Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland (G.S., T.T., A.H., N.L., A.D.H.).
Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (N.P., L.D., S.L.).
Ann Intern Med. 2022 Nov;175(11):1560-1571. doi: 10.7326/M22-1507. Epub 2022 Oct 18.
To what extent the COVID-19 pandemic and its containment measures influenced mental health in the general population is still unclear.
To assess the trajectory of mental health symptoms during the first year of the pandemic and examine dose-response relations with characteristics of the pandemic and its containment.
Relevant articles were identified from the living evidence database of the COVID-19 Open Access Project, which indexes COVID-19-related publications from MEDLINE via PubMed, Embase via Ovid, and PsycInfo. Preprint publications were not considered.
Longitudinal studies that reported data on the general population's mental health using validated scales and that were published before 31 March 2021 were eligible.
An international crowd of 109 trained reviewers screened references and extracted study characteristics, participant characteristics, and symptom scores at each timepoint. Data were also included for the following country-specific variables: days since the first case of SARS-CoV-2 infection, the stringency of governmental containment measures, and the cumulative numbers of cases and deaths.
In a total of 43 studies (331 628 participants), changes in symptoms of psychological distress, sleep disturbances, and mental well-being varied substantially across studies. On average, depression and anxiety symptoms worsened in the first 2 months of the pandemic (standardized mean difference at 60 days, -0.39 [95% credible interval, -0.76 to -0.03]); thereafter, the trajectories were heterogeneous. There was a linear association of worsening depression and anxiety with increasing numbers of reported cases of SARS-CoV-2 infection and increasing stringency in governmental measures. Gender, age, country, deprivation, inequalities, risk of bias, and study design did not modify these associations.
The certainty of the evidence was low because of the high risk of bias in included studies and the large amount of heterogeneity. Stringency measures and surges in cases were strongly correlated and changed over time. The observed associations should not be interpreted as causal relationships.
Although an initial increase in average symptoms of depression and anxiety and an association between higher numbers of reported cases and more stringent measures were found, changes in mental health symptoms varied substantially across studies after the first 2 months of the pandemic. This suggests that different populations responded differently to the psychological stress generated by the pandemic and its containment measures.
Swiss National Science Foundation. (PROSPERO: CRD42020180049).
新冠疫情及其防控措施对普通人群心理健康的影响程度仍不清楚。
评估疫情第一年期间心理健康症状的变化轨迹，并探讨与疫情及其防控相关特征的剂量反应关系。
从 COVID-19 开放获取项目的实时证据数据库中确定了相关文章，该数据库通过 PubMed 在 MEDLINE 中索引 COVID-19 相关出版物，通过 Ovid 在 Embase 中索引，通过 PsycInfo 在 PsyCINFO 中索引。预印本出版物未被考虑。
使用经过验证的量表报告普通人群心理健康数据且发表于 2021 年 3 月 31 日之前的纵向研究符合入选标准。
由 109 名受过国际培训的评审员筛选参考文献并提取研究特征、参与者特征和每个时间点的症状评分。还纳入了以下国家特定变量的数据：首例 SARS-CoV-2 感染后的天数、政府防控措施的严格程度以及病例和死亡人数的累计数。
在总共 43 项研究（331628 名参与者）中，心理健康困扰、睡眠障碍和心理健康的症状变化在研究之间差异很大。平均而言，抑郁和焦虑症状在疫情的头 2 个月恶化（60 天的标准化平均差异，-0.39 [95%可信区间，-0.76 至 -0.03]）；此后，轨迹存在异质性。随着报告的 SARS-CoV-2 感染病例数增加和政府措施的严格程度增加，抑郁和焦虑的恶化与呈线性关系。性别、年龄、国家、贫困程度、不平等、偏倚风险和研究设计并未改变这些关联。
由于纳入研究的偏倚风险高且存在大量异质性，证据的确定性较低。严格的措施和病例的激增密切相关，并且随着时间的推移而变化。所观察到的关联不应被解释为因果关系。
尽管发现了抑郁和焦虑症状的平均水平最初增加以及报告病例数增加与更严格措施之间的关联，但在疫情的头 2 个月后，研究之间心理健康症状的变化差异很大。这表明不同人群对疫情及其防控措施带来的心理压力有不同的反应。
瑞士国家科学基金会。（PROSPERO：CRD42020180049）。
