Scientific evidence on mental health in key regions under the COVID-19 pandemic – meta-analytical evidence from Africa, Asia, China, Eastern Europe, Latin America, South Asia, Southeast Asia, and Spain  <span class="so-article-trans-title" dir="auto"> Translated title: Evidencia científica sobre la salud mental en regiones clave en el contexto de la pandemia por la COVID-19 – Evidencia metaanalítica de África, Asia, China, Europa del este, Latinoamérica, Asia meridional, el Sudeste Asiático y España </span> <span class="so-article-trans-title" dir="auto"> Translated title: 疫情下关键地区心理健康的科学证据——来自非洲、亚洲、中国、东欧、拉丁美洲、南亚、东南亚和西班牙的元分析证据 </span>

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ABSTRACT

This systematic review aims to summarize the prevalence of anxiety, depression, and insomnia in the general adult population and healthcare workers (HCWs) in several key regions worldwide during the first year of the COVID pandemic. Several literature databases were systemically searched for meta-analyses published by 22 September 2021 on the prevalence rates of mental health symptoms worldwide. The prevalence rates of mental health symptoms were summarized based on 388 empirical studies with a total of 1,067,021 participants from six regions and four countries. Comparatively, Africa and South Asia had the worse overall mental health symptoms, followed by Latin America. The research effort on mental health during COVID-19 has been highly skewed in terms of the scope of countries and mental health outcomes. The mental health symptoms are highly prevalent yet differ across regions, and such evidence helps to enable prioritization of mental health assistance efforts to allocate attention and resources based on the regional differences in mental health.

HIGHLIGHTS

The prevalence rates of mental health symptoms were summarized from 388 studies of 1,067,021 individuals in Africa, Asia, Eastern Europe, and Latin America.
Mental health symptoms under COVID-19 pandemic were worst in Africa and South Asia followed by Latin America.

Translated abstract

El objetivo de esa revisión sistemática es el de resumir la prevalencia de la ansiedad, la depresión y el insomnio, tanto en la población general adulta como en los trabajadores de salud de diferentes regiones clave alrededor del mundo durante el primer año de la pandemia por la COVID-19. Se revisaron de manera sistemática diversas bases de datos científicas buscando metaanálisis sobre la prevalencia de síntomas en salud mental alrededor del mundo, publicados hasta el 22 de setiembre del 2021. Se resumió la prevalencia de los síntomas de salud mental sobre la base de 388 estudios empíricos, comprendiendo a 1.067.021 participantes de cuatro países y de seis regiones. África y Asia meridional tuvieron, de manera general, los peores síntomas de salud mental, seguidas por Latinoamérica. El esfuerzo por realizar investigación en salud mental durante la pandemia por la COVID-19 ha estado altamente sesgado en torno a la envergadura de los países y de las medidas de resultado empleadas en salud mental. Los síntomas de salud mental son altamente prevalentes; no obstante, difieren a lo largo de diferentes regiones. Esta evidencia ayuda a permitir la priorización de los esfuerzos de atención en salud mental asignando la atención y recursos basados sobre las diferencias regionales en salud mental.

Translated abstract

本系统综述旨在总结 COVID 疫情第一年期间全球几个关键地区的一般成年人和医护人员 (HCW) 中焦虑、抑郁和失眠的流行情况。系统检索了几个文献数据库,以获取 2021 年 9 月 22 日之前发表的关于全球心理健康症状流行率的元分析。基于总共来自六个地区和四个国家的 1,067,021 名参与者的388 项实证研究总结了心理健康症状的流行率。相比之下,非洲和南亚的整体心理健康症状更差,其次是拉丁美洲。就国家范围和心理健康结果而言,对 COVID-19 期间心理健康的研究工作存在高度偏差。心理健康症状非常普遍,但因地区而异,此类证据有助于确定心理健康援助工作的优先级,以根据心理健康的区域差异分配关注度和资源。

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The distress of Iranian adults during the Covid-19 pandemic – More distressed than the Chinese and with different predictors

Asghar Afshar Jahanshahi, Maryam Mokhtari Dinani, Abbas Nazarian Madavani … (2020)

Dear Editors, Although Covid-19 is expected to wreak havoc on mental health issues (Bao et al., 2020), there is little evidence of it, especially outside of China. Early evidence published in Brain, Behavior, and Immunity has explored the distress in adults population by their Covid-19 infection status in China (J. Zhang et al., 2020). Such research during the Covid-19 pandemic is critical to identify people to prioritize mental health assistance (Zandifar and Badrfam, 2020). One of the countries most affected by Covid-19 is Iran. The Covid-19 crisis in Iran has been compounded by the decade-long US-led sanctions. “All aspects of prevention, diagnosis, and treatment are directly and indirectly hampered, and the country (Iran) is falling short in combating the crisis. Lack of medical, pharmaceutical, and laboratory equipment such as protective gowns and necessary medication has been scaling up the burden of the epidemic and the number of casualties” (Takian et al., 2020). We provide the first empirical evidence on distress and its predictors of Iranian under the Covid-19 pandemic. We surveyed Iranian adults on March 25–28, 2020, when the situation was dire; e.g. on March 27, about 300 people died due to methanol poisoning in a desperate hope to kill the virus by any alcohol in an Islamic state. On March 28, prisoners in several prisons were distressed enough that they clashed with guards, set prisons on fire, and somehow escaped. Given the dire situation and the lockdown in Iran, we delivered the survey online across all 31 provinces in Iran. The survey, approval at Tsinghua University, received 1058 responses from all 31 Iranian provinces. The survey questions are summarized in Table 1 . In particular, Covid-19 Peritraumatic Distress Index (CPDI) is an index designed to capture specific phobias and stress disorders specific to Covid-19. CPDI was originally developed in Chinese, and we had the index translated from its English version to Persian (see English and Persian versions in the appendix). Table 1 Descriptions of the participants and OLS regression results on CPDI (Covid-19 Peritraumatic Distress Index) (n=1058) Variable Description Regression parameters Count (%) Coef. P Lower95% C.I. Upper 95% C.I. Covid-19 Peritraumatic Distress Index (CPDI) 58.99 0.000 29.14 88.83 Normal range (4-27) 412 (38.9%) Mildly to moderately distressed (28-51) 497 (47.0%) Severely distressed (52-100) 149 (14.1%) Gender Female 569 (53.8%) reference group Male 489 (46.2%) -3.62 0.000 -5.61 -1.63 Age 18–25 years old 137 (12.9%) 0.81 0.170 -0.35 1.98 26–35 years old 364 (34.4%) 36–45 years old 358 (33.8%) 46–55 years old 161 (15.2%) 56–65 years old 33 (3.1%) Over 65 years old 5 (0.05%) Education level Junior high school or less 24 (2.3%) 0.37 0.286 -0.31 1.05 Senior high school 30 (2.8%) High school diploma 122 (11.5%) 2-year college degree 97 (9.2%) Bachelor degree 411 (38.8%) Master degree 258 (24.4%) PhD 116 (11.0%) Number of children 0 422 (39.9%) -1.07 0.048 -2.14 -0.01 1 250 (23.6%) 2 305 (28.8%) 3 61 (5.8%) 4 or more 20 (1.9%) Infected by Covid-19 Unsure 182 (17.2%) reference group No 869 (82.1%) -8.91 0.000 -11.26 -6.57 Yes 7 (0.07%) -9.43 0.090 -20.34 1.48 Exercise hours per day in the past week 0 hours 666 (62.9%) -2.14 0.000 -3.23 -1.06 1 hour 320 (30.2%) 2 hours 46 (4.3%) 3 hours 12 (1.1%) 4 hours 4 (0.04%) 5 hours or more 10 (0.09%) Work situation Stopped working due to Covid-19 281 (26.6%) reference group Worked at office 179 (16.9%) -2.63 0.059 -5.36 0.10 Worked from home 408 (38.6%) -2.87 0.012 -5.11 -0.63 No work before and during outbreak 190 (18.0%) -3.44 0.023 -6.42 -0.47 Employment status Unemployed 140 (13.2%) reference group Employed 757 (71.5%) -3.89 0.020 -7.17 -0.60 Student 111 (10.5%) -5.29 0.020 -9.74 -0.85 Retired 50 (4.7%) -5.19 0.071 -10.83 0.45 The mean (SD) score of CPDI was 34.54 (14.92), higher than the CPDI of 23.65 (15.45) reported in China from January 31 to February 10, 2020 (Qiu et al., 2020). The difference in the mean values between Iranian and Chinese samples is 10.9 (t=22.7; p<0.0001; 95% CI: 10.0 to 11.8). Based on the cut-off values of CPDI, respectively 47.0% and 14.1% of the Iranian adults experienced mild to moderate and severe psychological distress, compared to 29.3% and 5.1% respectively in China. In Iran, females experienced more distress (β=-3.62, p=0.000), similar to China. Participants’ age (β=0.81, p=0.170) and education level (β=0.37, p=0.286) did not predict distress as in China (S. Zhang et al., 2020). Adults with more children (β=-1.07, p=0.048) or exercised more (β=-2.14, p=0.000) felt less distress. Adults who were unsure whether they had Covid-19 reported higher distress than those who reported Covid-19 negative (β=-8.91, p=0.000). There is no significant difference between those who were Covid-19 positive and the rest, possibly due to the small number (7) of positive Covid-19 cases in the sample. Adults who suspended working reported higher distress than those who telecommuted (β=-2.87, p=0.012), at the office (β=-2.63, p=0.059), or who were not working even before Covid-19 (β=-3.44, p=0.023). The unemployed reported higher distress than the employed (β=-3.89, p=0.020) and students (β=-5.29, p=0.020). Our findings suggest that the predictors of distress may vary across countries. While gender and exercise hours predicted distress in both Iran and China, age and education predicted distress in China but not in Iran. Moreover, Iranian adults who worked from home, at the office, or had not worked during and before Covid-19 all reported lower distress that those who suspended working. In comparison, in China, only individuals who went to workplace reported significantly lower distress than those who suspended working (S. Zhang et al., 2020). The differences in the predictors of distress during the Covid-19 pandemic across Iran and China are understandable, as countries vary in their medical systems, the availability of personal protective equipment (PPE), cultures, labor and employment conditions, the policies of lockdown, the ease of working from home and maintaining a living in a pandemic, and the information in both mainstream and social media, to name just a few. The results therefore suggest we need to identify useful predictors of mental health in individual countries during the Covid-19 pandemic. We provide the first empirical evidence of the distress of Iranian adults during the Covid-19 pandemic. The results suggest adults in Iran are experiencing more distress than adults in China, with level of distress predicted by different factors, suggesting future research needs to examine mental health and the predictors in individual countries to effectively identify those who are more susceptible mentally during the Covid-19 pandemic. 1 Declarations of interest none Uncited references Zhang et al., 2020a, Zhang et al., 2020b. CRediT authorship contribution statement Asghar Afshar Jahanshahi: Investigation, Resources, Conceptualization, Writing - review & editing. Maryam Mokhtari Dinani: Investigation. Abbas Nazarian Madavani: Investigation. Jizhen Li: Writing - review & editing, Funding acquisition. Stephen X. Zhang: Conceptualization, Investigation, Methodology, Formal analysis, Visualization, Writing - original draft, Writing - review & editing, Supervision.

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Prevalence of anxiety and depression in South Asia during COVID-19: A systematic review and meta-analysis

Md Mahbub Hossain, Mariya Rahman, Nusrat Fahmida Trisha … (2021)

Introduction The COVID-19 pandemic has impacted biopsychosocial health and wellbeing globally. Pre-pandemic studies suggest a high prevalence of common mental disorders, including anxiety and depression in South Asian countries, which may aggravate during this pandemic. This systematic meta-analytic review was conducted to estimate the pooled prevalence of anxiety and depression in South Asian countries during the COVID-19 pandemic. Method We systematically searched for cross-sectional studies on eight major bibliographic databases and additional sources up to October 12, 2020, that reported the prevalence of anxiety or depression in any of the eight South Asian countries. A random-effects model was used to calculate the pooled proportion of anxiety and depression. Results A total of 35 studies representing 41,402 participants were included in this review. The pooled prevalence of anxiety in 31 studies with a pooled sample of 28,877 was 41.3% (95% confidence interval [CI]: 34.7–48.1, I 2 = 99.18%). Moreover, the pooled prevalence of depression was 34.1% (95% CI: 28.9–39.4, I 2 = 99%) among 37,437 participants in 28 studies. Among the South Asian countries, India had a higher number of studies, whereas Bangladesh and Pakistan had a higher pooled prevalence of anxiety and depression. No studies were identified from Afghanistan, Bhutan, and Maldives. Studies in this review had high heterogeneity, high publication bias confirmed by Egger's test, and varying prevalence rates across sub-groups. Conclusion South Asian countries have high prevalence rates of anxiety and depression, suggesting a heavy psychosocial burden during this pandemic. Clinical and public mental health interventions should be prioritized alongside improving the social determinants of mental health in these countries. Lastly, a low number of studies with high heterogeneity requires further research exploring the psychosocial epidemiology during COVID-19, which may inform better mental health policymaking and practice in South Asia. COVID-19; Mental health; Anxiety; Depression; South Asia; Afghanistan; Bangladesh; Bhutan; India; Maldives; Nepal; Pakistan; Sri Lanka; Psychiatry; Epidemiology.

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Mental health responses to COVID-19 around the world Translated title: Respuestas en salud mental frente a la COVID-19 alrededor del mundo Translated title: 全世界对COVID-19的心理健康反应

Miranda Olff, Indira Primasari, Yulan Qing … (2021)

Background : The mental health impact of the COVID-19 crisis may differ from previously studied stressful events in terms of psychological reactions, specific risk factors, and symptom severity across geographic regions worldwide. Objective : To assess the impact of COVID-19 on a wide range of mental health symptoms, to identify relevant risk factors, to identify the effect of COVID-19 country impact on mental health, and to evaluate regional differences in psychological responses to COVID-19 compared to other stressful events. Method : 7034 respondents (74% female) participated in the worldwide Global Psychotrauma Screen – Cross-Cultural responses to COVID-19 study (GPS-CCC ), reporting on mental health symptoms related to COVID-19 ( n = 1838) or other stressful events ( n = 5196) from April to November 2020. Results : Events related to COVID-19 were associated with more mental health symptoms compared to other stressful events, especially symptoms of PTSD, anxiety, depression, insomnia, and dissociation. Lack of social support, psychiatric history, childhood trauma, additional stressful events in the past month, and low resilience predicted more mental health problems for COVID-19 and other stressful events. Higher COVID-19 country impact was associated with increased mental health impact of both COVID-19 and other stressful events. Analysis of differences across geographic regions revealed that in Latin America more mental health symptoms were reported for COVID-19 related events versus other stressful events, while the opposite pattern was seen in North America. Conclusions : The mental health impact of COVID-19-related stressors covers a wide range of symptoms and is more severe than that of other stressful events. This difference was especially apparent in Latin America. The findings underscore the need for global screening for a wide range of mental health problems as part of a public health approach, allowing for targeted prevention and intervention programs. In a large global sample, COVID-19 was associated with more severe mental health symptoms compared to other stressful or traumatic events. The impact of COVID-19 on mental health differed around the world with an especially large impact in Latin America. Antecedentes : El impacto de la crisis por la COVID-19 sobre la salud mental podría diferir de otros eventos estresantes estudiados con anterioridad en relación con reacciones psicológicas, factores de riesgo específicos y severidad de síntomas en diferentes regiones geográficas alrededor del mundo. Objetivo : Evaluar el impacto de la COVID-19 sobre una amplia variedad de síntomas de salud mental, identificar los factores de riesgo relevantes, identificar el efecto que el impacto de la COVID-19 sobre un país ejerce, a su vez, sobre la salud mental, y evaluar las diferencias regionales en las respuestas psicológicas a la COVID-19 comparadas con otros eventos estresantes. Método : 7034 encuestados (74 % mujeres) participaron en el Mapeo Global de Psicotrauma – Estudio de Respuestas Transculturales frente a la COVID-19 (GPS–CCC, por sus siglas en ingles), reportando síntomas de salud mental relacionados a la COVID-19 (n = 1838) u otros eventos estresantes (n = 5196) de abril a noviembre del 2020. Resultados : Los eventos relacionados a la COVID-19 se asociaron con un mayor número de síntomas de salud mental comparados con otros eventos estresantes, especialmente con síntomas del trastorno de estrés postraumático, ansiedad, depresión, insomnio, y disociación. La falta de apoyo social, los antecedentes psiquiátricos, el trauma infantil, los eventos estresantes adicionales ocurridos en el último mes y una baja resiliencia predijeron tener mayores problemas de salud mental por la COVID-19 y otros eventos estresantes. Un impacto más alto ejercido por la COVID-19 sobre un país se asoció, a su vez, con un mayor impacto sobre la salud mental, tanto por la COVID-19 como por otros eventos estresantes. Un análisis de las diferencias entre regiones geográficas reveló que en Latinoamérica se reportaron más síntomas de salud mental asociados a eventos relacionados con la COVID-19 en comparación con otros eventos estresantes, mientras que se observó un patrón opuesto en América del Norte. Conclusiones : El impacto de los estresores asociados a la COVID-19 sobre la salud mental abarca un amplio rango de síntomas y es más severo que otros eventos estresantes. Esta diferencia fue especialmente evidente en Latinoamérica. Estos hallazgos enfatizan la necesidad de un tamizaje global para detectar una amplia gama de problemas de salud mental como parte de un enfoque de salud pública, permitiendo programas específicos de prevención e intervención. 背景 : 在世界各地, COVID-19危机对心理健康的影响可能与对先前研究的压力事件, 特定风险因素和症状严重程度的心理反应有所不同。目的 : 评估COVID-19对广泛心理健康症状的影响, 确定相关风险因素, 确定COVID-19国家对心理健康的影响, 并评估与其他压力事件相比对COVID-19的心理反应。方法 : 7034名受访者 (74％为女性) 在2020年4月至11月期间参加了世界范围的‘全球心理创伤筛查’—对COVID-19的跨文化反应研究 (GPS-CCC), 报告了COVID-19相关 (n = 1838) 或其他压力事件相关 (n = 5196) 的心理健康症状。结果 : 相较于其他压力事件, COVID-19相关事件与更多的心理健康症状相关, 尤其是PTSD, 焦虑, 抑郁, 失眠和解离症状。缺乏社会支持, 精神病史, 童年创伤, 在过去一个月中出现了更多的压力事件, 和低心理韧性, 预测了更多COVID-19和其他压力事件相关的心理健康问题。更高的 COVID-19国家影响与COVID-19和其他压力事件对心理健康的更大影响都相关。跨地区的差异分析表明, 在拉丁美洲报告了比其他压力事件更多的COVID-19相关事件的心理健康症状, 而在北美则相反。结论 : COVID-19相关压力源对心理健康的影响涵盖了一系列广泛症状, 并且比其他压力事件更为严重。这种差异在拉丁美洲尤为明显。结果强调了考虑到针对性预防和干预计划, 需要把对广泛心理健康问题进行全球筛查作为公共卫生方法一部分。

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Journal ID (nlm-ta): Eur J Psychotraumatol

Journal ID (iso-abbrev): Eur J Psychotraumatol

Title: European Journal of Psychotraumatology

Publisher: Taylor & Francis

ISSN (Print): 2000-8198

ISSN (Electronic): 2000-8066

Publication date (Electronic, pub): 6 December 2021

Publication date (Electronic, collection): 2021

Publication date PMC-release: 6 December 2021

Volume: 12

Issue: 1

Electronic Location Identifier: 2001192

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[a ]Faculty of Professions, University of Adelaide; , Adelaide, Australia

[b ]College of Business, Oregon State University; , Corvallis, OR, USA

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CONTACT Jiyao Chen jiyao.chen@ 123456oregonstate.edu College of Business, Oregon State University; , Corvallis, OR 97330, USA

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Stephen X. Zhang https://orcid.org/0000-0001-6123-1193

Jiyao Chen https://orcid.org/0000-0003-2192-9778

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Publisher ID: 2001192

DOI: 10.1080/20008198.2021.2001192

PMC ID: 8654399

PubMed ID: 34900123

SO-VID: d3c3ad26-797a-4a12-b5b8-9d37de58378f

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This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Novel Coronavirus Disease COVID-19

Most cited references 13

The distress of Iranian adults during the Covid-19 pandemic – More distressed than the Chinese and with different predictors

Prevalence of anxiety and depression in South Asia during COVID-19: A systematic review and meta-analysis

Mental health responses to COVID-19 around the world Translated title: Respuestas en salud mental frente a la COVID-19 alrededor del mundo Translated title: 全世界对COVID-19的心理健康反应

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