Global prevalence of mental health issues among the general population during the coronavirus disease-2019 pandemic: a systematic review and meta-analysis

To provide a contemporary global prevalence of mental health issues among the general population amid the coronavirus disease-2019 (COVID-19) pandemic. We searched electronic databases, preprint databases, grey literature, and unpublished studies from January 1, 2020, to June 16, 2020 (updated on July 11, 2020), with no language restrictions. Observational studies using validated measurement tools and reporting data on mental health issues among the general population were screened to identify all relevant studies. We have included information from 32 different countries and 398,771 participants. The pooled prevalence of mental health issues amid the COVID-19 pandemic varied widely across countries and regions and was higher than previous reports before the COVID-19 outbreak began. The global prevalence estimate was 28.0% for depression; 26.9% for anxiety; 24.1% for post-traumatic stress symptoms; 36.5% for stress; 50.0% for psychological distress; and 27.6% for sleep problems. Data are limited for other aspects of mental health issues. Our findings highlight the disparities between countries in terms of the poverty impacts of COVID-19, preparedness of countries to respond, and economic vulnerabilities that impact the prevalence of mental health problems. Research on the social and economic burden is needed to better manage mental health problems during and after epidemics or pandemics. Systematic review registration: PROSPERO CRD 42020177120.


Supplementary Online Content
MOOSE Checklist for Meta-Analyses of Observational Studies S3

Table S2
Systematic Review Search Strategy S5

Table S3
Included Studies in the Systematic Review and Meta-Analysis S17

Table S4
Characteristics of the 107 Included Studies S23

Table S5
Risk of Bias Assessment of Included Studies S34

Table S15
Univariable Meta-Regression of Included Studies S63

Table S16
Meta-Analysis of Included Studies with Calibration for Publication Bias S69

Figure S1
Study Selection S70

Figure S2
Funnel Plot of Included Studies in the Meta-Analysis S71 Description of study outcome(s) 11 4 Type of exposure or intervention used 10, 11 5 Type of study designs used 10 6 Study population 10, 11 Reporting of search strategy should include 7 Qualifications of searches (eg, librarians and investigators) 10 8 Search strategy, including time period included in the synthesis and key words 10, Table S2 9 Effort to include all available studies, including contact with authors 10 10 Databases and registries searched 10, Table S2  11 Search software used, name and version, including special features used (eg, explosion) 10, Table S2 12 Use of hand searching (eg, reference lists of obtained articles) 10 13 List of citations located and those excluded, including justification 10, Table S3  14 Method of addressing articles published in languages other than English 10 15 Method of handing abstracts and unpublished studies 10 16 Description of any contact with authors 11, 12 Reporting of methods should include 17 Description of relevance or appropriateness of studies assembled for assessing the hypothesis to be tested Assessment of study quality, including blinding of quality assessors, stratification or regression on possible predictors of study results

22
Assessment of heterogeneity 13 23 Description of statistical methods (eg, complete description of fixed or random effects models, justification of whether the chosen models account for predictors of study results, dose-response models, or cumulative meta-analysis) in sufficient detail to be replicated

12-14 24
Provision of appropriate tables and graphics Throughout tables and graphics Reporting of results should include 25 Graphic summarising individual study estimates and overall estimate Figure 1 to Figure  6 26 Table giving descriptive information for each study included  Table 1, Table S4 27 Results of sensitivity testing (eg, subgroup analysis) Table S8 to Table  S15  28 Indication of statistical uncertainty of findings Throughout results Reporting of discussion should include 29 Quantitative assessment of bias (eg, publication bias) 19,  (public or general public or general population or patients or citizens or people or person or community or healthy or quarantine or isolation or confinement).ti,ab,kf.
7,530,991 #9 (((health* or medical of hospital or allied) and (worker$ or professional or personnel or staff)) or staff or physician* or doctor* or nurse* or dentist* or pharmacist* or psychologist* or therapist*).ti,ab,kf. (psychosocial or psychosomatic or unintended consequences or common mental disorder or (mental adj1 health) or (mental adj1 disorder$) or (mental adj1 illness) or (mental adj1 test$) or (mental adj1 problem$) or (psycho* adj1 problem$) or (psycho* adj1 disorder$) or (psycho* adj1 illness$) or (psychiat* adj1 disorder$) or (psychiat* adj1 illness$)).ti,ab,kf.   (public or general public or general population or patients or citizens or people or person or community or healthy or quarantine or isolation or confinement).ti,ab,kw.
10,234,811 #9 (((health* or medical of hospital or allied) and (worker$ or professional or personnel or staff)) or staff or physician* or doctor* or nurse* or dentist* or pharmacist* or psychologist* or therapist*).ti,ab,kw.             Initial psychological impact of COVID-19 and its correlates in Indian Community: An online (FEEL-COVID) survey. PLoS One 2020; 15 (5)

González-Sanguino et al, Spain
Mental health consequences during the initial stage of the 2020 coronavirus pandemic  in Spain. Brain Behav Immun 2020.

Odriozola-González et al, Spain
Psychological effects of the COVID-19 outbreak and lockdown among students and workers of a Spanish university. Psychiatry Res 2020; 290: 113108.
Ozamiz-Etxebarria et al, Spain S19 The distress of Iranian adults during the COVID-19 pandemic -More distressed than the Chinese and with different predictors. Brain Behav Immun 2020.

Chen et al, Iran
The curvilinear relationship between the age of adults and their mental health in Iran after its peak of COVID-19 cases. medRxiv 2020: 2020.06.11.20128132.

Moghanibashi-Mansourieh et al, Iran
Assessing the anxiety level of Iranian general population during COVID-19 outbreak. Asian Journal of Psychiatry. 2020;51.

Al-Tammemi et al, Jordan
Is it just about physical health? An internet-based cross-sectional study exploring the psychological impacts of COVID-19 pandemic on university students in Jordan using Kessler psychological distress scale. medRxiv 2020: 2020.05.14.20102343. Naser et al, Jordan Mental health status of the general population, healthcare professionals, and university students during 2019 coronavirus disease outbreak Effects of the COVID-19 pandemic and nationwide lockdown on trust, attitudes toward government, and well-being. Am Psychol 2020.

Nguyen et al, Vietnam
Fear of COVID-19 scale-associations of its scores with health literacy and health-related behaviors among medical students. Int J Environ Res Public Health 2020; 17(11).