COVID-19 and common mental health symptoms in the early phase of the pandemic: An umbrella review of the evidence.
COVID-19 and common mental health symptoms in the early phase of the pandemic: An umbrella review of the evidence.
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DOI：
10.1371/journal.pmed.1004206
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发表时间：
2023-04
期刊：
影响因子：
15.8
通讯作者：
中科院分区：
文献类型：
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2019冠状病毒病（COVID-19）大流行对心理健康的影响仍存在不确定性。这一总括性审查全面概述了大流行与常见精神障碍之间的关系。我们定性地总结了来自综述的证据，并对普通人群、医护人员和特定高危人群的个体研究数据进行了荟萃分析。在5个数据库中进行了系统搜索，对2019年12月31日至2022年8月12日期间发表的大流行期间抑郁、焦虑和创伤后应激障碍（PTSD）症状的患病率进行了同行评议的系统评价和荟萃分析。我们确定了123篇综述，其中7篇提供了与匹配的大流行前数据相比的纵向研究数据和大流行期间数据或横断面研究数据的标准化平均差异（SMDs）。多系统评价量表评分（AMSTAR 2）评定的方法学质量一般为低至中等。据报道，在普通人群、既往存在身体健康状况的人群和儿童中，抑郁、焦虑和/或一般精神健康症状虽小但显著增加（3篇综述；smd范围为0.11至0.28）。在社交限制期间，心理健康和抑郁症状显著增加（1次回顾；SMD分别为0.41和0.83），但焦虑症状没有（SMD: 0.26）。在大流行期间，抑郁症状的增加通常比焦虑症状的增加更大，持续时间更长（3篇综述；抑郁程度从0.16到0.23不等）（2篇综述：抑郁程度从0.12到0.18）。女性焦虑症状的增加明显大于男性（1篇综述：SMD为0.15）。在卫生保健工作者、既往存在精神障碍的人、任何患者群体、儿童和青少年以及学生中，没有发现大流行前和大流行期间的显著差异（2篇综述；SMD范围为- 0.16至0.48）。116篇综述汇总了人群中抑郁、焦虑和创伤后应激障碍症状的横断面患病率，从9%到48%不等。尽管研究之间的异质性很高，而且在很大程度上无法解释，但在一些综述中发现，使用的评估工具和截断值、年龄、性别或性别以及COVID-19暴露因素是调节因素。主要的限制是无法量化和解释所包括的综述的高度异质性，以及缺乏来自多个纵向研究的个人数据。在大流行早期和社会限制期间，一般人群和慢性躯体疾病患者的精神健康状况出现了轻微但持续的恶化，特别是抑郁症。此外，女性和年轻年龄组的心理健康与大流行之间的关联比其他年龄组更强。解释性的个人水平、COVID-19暴露和时间过程因素很少，并且在不同的综述中显示不一致。在政策和研究方面，建议对包括弱势群体在内的人口小组的心理健康状况进行反复评估，以应对当前和未来的健康危机。Anke B Witteveen及其同事综合了123项系统综述的证据，这些综述调查了COVID-19大流行期间的心理健康结果。2019冠状病毒病（COVID-19）大流行是上个世纪全球最大的公共卫生挑战之一，影响了健康和公共生活的多个方面。人们预料到大流行与全球心理健康之间存在不利联系，因此迅速制定了许多研究项目来评估这一点。大流行及其相关措施与心理健康之间的关联程度和范围尚不确定。这项总括性审查可以帮助临床医生、研究人员和政策制定者更好地了解目前关于COVID-19大流行与心理健康之间关系的证据，特别是在特定的弱势亚群体中。纳入的系统评价的可解释性受到研究之间患病率和相关性的巨大差异以及纵向数据的缺乏的限制。政策制定者和研究人员应该在未来的人口小组中实施系统的心理健康评估之前解决研究设计的常见陷阱。我们综合了123篇关于普通人群和特定人群以及医护人员中常见精神障碍症状（包括抑郁、焦虑和创伤后应激障碍）的个体研究的系统综述证据。七篇综述比较了COVID-19大流行期间或实施公共卫生和社会措施期间与大流行前时期或限制最少时期精神卫生结果的差异。另有116项审查提供了大流行期间心理健康结果流行率的综合数据。在大流行的头半年，一般人的精神健康，特别是情绪略有恶化，症状的增加与公共卫生措施和社会限制的时期有关。此外，先前存在身体健康问题的人、女性和年轻人的症状也出现了与大流行相关的增加。各个研究之间与大流行相关的精神健康患病率差异很大，而且往往无法解释。在一些综述中，方法、个人水平和COVID-19暴露因素确实解释了一些差异，但在其他综述中并非如此。系统评价的质量从差到中等。
There remains uncertainty about the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on mental health. This umbrella review provides a comprehensive overview of the association between the pandemic and common mental disorders. We qualitatively summarized evidence from reviews with meta-analyses of individual study-data in the general population, healthcare workers, and specific at-risk populations. A systematic search was carried out in 5 databases for peer-reviewed systematic reviews with meta-analyses of prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms during the pandemic published between December 31, 2019 until August 12, 2022. We identified 123 reviews of which 7 provided standardized mean differences (SMDs) either from longitudinal pre- to during pandemic study-data or from cross-sectional study-data compared to matched pre-pandemic data. Methodological quality rated with the Assessment of Multiple Systematic Reviews checklist scores (AMSTAR 2) instrument was generally low to moderate. Small but significant increases of depression, anxiety, and/or general mental health symptoms were reported in the general population, in people with preexisting physical health conditions, and in children (3 reviews; SMDs ranged from 0.11 to 0.28). Mental health and depression symptoms significantly increased during periods of social restrictions (1 review; SMDs of 0.41 and 0.83, respectively) but anxiety symptoms did not (SMD: 0.26). Increases of depression symptoms were generally larger and longer-lasting during the pandemic (3 reviews; SMDs depression ranged from 0.16 to 0.23) than those of anxiety (2 reviews: SMDs 0.12 and 0.18). Females showed a significantly larger increase in anxiety symptoms than males (1 review: SMD 0.15). In healthcare workers, people with preexisting mental disorders, any patient group, children and adolescents, and in students, no significant differences from pre- to during pandemic were found (2 reviews; SMD’s ranging from −0.16 to 0.48). In 116 reviews pooled cross-sectional prevalence rates of depression, anxiety, and PTSD symptoms ranged from 9% to 48% across populations. Although heterogeneity between studies was high and largely unexplained, assessment tools and cut-offs used, age, sex or gender, and COVID-19 exposure factors were found to be moderators in some reviews. The major limitations are the inability to quantify and explain the high heterogeneity across reviews included and the shortage of within-person data from multiple longitudinal studies. A small but consistent deterioration of mental health and particularly depression during early pandemic and during social restrictions has been found in the general population and in people with chronic somatic disorders. Also, associations between mental health and the pandemic were stronger in females and younger age groups than in others. Explanatory individual-level, COVID-19 exposure, and time-course factors were scarce and showed inconsistencies across reviews. For policy and research, repeated assessments of mental health in population panels including vulnerable individuals are recommended to respond to current and future health crises. Anke B Witteveen and colleagues synthesise evidence from 123 systematic reviews investigating mental health outcomes during the COVID-19 pandemic. The Coronavirus Disease 2019 (COVID-19) pandemic has been one of the greatest global public health challenges of the last century and has impacted multiple aspects of health and public life. An adverse association between the pandemic and global mental health was expected and many research projects have been rapidly developed to assess this. There is uncertainty about the degree and extent of the associations between the pandemic and its associated measures and mental health. This umbrella review could help clinicians, researchers, and policy makers to better understand the current evidence on the association between the COVID-19 pandemic and mental health, particularly in specific vulnerable subpopulations. The interpretability of the included systematic reviews was limited by the great variation in prevalence rates and associations between studies and because of the scarcity of longitudinal data. Policy makers and researchers should address common pitfalls of research designs prior to implementation of systematic mental health assessments in future population panels. We synthesized evidence from 123 systematic reviews of individual studies on symptoms of common mental disorders, including depression, anxiety, and PTSD, in general and specific populations and in healthcare workers. Seven reviews compared differences in mental health outcomes during the COVID-19 pandemic or during implementation of public health and social measures to pre-pandemic periods or periods with minimal restrictions. Another 116 reviews provided combined data on during pandemic prevalence rates of mental health outcomes. Mental health and particularly mood of the general population slightly deteriorated in the first half year of the pandemic, and symptom increases were associated with periods of public health measures and social restrictions. Also, people with preexisting physical health conditions, females, and young people showed pandemic-associated increases in symptoms. Variation in pandemic-associated mental health prevalence rates between individual studies was large and often unexplained. In several reviews, methodological, individual-level, and COVID-19 exposure factors did explain some of the variation but in others this was not the case. Quality of the systematic reviews was poor to moderate.
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DOI：
10.1016/j.amsu.2021.102634
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期刊：
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影响因子：
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