, N = 3,372). Changes in anxiety symptoms were close to zero and not statistically significant in university students (SMD = 0.00, 95% CI -0.35 to 0.36, I2 = 95.4%; 5 studies, N = 1,537); women or females (SMD = 0.02, 95% CI -0.35 to 0.39, I2 = 92.3%; 3 studies, N = 2,778); and men or males (SMD = 0.07, 95% CI -0.01 to 0.15; I2 = 0.01%; 3 studies, N = 1,250); anxiety symptoms increased, however, among people with pre-existing medical conditions (SMD = 0.27, 95% CI 0.01 to 0.54, I2 = 91.0%; 3 studies, N = 2,053). Changes in depression symptoms were close to zero or small and not statistically significant among university students (SMD = 0.19, 95% CI -0.08 to 0.45, I2 = 91.8%; 5 studies, N = 1,537); people with pre-existing medical conditions (SMD = 0.01, 95% CI -0.15 to 0.17, I2 = 14.9%; 3 studies, N = 2,006); women or females (SMD = 0.21, 95% CI -0.14 to 0.55, I2 = 91.2%; 3 studies, N = 2,843); and men or males (SMD = 0.00, 95% CI -0.21 to 0.22; I2 = 92.3%; 4 studies, N = 3,661). In 3 studies with data from both March to June 2020 and September to November 2020, symptoms were unchanged from pre-COVID-19 at both time points or there were increases at the first assessment that had largely dissipated by the second assessment. Conclusions: Evidence does not suggest a widespread negative effect on mental health symptoms in COVID-19, although it is possible that gaps in data have not allowed identification of changes in some vulnerable groups. Continued updating is needed as evidence accrues.

Comparison of Mental Health Symptom Changes from pre-COVID-19 to COVID-19 by Sex or Gender: A Systematic Review and Meta-analysis

“…[49][50][51][52] Likely risk factors include gender inequities and discrimination, higher rates of interpersonal stressors, and violence, 53,54 and many of these risk factors have been exacerbated for women during COVID-19. [5][6][7][8][9][10][11][12] Overall mental health does not appear to have changed substantively for the general population based on our main systematic review, 26 but there is concern that there could, nonetheless, be important sex-or gender-based differences. We found small symptom change differences that reflect relative worsening for women for 2 of 8 outcomes assessed, but no differences appeared to be clinically meaningful.…”

No buffer effect of perceived social support for people exposed to violence during the COVID-19 pandemic: a cross-sectional community study

“…Researchers have aimed to assess the mental health consequences in societies and to identify risk groups and protective factors. Whereas some of the studies conducted in an early phase of the pandemic reported an alarming increase in psychological distress in the general community (Salari et al, 2020 ), later research with study designs of higher quality have indicated less dramatic mental health consequences of the pandemic (Prati & Mancini, 2021 ; Sun et al 2021 ). Some researchers have proposed that the observed increase of psychological distress in the community for the most part might be attributed to vulnerable groups (Public Health England, 2021 ).…”

Mental health before and during the pandemic in people with systemic sclerosis

“… 2 A living systematic review (ie, a systematic review that is continually updated) found that general mental health, anxiety, and depression symptoms did not worsen substantively in the general population in the early months of the pandemic. 3 Among people with pre-existing medical conditions, however, anxiety symptoms worsened significantly (three studies; n=2053; standardised mean difference [SMD] 0·27 [95% CI 0·01 to 0·54]) but depression symptoms did not change (three studies; N=2006; SMD 0·01 [–0·15 to 0·17]). 3 …”

“… 3 Among people with pre-existing medical conditions, however, anxiety symptoms worsened significantly (three studies; n=2053; standardised mean difference [SMD] 0·27 [95% CI 0·01 to 0·54]) but depression symptoms did not change (three studies; N=2006; SMD 0·01 [–0·15 to 0·17]). 3 …”

“…More than 40% of people with systemic sclerosis have interstitial lung disease, many are frail, and immunosuppressant medication use is common. 4 , 5 Our Scleroderma Patient-centered Intervention Network (SPIN) Cohort study, 6 which was included in the COVID-19 living systematic review, 3 found that anxiety symptoms increased substantially from before COVID-19 to April 9–27, 2020 (n=435; SMD 0·51 [95% CI 0·37 to 0·64]) but depression symptoms did not (n=388; SMD –0·05 [–0·19 to 0·09]).…”