Cited by 3,221COVID-19 and Mental HealthMaternal Mental Health During Pregnancy and PostpartumLong-Term Effects of COVID-19

COVID-19 pandemic and mental health consequences: Systematic review of the current evidence

Open access
Vindegaard, Nina, Benros, Michael Eriksen·2020·Brain, Behavior, and Immunity

Abstract

Highlights • COVID-19 patients displayed high levels of PTSS and increased levels of depression.• Patients with preexisting psychiatric disorders reported worsening of psychiatric symptoms.• Higher levels of psychiatric symptoms were found among health care workers.• A decrease in psychological well-being was observed in the general public.• However, well conducted large-scale studies are highly needed.

Integrity signals

Registry

Crossref · 10.1016/j.bbi.2020.05.048

Cites

97 of 97 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

27 of 57 cited sources checked · 17 supported · 2 flagged · accuracy not yet measured

  • Findingcitation

    No difference in PTSS was observed among health care workers.

    “No difference in PTSS was observed (Sun et al., 2020)”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Sun et al., 2020 source

      The paper reports the opposite of the attributed claim. In “Associated factors for the severity of PTSD,” it states that PCL-5 scores differed significantly by population classification (p < 0.001), with health care workers reporting lower symptom levels than both low-risk and high-risk public groups. (LLM, conf=0.91)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Findingcitation

    Risk of PTSS was positively associated with lower education.

    “lower education (Liu et al., 2020)”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Liu et al., 2020 source

      In Results > Related factors of the occurrence of PTSS (page unavailable), the initial regression shows lower PTSS scores for respondents with high-school education or below than for those with university or college education. That difference is not significant in the final model. Results > The prevalence and demographic characteristics likewise reports a lower mean PTSS score for the lower-education group, not the higher risk claimed. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Findingcitation

    Risk of PTSS was positively associated with female gender.

    “The risk of PTSS were positively associated with female gender (Sun et al., 2020, Liu et al., 2020)”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites Sun et al., 2020 source
    • cites Liu et al., 2020 source
  • Findingcitation

    No difference was found between being in quarantine and not being in quarantine.

    “one study found no difference between being in quarantine (n = 1443) or not (n = 836) (Zhu et al., 2020).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Zhu et al., 2020 source
  • Findingcitation

    Poor self-rated health was linked to a higher likelihood of depression and/or anxiety.

    “Poor-self rated health (Wang et al., 2020a, Gao et al., 2020, Wang et al., 2020b)”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites Wang et al., 2020a

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Gao et al., 2020 source
    • cites Wang et al., 2020b

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim. 3
  • May combine two claims. 11
  • The quote only partly states this claim. 2
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    No significant difference in any items was found between workers/technical staff and management/executive staff (all P>0.05).

    “One study found no significant difference in any items between workers/technical staff (n = 551) and management/executive staff (n = 122) (all P > 0.05) (Tan et al., 2020)”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Tan et al., 2020 source

      The Results section on immediate mental health status reports no significant differences between the groups in PTSD symptoms, depression, anxiety, stress or insomnia (p > 0.05). But “any items” and “all P > 0.05” overstate the finding: the Results also report a difference in worries about young children’s health (p = 0.028), and Table 4 reports differences in some prevention measures (p = 0.040 and 0.048). Page numbers are unavailable in our copy. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
  • May combine two claims.

    Findingcitation

    Female gender was frequently reported as a risk factor for depression and/or anxiety, but findings were not consistent.

    “female gender (Zhang et al., 2020b, Lai et al., 2020, Mazza et al., 2020, Wang et al., 2020b, Ozdin and Bayrak Ozdin, 2020) was reported frequently, but was not consistent (Chen et al., 2020, Gao et al., 2020)”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites Zhang et al., 2020b

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Lai et al., 2020 source
    • cites Mazza et al., 2020 source
  • May combine two claims. The quote only partly states this claim.

    Findingcitation

    Among health care workers, anxiety was increased compared to norms, administrative staff, during pandemic control, or experienced staff.

    “Among health care workers depression/depressive symptoms (six papers) and anxiety (eight papers) were increased”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Chen et al., 2020 source
    • cites Mo et al., 2020

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Lu et al., 2020b

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    Parents of children hospitalized during the epidemic had higher anxiety, depression, and dream anxiety scores than parents in the non-epidemic period (all p<0.001).

    “Furthermore a study of parents of children hospitalized during the epidemic period had significant higher scores of anxiety, depression and dream anxiety compared to parents of children hospitalized in the non-epidemic period (all p < 0.001) (Yuan et al., 2020).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Yuan et al., 2020 source
  • May combine two claims. The quote only partly states this claim.

    Findingcitation

    Among health care workers, depressive symptoms were increased compared to norms, administrative staff, during pandemic control, or experienced staff.

    “Among health care workers depression/depressive symptoms (six papers) and anxiety (eight papers) were increased”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Chen et al., 2020 source
    • cites Mo et al., 2020

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Lu et al., 2020b

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    SARS-CoV-2 might act as a neurotrophic agent that enters via the olfactory bulb, raising neuropsychiatric symptoms in survivors.

    “Taken together this indicates that SARS-CoV-2 could be neurotrophic entering the brain through the olfactory bulb, leading to an increase in neuropsychiatric symptoms among the patients surviving COVID-19.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Troyer et al., 2020 source

      The “Viral infiltration into the central nervous system” section describes possible coronavirus entry via the olfactory nerve and discusses SARS-CoV-2 neuroinvasion. The “Sub-acute to chronic neuropsychiatric sequelae” section says long-term outcomes in COVID-19 survivors were still unknown. The paper does not specifically identify the olfactory bulb as the entry route or establish that this route would increase neuropsychiatric symptoms in survivors. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites Netland et al., 2008 source
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    The higher depression risk in COVID-19 patients could be due to the coronavirus affecting the brain directly or indirectly via a massive cytokine response.

    “This higher risk could be due to the corona-virus affecting the brain directly or indirectly by inducing a massive cytokine response affecting the brain (Troyer et al., 2020).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Troyer et al., 2020 source
  • May combine two claims.

    Findingcitation

    Among patients newly recovered from COVID-19, prevalence of depression was 29.2%, higher than 9.8% among quarantine participants (p=0.016).

    “The second study showed that the prevalence of depression (29.2%) was elevated (p = 0.016) among 57 patients newly recovered from COVID-19 compared to participants in quarantine (9.8%), while no difference in anxiety level was found (P = 0.154).”
    • Also stated in: § Psychiatric symptoms among COVID-19 patients · plain
      “The risk of depression was also found to be higher among patients with COVID-19 (Zhang et al., 2020a).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Zhang et al., 2020a

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingown data

    Most included studies were conducted in Asia, with only four from Europe and none from other continents.

    “Firstly, the majority of the studies were conducted in Asia (only four studies from Europe and none from other continents), limiting the current generalization of the results.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    Most included studies were not case-control (35/43) and had varied reported outcomes, measurement, and statistical analysis.

    “Secondly, most of the studies were not case-control studies no (35/43) and with a variety of reported outcomes, measuring of outcomes and statistical analysis was revealed.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The review was systematically conducted.

    “The strength of this review is that it was systematically conducted.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Interpretationreasoning

    Evidence suggests rising depressive and anxiety symptoms and worse general mental health, especially in health care workers.

    “Regarding the indirect effects of COVID-19 on general mental health there seems to be evidence of an increase in depressive and anxiety symptoms along with negative impact on general mental health, particularly among health care workers.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Interpretationreasoning

    Due to altered living conditions, many identified risk factors will increase, likely leading to an increase in patients.

    “Due to the altered living conditions many of the identified risk factors will increase most likely leading to an increase in patients.”
    Quote in the paperNot a substantial claim
13 of 13

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • A systematic review of 19 of 43 public studies found early pandemic changes in psychological well-being, anxiety, and depression.

    “A systematic review of 19 of 43 studies in the public demonstrated mental health changes in psychological well-being, anxiety and depression early in the pandemic [23].”

    From Overview of sleep management during COVID-19. (2022) · cites this paper as [23]

    The Results section says that 19 of the 43 included studies concerned the general public, and reports lower psychological well-being and some indicators of increased anxiety and depression. But the Results and Discussion also report a longitudinal study finding no change in anxiety or depression, so the claim overstates the consistency of those changes across the public studies. (LLM, conf=0.85)

    Experimental — accuracy not yet measured
  • Health care workers had the highest rates of disturbed sleep in 20 of 41 studies.

    “Health care workers reported the highest rates of disturbed sleep in 20 of the 41 studies [23].”

    From Overview of sleep management during COVID-19. (2022) · cites this paper as [23]

    The Results section on health care workers reports poor sleep quality compared with norms, supporting the sleep-related part of the claim. But the Results overview says that 20 of 41 studies of the pandemic’s indirect effects examined health care workers; it does not say that those 20 studies found the highest rates of disturbed sleep. (LLM, conf=0.89)

    Experimental — accuracy not yet measured
  • A considerable proportion of nurses experienced high levels of depression, anxiety, psychological distress, post-traumatic symptoms, burnout, and insomnia during COVID-19.

    “Studies reported that a considerable proportion of nurses were experiencing high levels of depression, anxiety, psychological distress, post-traumatic symptoms, burnout, and insomnia (4–6).”

    From Translation, adaptation, and initial evaluation of a guided self-help intervention to reduce psychological distress among nurses during COVID-19 in China (2023) · cites this paper as [6]

    The Discussion (page unavailable) reports increased depression, anxiety, psychological distress and poor sleep quality among health care workers, supporting part of the claim. It does not establish that a considerable proportion of nurses had all the listed symptoms or report burnout; the Results section on health care workers (page unavailable) says one study found no difference in post-traumatic stress symptoms. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • The COVID-19 pandemic has been associated with significantly higher levels of distress in the general population and people with persistent pain.

    “The COVID-19 pandemic has been associated with significantly higher levels of distress in the general population and people with persistent pain (Salari et al., 2020;Vindegaard & Benros, 2020;Yu al., 2021).”

    From Acceptance and Commitment Therapy for women living with Vulvodynia: A single-case experimental design study of a treatment delivered online (2022) · cites this paper as Vindegaard & Benros, 2020

    The Results section on the general public reports lower psychological well-being compared with before COVID-19, supporting a pandemic-related mental-health impact. It does not establish significantly higher distress across the general population—the Discussion also notes a longitudinal study finding no difference in stress symptoms—and the paper does not address people with persistent pain. (LLM, conf=0.87)

    Experimental — accuracy not yet measured
  • Pre-existing medical conditions, chronic illness and/or self-evaluated poor health are considerable risk factors for loneliness, anxiety, depression and psychological distress.

    “Further to this, pre-existing medical conditions, chronic illness and/or self-evaluated poor health, are considerable risk factors for loneliness, anxiety, depression and psychological distress [7,8,9].”

    From The impact of the SARS-CoV-2 outbreak on the psychological flexibility and behaviour of cancelling medical appointments of italian patients with pre-existing medical condition: The “impact-COVID-19 for patients” multi-centre observational study (2021) · cites this paper as [9]

    The Results section, “Risk factors of anxiety and depression” (page not available), associates current or past medical history and poor self-rated health with depression and/or anxiety. The cited passages do not establish these conditions as risk factors for loneliness or specifically for psychological distress, and they do not distinguish chronic illness from other medical disease. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Self-check results appear here once an independent check has confirmed them.

Cited works that were retracted

Works this paper cites that were later retracted, from the retraction notices publishers deposit. Major when the notice came out before this paper was published.

  • Cites a retracted work: 10.1016/j.ajp.2020.102052

    Info

    The cited work was retracted on 2020-11-03 (notice 10.1016/j.ajp.2020.102482), not before this paper was published (2020-10).

    Cited work 10.1016/j.ajp.2020.102052 · retracted 2020-11-03 · notice 10.1016/j.ajp.2020.102482 · this paper published 2020-10

  • Cites a retracted work: 10.1016/j.ajp.2020.102482

    Info

    The cited work was retracted; the date of the notice is not on record.

    Cited work 10.1016/j.ajp.2020.102482 · retraction date not known · this paper published 2020-10

2 of 2

Cites

2 retracted

Flagged first, then by citations

9 of the 106 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Haldrup, 2020, Lugte- og smagstab som primære symptom på COVID-19, Ugeskr. Laeger, 04200205

Cited by

Sorted by citations

Authors
Vindegaard, N., & Benros, M. E.
Affiliations
University of Copenhagen (DK)
Corresponding author
Benros, Michael Eriksen
Venue
Brain, Behavior, and Immunity
Publisher
Elsevier BV
Published
2020-10
Volume
89
Pages
531-542
ISSN
0889-1591 (ISSN-L)
OpenAlex
W3030352285
Cited by
3,221
References
106
Citations by year
2026: 112 · 2025: 198 · 2024: 328 · 2023: 602 · 2022: 853 · 2021: 905 · 2020: 216 · 2019: 1 · 2017: 1 · 2016: 1
FWCI
50.93
Type
journal article
Language
en
Open access
Locations
  • Brain Behavior and Immunity (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
Funders
Lundbeckfonden
Topics
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
Keywords
COVID-19 pandemic, mental health, psychiatric symptoms, posttraumatic stress symptoms, depression, anxiety, psychological distress, sleep quality, healthcare workers, psychological well-being, risk factors, gender differences
MeSH terms
Betacoronavirus, Psychological Distress, COVID-19, SARS-CoV-2, Anxiety, Mental Disorders, Depression, Health Personnel, Humans, Mental Health, Pneumonia, Viral, Stress Disorders, Post-Traumatic, Coronavirus Infections, Disease Progression, Persons with Psychiatric Disorders, Pandemics

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