Effect direction plot/table.

The COVID-19 pandemic imposed additional and specific challenges on the lives and wellbeing of informal unpaid carers. Addressing an important gap in the existing literature, this systematic review (prospectively registered with PROSPERO CRD42022376012) synthesises and evaluates the quantitative evidence examining the association between unpaid caregiving and mental health (compared to non-caring), during the pandemic. Five databases were searched (Medline, PsycInfo, EMBASE, Scopus, Web of Science) from Jan 1, 2020, to March 1, 2023. Population-based, peer-reviewed quantitative studies using any observational design were included, with screening, data extraction and quality assessment (amended NOS) independently conducted by two reviewers. Of the 3,073 records screened, 20 eligible studies (113,151 participants) were included. Overall quality of evidence was moderate. Narrative synthesis was complemented by Effect-direction and Albatross plots (given significant between-study heterogeneity precluded meta-analysis). Results indicate that the mental health of informal carers, already poorer pre-COVID compared to non-caregivers, was disproportionally impacted as a result of the pandemic and its associated public health containment measures. This review highlights the vulnerability of this group and should motivate political will and commensurate policies to ensure unpaid caregivers are better supported now, in the medium term, and crucially if, and when, another global public health emergency emerges.

新型冠状病毒肺炎（COVID-19）疫情给非正式无偿护理者的生活与福祉带来了额外且具有针对性的挑战。为填补现有研究文献中的重要空白，本系统综述（已预先在PROSPERO平台完成注册，注册号为CRD42022376012）对新冠疫情期间无偿护理与心理健康（相较于非护理人群）之间关联的定量研究证据进行了综合分析与质量评估。本研究检索了2020年1月1日至2023年3月1日期间Medline、PsycInfo、EMBASE、Scopus、Web of Science这5个数据库的相关文献。研究纳入所有采用任意观察性研究设计的基于人群的同行评议定量研究，由两名研究者独立完成文献筛选、数据提取与质量评估（经修订的纽卡斯尔-渥太华量表，amended NOS）。在经筛选的3073条文献记录中，最终纳入20项符合入组标准的研究，共纳入113151名研究参与者，整体证据质量为中等水平。鉴于研究间存在显著异质性，无法开展元分析，因此本研究在叙述性综合的基础上，补充了效应方向图（Effect-direction plots）与信天翁图（Albatross plots）。研究结果显示，相较于非护理人群，非正式护理者在新冠疫情暴发前的心理健康状况本就较差，而疫情及其相关公共卫生防控措施进一步对其心理健康造成了不成比例的负面影响。本综述凸显了该群体的脆弱性，有望激发相关政治意愿并出台相应配套政策，以确保在当下、中期乃至未来一旦出现新一轮全球公共卫生紧急事件时，无偿护理者都能获得更为充分的支持。