CoChat
Sign Up
Cited by 127COVID-19 and Mental HealthMental Health Treatment and AccessMaternal Mental Health During Pregnancy and Postpartum

Prevalence rates of anxiety, depressive, and eating pathology symptoms between the pre- and peri-COVID-19 eras: A meta-analysis

Open access
Schafer, Katherine Musacchio, Lieberman, Amy, Sever, Anna C., Joiner, Thomas·2022·Journal of Affective Disorders
DOI 10.1016/j.jad.2021.10.115PMC PMC8593520
Open this paper in CoChat — free account

Abstract

COVID-19 emerged in 2019 and has since killed more than two and a half million people worldwide. Several studies have investigated the role of COVID-19 on the prevalence of mental health outcomes, with general findings indicating elevated rates of mental health issues as compared to the pre-COVID-19 era. However, the effect of specific demographic features is less clear. As such, we investigated whether anxiety, depressive, and eating pathology symptoms varied by gender, age, status as a medical provider (compared to the general public), race, or region of origin. Forty-three effect sizes from 36 studies indicated that all three symptoms increased from pre- to peri‑COVID-19-eras across all regions. No symptom varied by age, status as a medical provider, or race, though females were significantly more likely to experience eating pathology than males. Findings from our study indicate that worldwide, regardless of age, status as a medical provider, race, or region of origin, respondents experienced significantly elevated rates of psychopathology symptoms during the onset of the COVID-19 pandemic.

AI snapshot

Written from the paper’s full text.

TL;DR

This meta-analysis of 36 studies and 43 effect sizes found that anxiety, depressive, and eating pathology symptoms were more prevalent during the early COVID-19 period than before the pandemic. Most demographic moderators did not explain symptom differences, except that females reported more eating pathology than males.

Key findings

  • Peri-COVID-19 prevalence estimates were 22.6% for anxiety (k = 24, 95% CI 18.3–27.6), 18.3% for depressive symptoms (k = 13, 95% CI 13.5–24.3), and 23.2% for eating pathology (k = 6, 95% CI 18.4–28.9).
  • Compared with pre-COVID-19 estimates, symptoms rose significantly for anxiety (8.9% to 22.6%), depressive symptoms (8.7% to 18.3%), and eating pathology (15.3% to 23.3%), all p < .001.
  • Anxiety and depressive symptoms did not vary by age, medical-provider status, or race; eating pathology had too few effects for race, age, and medical-provider moderator analyses. Eating pathology was significantly higher in females than males (B = −0.013, p = .049), while anxiety and depressive symptoms did not differ by gender.
  • Regionally, symptoms were significant across all reported regions; Eastern Mediterranean estimates were elevated versus other regions (50.9%, p = .004), Pacific estimates were lower (17.6%, p = .002), and Americas and Europe did not differ from other regions. Publication bias was evident (Egger’s intercept = −8.17, p = .001).

Methods

  • Systematic review and meta-analysis following PRISMA, searching PsycInfo and GoogleScholar through July 31, 2020, plus reference lists, for published and unpublished reports; 584 records were identified, 83 retained after title/abstract screening, and 36 studies with 43 unique effects were included.
  • Eligible studies reported prevalence estimates for anxiety, depressive, and/or eating pathology symptoms in the COVID-19 context; treatment, qualitative, case, editorial, commentary, and combined-outcome studies were excluded. Most included studies were cross-sectional and self-report.
  • Effect sizes were converted to event rates, analyzed with random-effects models because of high heterogeneity (I² = 99.160), and moderator analyses used meta-regressions for age, gender, medical-provider status, race, and region; funnel plots assessed precision, using Comprehensive Meta-Analysis.

Limitations

  • The paper states significant publication bias and missing effect sizes, warns that region findings with few effects may be skewed, and notes limited racial groups reduce generalizability.
  • The paper states most studies used self-report and web-based methods, potentially excluding people without reliable internet or devices and poorer populations; many used abbreviated scales without specifying included items, and cross-sectional designs prevented within-sample longitudinal comparisons, with most studies from the Pacific region, especially China.
  • Evident from the text: eating pathology moderator analyses were underpowered for race, age, and medical-provider status, and pre-COVID-19 rates came from separate large studies rather than the same samples, so era comparisons are not within-person.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.jad.2021.10.115

Cites

29 of 29 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 22 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Depressive symptoms did not vary by gender.

    “Meta-regressions indicated that although anxiety (B = −0.005, CI −0.018 – 0.005, p = .268) and depressive (B = 0.008, CI = −0.013 – 0.014, p = .905) symptoms did not vary by gender, symptoms of eating pathology (B = −0.013, CI – 0.022 – 0.004, p = .049) were significantly more prevalent in female participants than in male participants.”
    Quote in the paperNot a substantial claim
  • Findingcitation

    The pre-pandemic prevalence of anxiety symptoms was estimated to range from 5% to 14.4%.

    “Based on effect sizes from Lowe et al. (2008), Slade et al. (2011), and Baxter et al., 2013), the pre-pandemic rate of anxiety symptoms was estimated to range from 5% to 14.4%.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Lowe et al. (2008) source

      Not checked in the free run.

    • cites Slade et al. (2011) source

      Not checked in the free run.

    • cites Baxter et al., 2013 source

      Not checked in the free run.

  • Findingown data

    The Americas region had a pooled psychopathology symptom prevalence of 41.2% (k=4, 95% CI 38.5-43.9, p<.001).

    “Americas (k = 4, ER = 41.2%, 95% CI 38.5% - 43.9%, p < .001)”
    Quote in the paperNot a substantial claim
  • Findingown data

    Americas effect sizes did not differ from all other regions (z=1.3293, p=.18).

    “effect sizes from the Americas (k = 4, ER = 41.2% [38.5–43.9%]) did not differ (z-score =1.3293, p = .18) from all other regions (k = 42, ER = 30.5% [30.1–30.8%])”
    Quote in the paperNot a substantial claim
  • Findingown data

    Eating pathology symptom prevalence was significantly higher in the peri-COVID-19 era than in the pre-COVID-19 era (pre 15.3%, peri 23.3%, z=16.17, p<.001).

    “eating pathology (pre-COVID-19 = 15.3%; peri‑COVID-19 = 23.3%; z-score = 16.17, p < .001)”
    • Also stated in: § Abstract · plain
      “all three symptoms increased from pre- to peri‑COVID-19-eras across all regions.”
    Quote in the paperSubstantial claim
  • May combine two claims. 13
  • Classified as probably not a substantial claim. 12

  • May combine two claims.

    Findingown data

    The meta-analysis included 36 studies with 43 unique effect sizes.

    “In all, 36 studies were eligible, with 43 unique effects.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The Americas and Mediterranean regions appeared to have more symptoms of psychopathology, but these studies had fewer effect sizes and the effects may be skewed.

    “although the Americas and Mediterranean regions appear to have more symptoms of psychopathology, these studies also had fewer effect sizes, and the effects that did emerge may be skewed.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Region of origin did not significantly predict differences in anxiety, depressive, or eating pathology symptoms in the peri-COVID-19 era.

    “our findings indicated that the increase in psychopathology symptoms did not vary by region.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The self-report measures used across the included studies validly and reliably assess anxiety, depressive, and eating pathology symptoms.

  • May combine two claims.

    Findingown data

    Status as a medical provider did not significantly predict differences in anxiety, depressive, or eating pathology symptoms in the peri-COVID-19 era.

    “moderator analyses again indicated that symptoms were elevated across the entire sample, regardless of status as a medical provider.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The self-report measures used across the included studies validly and reliably assess anxiety, depressive, and eating pathology symptoms.

  • May combine two claims.

    Findingown data

    Race did not significantly predict differences in anxiety, depressive, or eating pathology symptoms in the peri-COVID-19 era.

    “moderator analyses of available literature did not support this hypothesis, as psychopathology symptoms were experienced at similar rates across racial groups.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The self-report measures used across the included studies validly and reliably assess anxiety, depressive, and eating pathology symptoms.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The authors followed PRISMA guidelines for the review.

    “The review was conducted according to the PRISMA guidelines (www.prisma-statement.org/).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    High between-effect-size heterogeneity suggests that samples differed substantially in psychopathology experiences, possibly due to sample-specific features.

    “The elevated level of heterogeneity between effect sizes indicates that between samples, there were significantly differing experiences of psychopathology, perhaps pointing to specific features within each sample accounting for between-study variance.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The review considered both published and unpublished reports.

    “Both published and unpublished reports were considered in the review process.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    COVID-19 morbidity and mortality are lower among young people.

    “as young people experience lower rates of morbidity and mortality due to COVID-19 (WHO, 2020)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites WHO, 2020

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The authors conclude that during the initial COVID-19 period, psychopathology symptom rates were significantly higher worldwide and did not depend on age, medical-provider status, race, or region.

    “Findings from our study indicate that worldwide, regardless of age, status as a medical provider, race, or region of origin, respondents experienced significantly elevated rates of psychopathology symptoms during the onset of the COVID-19 pandemic.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    A study of 4550 inpatients reported more psychopathology, including suicidal ideation, and longer hospital stays in the COVID-19 era than before it (Boldrini et al., 2021).

    “In a study of 4550 inpatients, researchers found evidence of increased psychopathology (i.e., suicidal ideation) and the need for longer hospital stays during the COVID-19 era, as compared to the pre-COVID-19 era (Boldrini et al., 2021).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Boldrini et al., 2021 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The precision of estimates was assessed with funnel plots.

    “Funnel plots were used to assess the precision of estimates.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    K.M.S. performed the initial searches; A.L. oversaw later checking and searches; classification disagreements were settled by consensus.

    “The initial data searches were conducted by K.M.S. Subsequent data checking and searches were overseen by A.L., and mismatches in classification of studies were resolved by consensus.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Eating pathology was left out of the medical-provider meta-regression because too few effect sizes were available.

    “Symptoms of eating pathology were omitted from meta-regression based on insufficient number of effect sizes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    WHO's 2019 reports gave global prevalence rates of 4% for anxiety, 5% for depression, and 9% for eating pathology diagnoses.

    “the WHO released its annual reports of the global prevalence rates of anxiety, depression, and eating pathology diagnoses (4%, 5%, and 9%, respectively; WHO, 2019).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites WHO, 2019

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Participants reported higher psychopathology symptoms in the peri-COVID-19 era than in the pre-COVID-19 era across all examined demographic groups: gender, age, race, medical provider status, and geographic location.

    “Regardless of gender, age, race, status as a medical provider, or geographic location, participants reported increased symptoms of psychopathology in the peri‑ as compared to the pre-COVID-19 era.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The self-report measures used across the included studies validly and reliably assess anxiety, depressive, and eating pathology symptoms.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Many studies employed abbreviated versions of scales and did not specify which items were included.

    “many studies employed abbreviated versions of these scales, and those studies did not articulate specifically which items were included in their abbreviated measures.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The rates were similar to those in the five years before 2019, suggesting stability.

    “These values were similar to the five years preceding 2019, indicating that the prevalence rates of these specific forms of psychopathology were relatively stable.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites WHO, 2019

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Recent literature from an Italian sample indicates that vulnerability and helplessness contribute to the development and exacerbation of psychopathology.

    “Recent literature within an Italian sample points to vulnerability and helplessness as contributors to the development and exacerbation of psychopathology (Rossi et al., 2021).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Rossi et al., 2021 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationreasoning

    The substantial increase in anxiety symptoms likely reflects concerted but partly thwarted attempts to prepare for an uncertain and unprecedented course of events.

    “That is, the substantial increase in anxiety symptoms likely reflects concerted, yet to a degree thwarted attempts, to prepare for an uncertain, unprecedented course of events.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The self-report measures used across the included studies validly and reliably assess anxiety, depressive, and eating pathology symptoms.

  • May combine two claims.

    Study design and conductnone given

    Studies were primarily completed over web-based formats, excluding participants without reliable internet or electronic devices.

    “they were primarily completed over web-based formats excluding participants who do not have reliable access to internet or electronic devices.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Some authors viewed race/ethnicity as moderating the link between COVID-19 onset and psychopathology, often citing misinformation and racist remarks.

    “Still others conceptualized race/ethnicity as a moderating factor between the onset of COVID-19 and psychopathology, generally attributing this moderating effect to misinformation and racist remarks expressed by national and international leaders (Lee and Crunk, 2020; Tanhan et al., 2020).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Lee and Crunk, 2020

      Not checked in the free run.

    • cites Tanhan et al., 2020

      Not checked in the free run.

22 of 22

  • The paper relies on this without support.

    Before this study, the influence of particular demographic characteristics on mental health outcomes during COVID-19 was not well established.

    “However, the effect of specific demographic features is less clear.”

  • The paper relies on this without support.

    The pre-2019 prevalence estimates drawn from large, varied studies can stand in for the pre-COVID-19 rates of the samples analyzed here.

    “We estimated the pre-COVID-19 prevalence rate of anxiety, depressive, and eating pathology symptoms by searching the literature and extracting pre-pandemic prevalence rates from large, diverse studies that were published prior to 2019”

  • The paper relies on this without support.

    General eating pathology symptoms are equivalent enough across the pre- and peri-COVID-19 periods to represent eating pathology.

    “In doing so, we compared pre- and peri‑COVID-19 era prevalence rates of similar phenomena: symptoms of general eating pathology, as opposed to specific eating disorders.”

  • The paper relies on this without support.

    Despite varied measures and samples, the included prevalence estimates can be combined into one event-rate metric.

    “All effect sizes were transformed into a single common metric, event rate, which indicated the number of participants in each sample endorsing anxiety, depressive, and eating pathology symptoms.”

  • The paper relies on this without support.

    The self-report measures used across the included studies validly and reliably assess anxiety, depressive, and eating pathology symptoms.

    “most studies relied exclusively on self-report measures”
5 of 5

Self-check

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

Each contradiction between two passages listed here was confirmed by an independent check.

  • Discussion denies regional differences reported in the results

    Major

    The discussion says symptoms did not vary by region, whereas the results report significantly higher rates for the Eastern Mediterranean and significantly lower rates for the Pacific relative to other regions.

  • A regional estimate lies outside its printed confidence interval

    Minor

    The estimate for regions other than Europe is 31.5%, but its printed interval is 31.1%-1.9%. The endpoints are reversed, and neither an interval between them nor the printed ordering contains the estimate.

  • One region is called significant despite its reported p-value

    Minor

    The Eastern Mediterranean result has p = .067, yet the next sentence says the evidence was significant across all reported regions.

  • Asian depressive-symptom coefficient falls outside its confidence interval

    Minor

    The reported coefficient is −0.13, whereas its stated 95% confidence interval runs from −0.03 to 0.01. The interval does not contain its own point estimate.

  • The stated gender hypothesis reverses between sections

    Minor

    The introduction says the authors expected more symptoms in women. The discussion instead describes a hypothesis that men would have more symptoms than women.

  • Two different peri-pandemic eating-pathology rates are reported

    Minor

    The peri-pandemic eating-pathology estimate is given as 23.2% in one results section and 23.3% in the comparison section. Both are printed to one decimal place.

6 of 6

Cites

Flagged first, then by citations

1 of the 30 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Schafer, K. M., Lieberman, A., Sever, A. C., & Joiner, T.
Affiliations
  • Florida State University (US)
  • Texas Woman's University (US)
Corresponding author
Schafer, Katherine Musacchio
ORCID
Venue
Journal of Affective Disorders
Publisher
Elsevier BV
Published
2022-02
Volume
298
Issue
Pt A
Pages
364-372
ISSN
0165-0327 (ISSN-L)
DOI
10.1016/j.jad.2021.10.115
PMC
PMC8593520
OpenAlex
W3209696637
Cited by
127
References
30
Citations by year
2026: 13 · 2025: 8 · 2024: 30 · 2023: 43 · 2022: 30 · 2021: 3
FWCI
3.52
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Affective Disorders (acceptedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
Office of the Assistant Secretary of Defense for Health Affairs
Topics
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
Keywords
COVID-19 pandemic, anxiety symptoms, depressive symptoms, eating pathology, mental health prevalence, gender differences, healthcare workers, race, age differences, regional variation
MeSH terms
COVID-19, SARS-CoV-2, Anxiety, Depression, Female, Humans, Male, Prevalence, Pandemics

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review