Learning from the Past: A Systematic Review on Risk and Protective Factors for Psychological Distress in Past Infectious Epidemics and COVID-19

Abstract

COVID-19 and the resulting social and economic lockdown has reportedly given rise to mental health issues globally. Existing literature suggests some groups experience higher psychological distress during pandemics than others. This systematic literature review highlights risk and protective factors that make these groups more vulnerable to psychological distress during an epidemic. We focus on trauma symptoms, post-traumatic stress disorder, anxiety, and depression studied in clinical science literature between 2010 and 2020, focusing on the SARS, MERS, Ebola, H1N1 and Zika virus epidemics, and draw parallels with COVID-19. Since out of the 29 selected studies, most included in this review focus on symptoms rather than risk factors, this paper determines these factors by identifying comparative statistics noted in findings. Gender, age, location, economic factors, information access, media exposure, being infected or knowing an infected person, and stigma around infection are risk factors isolated for negative psychological outcomes. Protective factors identified are religion, social support, and strong leadership. A missing focus on minority and underserved populations across cultures was noted. We recommend that media exposure be regulated and trauma screening at primary healthcare level be used to identify at-risk individuals. Additionally, interventions should incorporate preventative measures against mental health problems for high-risk populations, including educational programs de-stigmatizing infection.