Association between the COVID‐19 pandemic and psychiatric symptoms in people with preexisting obsessive‐compulsive, eating, anxiety, and mood disorders: a systematic review and meta‐analysis of before‐after studies

Abstract

AimTo determine whether the coronavirus disease 2019 (COVID‐19) pandemic was associated with a change in psychiatric symptoms in people with preexisting obsessive‐compulsive, eating, anxiety, and mood disorders compared to their prepandemic levels.MethodsWe searched MEDLINE, CINAHL, PsycINFO, and Embase from inception until February 16, 2022. Studies were included if they reported prepandemic and during‐pandemic psychiatric symptoms, using validated scales, in people with preexisting mood, anxiety, eating, or obsessive‐compulsive disorders. Two reviewers independently screened studies, extracted data, and assessed evidence certainty. Random‐effects meta‐analyses were conducted. Effect sizes were reported as standardized mean differences (SMDs) with 95% confidence intervals (CIs).ResultsEighteen studies from 10 countries were included. Of the 4465 included participants, 68% were female and the average age was 43 years. Mood and obsessive‐compulsive disorders were the most studied disorders. During‐pandemic psychiatric measurements were usually collected during nationwide lockdown. Obsessive‐compulsive symptoms worsened among people with obsessive‐compulsive and related disorders, with a moderate effect size (N = 474 [six studies], SMD = −0.45 [95% CI, −0.82 to −0.08], I2 = 83%; very low certainty). We found a small association between the COVID‐19 pandemic and reduced anxiety symptoms in people with mood, anxiety, obsessive‐compulsive, and eating disorders (N = 3738 [six studies], SMD = 0.11 [95% CI, 0.02–0.19], I2 = 63%; very low certainty). No change in loneliness, depressive, or problematic eating symptoms was found.ConclusionPeople with obsessive‐compulsive and related disorders may benefit from additional monitoring during the COVID‐19 pandemic and possibly future pandemics. Other psychiatric symptoms were stable in people with the specific disorders studied. Overall, evidence certainty was very low.