Mental burden and its risk and protective factors during the early phase of the SARS-CoV-2 pandemic: Systematic review and meta-analyses
Open accessAbstract
BACKGROUND: Mental burden due to the SARS-CoV-2 pandemic has been widely reported for the general public and specific risk groups like healthcare workers and different patient populations. We aimed to assess its impact on mental health during the early phase by comparing pandemic with prepandemic data and to identify potential risk and protective factors. METHODS: For this systematic review and meta-analyses, we systematically searched PubMed, PsycINFO, and Web of Science from January 1, 2019 to May 29, 2020, and screened reference lists of included studies. In addition, we searched PubMed and PsycINFO for prepandemic comparative data. Survey studies assessing mental burden by the SARS-CoV-2 pandemic in the general population, healthcare workers, or any patients (eg, COVID-19 patients), with a broad range of eligible mental health outcomes, and matching studies evaluating prepandemic comparative data in the same population (if available) were included. We used multilevel meta-analyses for main, subgroup, and sensitivity analyses, focusing on (perceived) stress, symptoms of anxiety and depression, and sleep-related symptoms as primary outcomes. RESULTS: Of 2429 records retrieved, 104 were included in the review (n = 208,261 participants), 43 in the meta-analysis (n = 71,613 participants). While symptoms of anxiety (standardized mean difference [SMD] 0.40; 95% CI 0.15-0.65) and depression (SMD 0.67; 95% CI 0.07-1.27) were increased in the general population during the early phase of the pandemic compared with prepandemic conditions, mental burden was not increased in patients as well as healthcare workers, irrespective of COVID-19 patient contact. Specific outcome measures (eg, Patient Health Questionnaire) and older comparative data (published ≥5 years ago) were associated with increased mental burden. Across the three population groups, existing mental disorders, female sex, and concerns about getting infected were repeatedly reported as risk factors, while older age, a good economic situation, and education were protective. CONCLUSIONS: This meta-analysis paints a more differentiated picture of the mental health consequences in pandemic situations than previous reviews. High-quality, representative surveys, high granular longitudinal studies, and more research on protective factors are required to better understand the psychological impacts of the SARS-CoV-2 pandemic and to help design effective preventive measures and interventions that are tailored to the needs of specific population groups.
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A recent systematic review yielded heterogeneous findings on pre-existing mental disorders, so the role of pre-existing mental disorders has yet to be determined.
“a recent systematic review [27] yielded heterogenous findings, with both improving and deteriorating mental health observed compared to pre-pandemic data, highlighting that the role of pre-existing mental disorders has yet to be determined.”
From The Role of Pre-Pandemic Mental Health Status and Personality Traits on Psychological Distress during the COVID-19 Lockdown among Italian Young Adults (2023) · cites this paper as [27]
The Discussion (page unavailable) reports substantial between-study heterogeneity, but does not link it to both improving and deteriorating mental health among people with pre-existing mental disorders. The Results (page unavailable) instead list pre-existing mental disorders among frequently reported risk factors; the patient comparison found no evidence of a change from prepandemic outcomes, based on only four samples. Thus the review supports heterogeneity and limited patient evidence, not the specific account of opposing changes that the citing sentence gives. (LLM, conf=0.84)
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Adorjan, K., Pogarell, O., Pröbstl, L., Rüb, M., Wiegand, H. F., Tüscher, O., Lieb, K., Wassiliwizky, M., Gerlinger, G., Heinz, A., et al. (2021) · Der Nervenarzt · doi:10.1007/s00115-021-01129-6 · Cited by 36 · see citing works
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“However, a recent systematic review [27] yielded heterogenous findings, with both improving and deteriorating mental health observed compared to pre-pandemic data, highlighting that the role of pre-existing mental disorders has yet to be determined.”
The association between facets of mindfulness and COVID-19 related distress: A cross-sectional study
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- Authors
- Kunzler, A. M., Röthke, N., Günthner, L., Stoffers-Winterling, J., Tüscher, O., Coenen, M., Rehfuess, E., Schwarzer, G., Binder, H., Schmucker, C., Meerpohl, J. J., & Lieb, K.
- Affiliations
- Leibniz Institute for Resilience Research (DE)
- University Medical Center of the Johannes Gutenberg University Mainz (DE)
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (DE)
- University of Freiburg (DE)
- Corresponding author
- Kunzler, Angela M.
- Lieb, Klaus
- ORCID
- Venue
- Globalization and Health
- Published
- 2021-03-29
- Volume
- 17
- Issue
- 1
- Pages
- 34-34
- ISSN
- 1744-8603 (ISSN-L)
- PMC
- PMC8006628
- OpenAlex
- W3145093806
- Cited by
- 262
- References
- 195
- Citations by year
- 2026: 12 · 2025: 14 · 2024: 60 · 2023: 66 · 2022: 73 · 2021: 36 · 2020: 1
- FWCI
- 7.80
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Globalization and Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Informationszentrum Lebenswissenschaften (ZB MED) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Open access LMU (Ludwid Maxmilian's Universitat Munchen) (submittedVersion, cc-by)
- Funders
- Bundesministerium für Bildung und Forschung (01KX2021)
- 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
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- psychological burden, COVID-19 pandemic, mental health, anxiety, depression, perceived stress, sleep symptoms, risk factors, protective factors, healthcare workers, COVID-19 patients, pre-pandemic comparison, fear of infection, economic conditions, sex differences, old age, psychological impact of pandemic, Patient Health Questionnaire, PHQ-4, PHQ-9
- MeSH terms
- COVID-19, SARS-CoV-2, Adolescent, Adult, Aged, Anxiety, Mental Disorders, Depression, Female, Humans, Male, Mental Health, Middle Aged, Sleep Wake Disorders, Stress, Psychological, Pandemics, Protective Factors
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.
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