Study Finds Pandemic Did Not Largely Impact General Population’s Mental Health

Overall symptoms of anxiety and depression were not largely impacted by the COVID-19 pandemic and that females experienced generally worse mental health symptoms, but the results were marginal, according to a study published in the BMJ.

“Mental health was either unchanged or worsened by minimal to small amounts in the general population and subgroups,” the study authors wrote in the article. “The effects of COVID-19 on mental health are more nuanced than the ‘tsunami’ descriptor or other similar terms used by some investigators and in many media articles.”

Investigators compared general mental health, anxiety, and depression symptoms during COVID-19 with pre-pandemic outcomes in the general population and other subgroups, reviewing more than 94,000 citations from 137 studies.

“Most symptom change estimates for general mental health, anxiety symptoms, and depression symptoms were close to 0 and not statistically significant, and significant changes were of minimal to small magnitudes,” the study authors wrote in the article.

But those who had statistically insignificant and worsening symptoms had stabilized or improved symptoms by late 2020 and 2021. Investigators report that the public showed greater mental resilience than they did a decline in mental health. This finding may be important in understanding the true severity of mental health outcomes due to the pandemic, but more validated and reliable sources would need to support these findings.

In a subgroup analysis, older adults, university students, and people who identify as belonging to sexual or gender minority groups experienced worsening symptoms of depression, albeit minimally. Parents experienced a small increase in anxiety symptoms and general mental health compared to other subgroups.

“General mental health and depression symptoms were shown to improve for people with pre-existing mental health conditions, but these findings were based on only 2 studies (n=457) for general mental health, and improvement was negligible even though statistically significant for depression symptoms,” the study authors wrote.

Although the difference in the mental health outcomes of males and females was small, females had worse outcomes, according to the study. Women were also the only subgroup to have an aggregate of worse mental health, growing depression, and anxiety during the early period of the pandemic. Other studies share these findings, and it could be an important indication that the pandemic had a disproportionate effect on mental health.

The current study includes some limitations, the first of which being that the study was not peer reviewed. Second, many of the studies examined were missing follow-up data. In addition, there were no cross-sectional studies, few studies from low to lower middle-income countries, and the evidence is ever evolving.

“In terms of research, the results of our study underline gaps in mental health surveillance across countries. Since early in the pandemic, the need for high quality surveys with appropriately representative probabilistic sampling methods and pre-pandemic data has been emphasized,” the study authors wrote. “However, we found few examples of mental health surveillance frameworks that generated high quality data based on this type of sampling. Investment in more robust mental health surveillance mechanisms that can be used to identify and deal with mental health needs at all times, including in times of crisis, is needed.”

Pan-national organizations have invested in resources to support public mental health, which could explain the small change in mental health. However, not every country had good mental health surveillance mechanisms to address these issues, according to the study.

“Many or most people have experienced different aspects of COVID-19 as highly unpleasant or distressing,” the study authors wrote. “Most people have been resilient, and that population level mental health has not changed by large amounts…[but] It will be important to continue to assess mental health.”

Reference

Sun Y, Wu Y, Fan S, et al. Comparison of mental health symptoms before and during the covid-19 pandemic: evidence from a systematic review and meta-analysis of 134 cohorts. BMJ 2023. doi: https://doi.org/10.1136/bmj-2022-074224