Investigating the effect of national government physical distancing measures on depression and anxiety during the COVID-19 pandemic through meta-analysis and meta-regression

Abstract

Abstract (following PRISMA statement)BackgroundCOVID-19 physical distancing measures can potentially increase the likelihood of mental disorders. It is unknown whether these measures are associated with depression and anxiety.ObjectivesTo investigate meta-analytic global levels of depression and anxiety during the COVID-19 pandemic and how implementation of mitigation strategies (i.e. public transportation closures, stay-at-home orders, etc.) impacted such disorders.Data sourcesPubmed, MEDLINE, Web of Science, BIOSIS Citation Index, Current Content Connect, PsycINFO, CINAHL, medRxiv, and PsyArXiv databases for depression and anxiety prevalences; Oxford Covid-19 Government Response Tracker for the containment and closure policies indexes; Global Burden of Disease Study for previous levels of depression and anxiety.Study eligibility criteriaOriginal studies conducted during COVID-19 pandemic, which assessed categorical depression and anxiety, using PHQ-9 and GAD-7 scales (cutoff ≥ 10).Participants and interventionsGeneral population, healthcare providers, students, and patients. National physical distancing measures.Study appraisal and synthesis methodsMeta-analysis and meta-regresssion.ResultsIn total, 226,638 individuals were assessed within the 60 included studies. Global prevalence of both depression and anxiety during COVID-19 pandemic were 24.0% and 21.3%, respectively. There was a wide variance in the prevalence of both anxiety and depression reported in different regions of the world and countries. Asia, and China particularly, had the lowest prevalence of both disorders. Regarding the impact of mitigation strategies on mental health, only public transportation closures increased anxiety prevalence.LimitationsCountry-level data on physical distancing measures and previous anxiety/depression may not necessarily reflect local (i.e., city-specific) contexts.Conclusions and implications of key findingsMental health concerns should not be viewed only as a delayed consequence of the COVID-19 pandemic, but also as a concurrent epidemic. Our data provides support for policy-makers to consider real-time enhanced mental health services, and increase initiatives to foster positive mental health outcomes.Systematic review registration numberhttps://doi.org/10.17605/OSF.IO/JQGSF