Data_Sheet_1_A hidden pandemic? An umbrella review of global evidence on mental health in the time of COVID-19.docx

BackgroundThe mental health impacts of the COVID-19 pandemic remain a public health concern. High quality synthesis of extensive global literature is needed to quantify this impact and identify factors associated with adverse outcomes.
MethodsWe conducted a rigorous umbrella review with meta-review and present (a) pooled prevalence of probable depression, anxiety, stress, psychological distress, and post-traumatic stress, (b) standardised mean difference in probable depression and anxiety pre-versus-during the pandemic period, and (c) comprehensive narrative synthesis of factors associated with poorer outcomes. Databases searched included Scopus, Embase, PsycINFO, and MEDLINE dated to March 2022. Eligibility criteria included systematic reviews and/or meta-analyses, published post-November 2019, reporting data in English on mental health outcomes during the COVID-19 pandemic.
FindingsThree hundred and thirty-eight systematic reviews were included, 158 of which incorporated meta-analyses. Meta-review prevalence of anxiety symptoms ranged from 24.4% (95%CI: 18–31%, I2: 99.98%) for general populations to 41.1% (95%CI: 23–61%, I2: 99.65%) in vulnerable populations. Prevalence of depressive symptoms ranged from 22.9% (95%CI: 17–30%, I2: 99.99%) for general populations to 32.5% (95%CI: 17–52%, I2: 99.35) in vulnerable populations. Prevalence of stress, psychological distress and PTSD/PTSS symptoms were 39.1% (95%CI: 34–44%; I2: 99.91%), 44.2% (95%CI: 32–58%; I2: 99.95%), and 18.8% (95%CI: 15–23%; I2: 99.87%), respectively. Meta-review comparing pre-COVID-19 to during COVID-19 prevalence of probable depression and probable anxiety revealed standard mean differences of 0.20 (95%CI = 0.07–0.33) and 0.29 (95%CI = 0.12–0.45), respectively.
ConclusionThis is the first meta-review to synthesise the longitudinal mental health impacts of the pandemic. Findings show that probable depression and anxiety were significantly higher than pre-COVID-19, and provide some evidence that that adolescents, pregnant and postpartum people, and those hospitalised with COVID-19 experienced heightened adverse mental health. Policymakers can modify future pandemic responses accordingly to mitigate the impact of such measures on public mental health.

背景：新冠大流行对心理健康的影响仍是公共卫生领域的重点关切问题。亟需通过高质量整合全球海量学术文献，量化该疫情对公众心理健康的影响，并明确与不良心理健康结局相关的风险因素。

方法：本研究开展了兼具元综述（meta-review）属性的严谨伞状综述（umbrella review），并呈现以下三方面内容：(a) 疑似抑郁、焦虑、压力、心理痛苦及创伤后应激症状的合并患病率；(b) 大流行前后疑似抑郁与焦虑症状的标准化均差；(c) 与不良预后相关因素的全面叙述性整合分析。本研究检索了Scopus、Embase、PsycINFO及MEDLINE数据库，检索时限截至2022年3月。纳入标准为2019年11月后发表、以英文报道新冠大流行期间心理健康结局的系统综述（systematic review）和/或荟萃分析（meta-analysis）。

结果：共纳入338项系统综述，其中158项包含荟萃分析。伞状综述结果显示，普通人群的焦虑症状患病率为24.4%（95%置信区间：18%~31%，I²=99.98%），脆弱人群则为41.1%（95%置信区间：23%~61%，I²=99.65%）。抑郁症状患病率方面，普通人群为22.9%（95%置信区间：17%~30%，I²=99.99%），脆弱人群为32.5%（95%置信区间：17%~52%，I²=99.35%）。压力、心理痛苦及创伤后应激障碍（PTSD/PTSS）症状的患病率分别为39.1%（95%置信区间：34%~44%；I²=99.91%）、44.2%（95%置信区间：32%~58%；I²=99.95%）及18.8%（95%置信区间：15%~23%；I²=99.87%）。对比新冠大流行前后疑似抑郁与焦虑症状患病率的伞状综述分析显示，二者的标准化均差分别为0.20（95%置信区间：0.07~0.33）与0.29（95%置信区间：0.12~0.45）。

结论：本研究是首个针对新冠大流行心理健康影响开展纵向整合分析的元综述。研究结果表明，疑似抑郁与焦虑症状的患病率显著高于新冠大流行前，且有证据显示青少年、孕产妇及产后人群、新冠住院患者的不良心理健康风险显著升高。政策制定者可据此调整未来大流行应对策略，以减轻相关防控措施对公众心理健康的负面影响。