Comparison of mental health symptoms before and during the covid-19 pandemic: evidence from a systematic review and meta-analysis of 134 cohorts

AbstractObjectiveTo synthesise results of mental health outcomes in cohorts before and during the covid-19 pandemic.DesignSystematic review.Data sourcesMedline, PsycINFO, CINAHL, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, medRxiv, and Open Science Framework Preprints.E...

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Published in:	BMJ (Online) Vol. 380; p. e074224
Main Authors:	Sun, Ying, Wu, Yin, Fan, Suiqiong, Dal Santo, Tiffany, Li, Letong, Jiang, Xiaowen, Li, Kexin, Wang, Yutong, Tasleem, Amina, Krishnan, Ankur, He, Chen, Bonardi, Olivia, Boruff, Jill T, Rice, Danielle B, Markham, Sarah, Levis, Brooke, Azar, Marleine, Thombs-Vite, Ian, Neupane, Dipika, Agic, Branka, Fahim, Christine, Martin, Michael S, Sockalingam, Sanjeev, Turecki, Gustavo, Benedetti, Andrea, Thombs, Brett D
Format:	Journal Article
Language:	English
Published:	England British Medical Journal Publishing Group 08.03.2023 BMJ Publishing Group LTD
Subjects:	Anxiety Anxiety - epidemiology Confidence intervals COVID-19 COVID-19 - epidemiology Estimates Female Humans Librarians Mental depression Mental disorders Mental Disorders - epidemiology Mental Health Mental health care Meta-analysis Pandemics Population studies Standard deviation Statistical analysis Systematic review Canada China
ISSN:	1756-1833, 1756-1833
Online Access:	Get full text
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Abstract	AbstractObjectiveTo synthesise results of mental health outcomes in cohorts before and during the covid-19 pandemic.DesignSystematic review.Data sourcesMedline, PsycINFO, CINAHL, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, medRxiv, and Open Science Framework Preprints.Eligibility criteria for selecting studiesStudies comparing general mental health, anxiety symptoms, or depression symptoms assessed from 1 January 2020 or later with outcomes collected from 1 January 2018 to 31 December 2019 in any population, and comprising ≥90% of the same participants before and during the covid-19 pandemic or using statistical methods to account for missing data. Restricted maximum likelihood random effects meta-analyses (worse covid-19 outcomes representing positive change) were performed. Risk of bias was assessed using an adapted Joanna Briggs Institute Checklist for Prevalence Studies.ResultsAs of 11 April 2022, 94 411 unique titles and abstracts including 137 unique studies from 134 cohorts were reviewed. Most of the studies were from high income (n=105, 77%) or upper middle income (n=28, 20%) countries. Among general population studies, no changes were found for general mental health (standardised mean difference (SMD)change 0.11, 95% confidence interval −0.00 to 0.22) or anxiety symptoms (0.05, −0.04 to 0.13), but depression symptoms worsened minimally (0.12, 0.01 to 0.24). Among women or female participants, general mental health (0.22, 0.08 to 0.35), anxiety symptoms (0.20, 0.12 to 0.29), and depression symptoms (0.22, 0.05 to 0.40) worsened by minimal to small amounts. In 27 other analyses across outcome domains among subgroups other than women or female participants, five analyses suggested that symptoms worsened by minimal or small amounts, and two suggested minimal or small improvements. No other subgroup experienced changes across all outcome domains. In three studies with data from March to April 2020 and late 2020, symptoms were unchanged from pre-covid-19 levels at both assessments or increased initially then returned to pre-covid-19 levels. Substantial heterogeneity and risk of bias were present across analyses.ConclusionsHigh risk of bias in many studies and substantial heterogeneity suggest caution in interpreting results. Nonetheless, most symptom change estimates for general mental health, anxiety symptoms, and depression symptoms were close to zero and not statistically significant, and significant changes were of minimal to small magnitudes. Small negative changes occurred for women or female participants in all domains. The authors will update the results of this systematic review as more evidence accrues, with study results posted online (https://www.depressd.ca/covid-19-mental-health).Review registrationPROSPERO CRD42020179703.
AbstractList	ObjectiveTo synthesise results of mental health outcomes in cohorts before and during the covid-19 pandemic.DesignSystematic review.Data sourcesMedline, PsycINFO, CINAHL, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, medRxiv, and Open Science Framework Preprints.Eligibility criteria for selecting studiesStudies comparing general mental health, anxiety symptoms, or depression symptoms assessed from 1 January 2020 or later with outcomes collected from 1 January 2018 to 31 December 2019 in any population, and comprising ≥90% of the same participants before and during the covid-19 pandemic or using statistical methods to account for missing data. Restricted maximum likelihood random effects meta-analyses (worse covid-19 outcomes representing positive change) were performed. Risk of bias was assessed using an adapted Joanna Briggs Institute Checklist for Prevalence Studies.ResultsAs of 11 April 2022, 94 411 unique titles and abstracts including 137 unique studies from 134 cohorts were reviewed. Most of the studies were from high income (n=105, 77%) or upper middle income (n=28, 20%) countries. Among general population studies, no changes were found for general mental health (standardised mean difference (SMD)change 0.11, 95% confidence interval −0.00 to 0.22) or anxiety symptoms (0.05, −0.04 to 0.13), but depression symptoms worsened minimally (0.12, 0.01 to 0.24). Among women or female participants, general mental health (0.22, 0.08 to 0.35), anxiety symptoms (0.20, 0.12 to 0.29), and depression symptoms (0.22, 0.05 to 0.40) worsened by minimal to small amounts. In 27 other analyses across outcome domains among subgroups other than women or female participants, five analyses suggested that symptoms worsened by minimal or small amounts, and two suggested minimal or small improvements. No other subgroup experienced changes across all outcome domains. In three studies with data from March to April 2020 and late 2020, symptoms were unchanged from pre-covid-19 levels at both assessments or increased initially then returned to pre-covid-19 levels. Substantial heterogeneity and risk of bias were present across analyses.ConclusionsHigh risk of bias in many studies and substantial heterogeneity suggest caution in interpreting results. Nonetheless, most symptom change estimates for general mental health, anxiety symptoms, and depression symptoms were close to zero and not statistically significant, and significant changes were of minimal to small magnitudes. Small negative changes occurred for women or female participants in all domains. The authors will update the results of this systematic review as more evidence accrues, with study results posted online (https://www.depressd.ca/covid-19-mental-health).Review registrationPROSPERO CRD42020179703. To synthesise results of mental health outcomes in cohorts before and during the covid-19 pandemic. Systematic review. Medline, PsycINFO, CINAHL, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, medRxiv, and Open Science Framework Preprints. Studies comparing general mental health, anxiety symptoms, or depression symptoms assessed from 1 January 2020 or later with outcomes collected from 1 January 2018 to 31 December 2019 in any population, and comprising ≥90% of the same participants before and during the covid-19 pandemic or using statistical methods to account for missing data. Restricted maximum likelihood random effects meta-analyses (worse covid-19 outcomes representing positive change) were performed. Risk of bias was assessed using an adapted Joanna Briggs Institute Checklist for Prevalence Studies. As of 11 April 2022, 94 411 unique titles and abstracts including 137 unique studies from 134 cohorts were reviewed. Most of the studies were from high income (n=105, 77%) or upper middle income (n=28, 20%) countries. Among general population studies, no changes were found for general mental health (standardised mean difference (SMD) 0.11, 95% confidence interval -0.00 to 0.22) or anxiety symptoms (0.05, -0.04 to 0.13), but depression symptoms worsened minimally (0.12, 0.01 to 0.24). Among women or female participants, general mental health (0.22, 0.08 to 0.35), anxiety symptoms (0.20, 0.12 to 0.29), and depression symptoms (0.22, 0.05 to 0.40) worsened by minimal to small amounts. In 27 other analyses across outcome domains among subgroups other than women or female participants, five analyses suggested that symptoms worsened by minimal or small amounts, and two suggested minimal or small improvements. No other subgroup experienced changes across all outcome domains. In three studies with data from March to April 2020 and late 2020, symptoms were unchanged from pre-covid-19 levels at both assessments or increased initially then returned to pre-covid-19 levels. Substantial heterogeneity and risk of bias were present across analyses. High risk of bias in many studies and substantial heterogeneity suggest caution in interpreting results. Nonetheless, most symptom change estimates for general mental health, anxiety symptoms, and depression symptoms were close to zero and not statistically significant, and significant changes were of minimal to small magnitudes. Small negative changes occurred for women or female participants in all domains. The authors will update the results of this systematic review as more evidence accrues, with study results posted online (https://www.depressd.ca/covid-19-mental-health). PROSPERO CRD42020179703. AbstractObjectiveTo synthesise results of mental health outcomes in cohorts before and during the covid-19 pandemic.DesignSystematic review.Data sourcesMedline, PsycINFO, CINAHL, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, medRxiv, and Open Science Framework Preprints.Eligibility criteria for selecting studiesStudies comparing general mental health, anxiety symptoms, or depression symptoms assessed from 1 January 2020 or later with outcomes collected from 1 January 2018 to 31 December 2019 in any population, and comprising ≥90% of the same participants before and during the covid-19 pandemic or using statistical methods to account for missing data. Restricted maximum likelihood random effects meta-analyses (worse covid-19 outcomes representing positive change) were performed. Risk of bias was assessed using an adapted Joanna Briggs Institute Checklist for Prevalence Studies.ResultsAs of 11 April 2022, 94 411 unique titles and abstracts including 137 unique studies from 134 cohorts were reviewed. Most of the studies were from high income (n=105, 77%) or upper middle income (n=28, 20%) countries. Among general population studies, no changes were found for general mental health (standardised mean difference (SMD)change 0.11, 95% confidence interval −0.00 to 0.22) or anxiety symptoms (0.05, −0.04 to 0.13), but depression symptoms worsened minimally (0.12, 0.01 to 0.24). Among women or female participants, general mental health (0.22, 0.08 to 0.35), anxiety symptoms (0.20, 0.12 to 0.29), and depression symptoms (0.22, 0.05 to 0.40) worsened by minimal to small amounts. In 27 other analyses across outcome domains among subgroups other than women or female participants, five analyses suggested that symptoms worsened by minimal or small amounts, and two suggested minimal or small improvements. No other subgroup experienced changes across all outcome domains. In three studies with data from March to April 2020 and late 2020, symptoms were unchanged from pre-covid-19 levels at both assessments or increased initially then returned to pre-covid-19 levels. Substantial heterogeneity and risk of bias were present across analyses.ConclusionsHigh risk of bias in many studies and substantial heterogeneity suggest caution in interpreting results. Nonetheless, most symptom change estimates for general mental health, anxiety symptoms, and depression symptoms were close to zero and not statistically significant, and significant changes were of minimal to small magnitudes. Small negative changes occurred for women or female participants in all domains. The authors will update the results of this systematic review as more evidence accrues, with study results posted online (https://www.depressd.ca/covid-19-mental-health).Review registrationPROSPERO CRD42020179703. To synthesise results of mental health outcomes in cohorts before and during the covid-19 pandemic.OBJECTIVETo synthesise results of mental health outcomes in cohorts before and during the covid-19 pandemic.Systematic review.DESIGNSystematic review.Medline, PsycINFO, CINAHL, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, medRxiv, and Open Science Framework Preprints.DATA SOURCESMedline, PsycINFO, CINAHL, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, medRxiv, and Open Science Framework Preprints.Studies comparing general mental health, anxiety symptoms, or depression symptoms assessed from 1 January 2020 or later with outcomes collected from 1 January 2018 to 31 December 2019 in any population, and comprising ≥90% of the same participants before and during the covid-19 pandemic or using statistical methods to account for missing data. Restricted maximum likelihood random effects meta-analyses (worse covid-19 outcomes representing positive change) were performed. Risk of bias was assessed using an adapted Joanna Briggs Institute Checklist for Prevalence Studies.ELIGIBILITY CRITERIA FOR SELECTING STUDIESStudies comparing general mental health, anxiety symptoms, or depression symptoms assessed from 1 January 2020 or later with outcomes collected from 1 January 2018 to 31 December 2019 in any population, and comprising ≥90% of the same participants before and during the covid-19 pandemic or using statistical methods to account for missing data. Restricted maximum likelihood random effects meta-analyses (worse covid-19 outcomes representing positive change) were performed. Risk of bias was assessed using an adapted Joanna Briggs Institute Checklist for Prevalence Studies.As of 11 April 2022, 94 411 unique titles and abstracts including 137 unique studies from 134 cohorts were reviewed. Most of the studies were from high income (n=105, 77%) or upper middle income (n=28, 20%) countries. Among general population studies, no changes were found for general mental health (standardised mean difference (SMD)change 0.11, 95% confidence interval -0.00 to 0.22) or anxiety symptoms (0.05, -0.04 to 0.13), but depression symptoms worsened minimally (0.12, 0.01 to 0.24). Among women or female participants, general mental health (0.22, 0.08 to 0.35), anxiety symptoms (0.20, 0.12 to 0.29), and depression symptoms (0.22, 0.05 to 0.40) worsened by minimal to small amounts. In 27 other analyses across outcome domains among subgroups other than women or female participants, five analyses suggested that symptoms worsened by minimal or small amounts, and two suggested minimal or small improvements. No other subgroup experienced changes across all outcome domains. In three studies with data from March to April 2020 and late 2020, symptoms were unchanged from pre-covid-19 levels at both assessments or increased initially then returned to pre-covid-19 levels. Substantial heterogeneity and risk of bias were present across analyses.RESULTSAs of 11 April 2022, 94 411 unique titles and abstracts including 137 unique studies from 134 cohorts were reviewed. Most of the studies were from high income (n=105, 77%) or upper middle income (n=28, 20%) countries. Among general population studies, no changes were found for general mental health (standardised mean difference (SMD)change 0.11, 95% confidence interval -0.00 to 0.22) or anxiety symptoms (0.05, -0.04 to 0.13), but depression symptoms worsened minimally (0.12, 0.01 to 0.24). Among women or female participants, general mental health (0.22, 0.08 to 0.35), anxiety symptoms (0.20, 0.12 to 0.29), and depression symptoms (0.22, 0.05 to 0.40) worsened by minimal to small amounts. In 27 other analyses across outcome domains among subgroups other than women or female participants, five analyses suggested that symptoms worsened by minimal or small amounts, and two suggested minimal or small improvements. No other subgroup experienced changes across all outcome domains. In three studies with data from March to April 2020 and late 2020, symptoms were unchanged from pre-covid-19 levels at both assessments or increased initially then returned to pre-covid-19 levels. Substantial heterogeneity and risk of bias were present across analyses.High risk of bias in many studies and substantial heterogeneity suggest caution in interpreting results. Nonetheless, most symptom change estimates for general mental health, anxiety symptoms, and depression symptoms were close to zero and not statistically significant, and significant changes were of minimal to small magnitudes. Small negative changes occurred for women or female participants in all domains. The authors will update the results of this systematic review as more evidence accrues, with study results posted online (https://www.depressd.ca/covid-19-mental-health).CONCLUSIONSHigh risk of bias in many studies and substantial heterogeneity suggest caution in interpreting results. Nonetheless, most symptom change estimates for general mental health, anxiety symptoms, and depression symptoms were close to zero and not statistically significant, and significant changes were of minimal to small magnitudes. Small negative changes occurred for women or female participants in all domains. The authors will update the results of this systematic review as more evidence accrues, with study results posted online (https://www.depressd.ca/covid-19-mental-health).PROSPERO CRD42020179703.REVIEW REGISTRATIONPROSPERO CRD42020179703.
Author	Sun, Ying Agic, Branka Li, Letong Markham, Sarah Martin, Michael S Bonardi, Olivia Boruff, Jill T Fan, Suiqiong Tasleem, Amina Li, Kexin Wang, Yutong Benedetti, Andrea Levis, Brooke He, Chen Fahim, Christine Neupane, Dipika Dal Santo, Tiffany Thombs, Brett D Wu, Yin Jiang, Xiaowen Rice, Danielle B Sockalingam, Sanjeev Thombs-Vite, Ian Krishnan, Ankur Azar, Marleine Turecki, Gustavo
Author_xml	– sequence: 1 givenname: Ying surname: Sun fullname: Sun, Ying organization: Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada – sequence: 2 givenname: Yin surname: Wu fullname: Wu, Yin organization: Department of Psychiatry, McGill University, Montreal, Quebec, Canada – sequence: 3 givenname: Suiqiong surname: Fan fullname: Fan, Suiqiong organization: Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada – sequence: 4 givenname: Tiffany surname: Dal Santo fullname: Dal Santo, Tiffany organization: Department of Psychiatry, McGill University, Montreal, Quebec, Canada – sequence: 5 givenname: Letong surname: Li fullname: Li, Letong organization: Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada – sequence: 6 givenname: Xiaowen surname: Jiang fullname: Jiang, Xiaowen organization: Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada – sequence: 7 givenname: Kexin surname: Li fullname: Li, Kexin organization: Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada – sequence: 8 givenname: Yutong surname: Wang fullname: Wang, Yutong organization: Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada – sequence: 9 givenname: Amina surname: Tasleem fullname: Tasleem, Amina organization: Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada – sequence: 10 givenname: Ankur surname: Krishnan fullname: Krishnan, Ankur organization: Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada – sequence: 11 givenname: Chen surname: He fullname: He, Chen organization: Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada – sequence: 12 givenname: Olivia surname: Bonardi fullname: Bonardi, Olivia organization: Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada – sequence: 13 givenname: Jill T surname: Boruff fullname: Boruff, Jill T organization: Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Quebec, Canada – sequence: 14 givenname: Danielle B surname: Rice fullname: Rice, Danielle B organization: Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada – sequence: 15 givenname: Sarah surname: Markham fullname: Markham, Sarah organization: Department of Biostatistics and Health Informatics, King’s College London, London, UK – sequence: 16 givenname: Brooke surname: Levis fullname: Levis, Brooke organization: Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada – sequence: 17 givenname: Marleine surname: Azar fullname: Azar, Marleine organization: Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada – sequence: 18 givenname: Ian surname: Thombs-Vite fullname: Thombs-Vite, Ian organization: Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada – sequence: 19 givenname: Dipika surname: Neupane fullname: Neupane, Dipika organization: Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada – sequence: 20 givenname: Branka surname: Agic fullname: Agic, Branka organization: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada – sequence: 21 givenname: Christine surname: Fahim fullname: Fahim, Christine organization: Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada – sequence: 22 givenname: Michael S surname: Martin fullname: Martin, Michael S organization: Correctional Service of Canada, Ottawa, Ontario, Canada – sequence: 23 givenname: Sanjeev surname: Sockalingam fullname: Sockalingam, Sanjeev organization: Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada – sequence: 24 givenname: Gustavo surname: Turecki fullname: Turecki, Gustavo organization: McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada – sequence: 25 givenname: Andrea surname: Benedetti fullname: Benedetti, Andrea organization: Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada – sequence: 26 givenname: Brett D orcidid: 0000-0002-5644-8432 surname: Thombs fullname: Thombs, Brett D email: brett.thombs@mcgill.ca organization: Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/36889797$$D View this record in MEDLINE/PubMed
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Snippet	AbstractObjectiveTo synthesise results of mental health outcomes in cohorts before and during the covid-19 pandemic.DesignSystematic review.Data... To synthesise results of mental health outcomes in cohorts before and during the covid-19 pandemic. Systematic review. Medline, PsycINFO, CINAHL, Embase, Web... ObjectiveTo synthesise results of mental health outcomes in cohorts before and during the covid-19 pandemic.DesignSystematic review.Data sourcesMedline,... To synthesise results of mental health outcomes in cohorts before and during the covid-19 pandemic.OBJECTIVETo synthesise results of mental health outcomes in...
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SubjectTerms	Anxiety Anxiety - epidemiology Confidence intervals COVID-19 COVID-19 - epidemiology Estimates Female Humans Librarians Mental depression Mental disorders Mental Disorders - epidemiology Mental Health Mental health care Meta-analysis Pandemics Population studies Standard deviation Statistical analysis Systematic review
Title	Comparison of mental health symptoms before and during the covid-19 pandemic: evidence from a systematic review and meta-analysis of 134 cohorts
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