Researchers in the United States have conducted an analysis showing the high prevalence of mental disorders across populations impacted by coronavirus pandemics.
The team’s meta-analysis of research on COVID-19, severe acute respiratory syndrome coronavirus (SARS) and Middle East respiratory syndrome (MERS) found that one in five adults developed pandemic-related mental disorders.
Psychiatric morbidity and post-traumatic stress disorder (PTSD) were the most prevalent disorders among most populations.
These disorders occurred most frequently among infected or recovered adults, followed by healthcare providers, adults in the community and quarantined adults.
Future research examining subpopulations most at-risk of mental disorders will be key to implementing interventions in a cost-effective and equitable manner, says Matthew Boden from VA Palo Alto Healthcare System in California and colleagues.
A pre-print version of the paper is available on the medRxiv* server, while the article undergoes peer review.
Pandemic-related stressors likely to increase risk of mental disorders
Numerous studies have previously documented the adverse mental health effects associated with coronavirus pandemics.
In the context of COVID-19, a systematic review of this literature would provide useful information about the prevalence of different mental disorders that may be common among impacted populations.
Pandemic-related stressors, threats and traumas such as viral exposure, witnessing illness or death, restricted mobility, unemployment and economic loss are all likely to increase the risk of mental disorders.
“Infected/recovered adults and healthcare providers, in particular, may experience traumatic events (e.g., invasive treatments, witnessing death) that increase risk of post-traumatic stress disorder,” writes the team.
What did the researchers do?
The team conducted a systematic review and meta-analysis of research on COVID-19, SARS and MERS pandemics to investigate the prevalence of mental disorders among impacted populations.
In particular, the team investigated whether mental disorder prevalence is elevated among these populations relative to unselected populations (random samples) reported in the literature.
For example, a 2014 meta-analysis of 157 studies from 59 countries reported a 12-month prevalence of 15.4% for combined mood and anxiety disorders.
A 2019 epidemiologic study conducted in China found that the twelve-month (or less) prevalence of any mental disorder was 9.3%, while it was 5.0% for anxiety disorder, 3.6% for depressive disorder and 2% for PTSD. A 2004 study conducted in Europe also reported that the twelve-month (or less) prevalence of anxiety disorder and major depression was 6.4% and 3.9%, respectively.
“We hypothesized that, relative to these estimates, all disorders would be more prevalent in all populations (we investigated) given the frequent and often impactful threats, stressors and traumas associated with coronavirus pandemics,” says Boden and colleagues.
One in five people had a mental disorder
The team searched various electronic databases between April 15 until June 1 2020 and identified 60 published articles covering 66,190 participants.
From these articles, 725 individual estimates of point prevalence (proportion of population with disease at a particular timepoint) were obtained and included in a series of multilevel meta-analyses.
The median summary point prevalence of mental disorders (psychiatric morbidity, anxiety, depressive, and PTSD) across the different populations studied (community, infected/recovered, healthcare provider, quarantined) was 20%.
Overall, prevalence estimates were generally much higher than those reported by previous studies of unselected samples.
Psychiatric morbidity was the most prevalent (32%) disorder across all populations, with the exception of depression in community adults.
The second most prevalent disorder was PTSD (21%,) followed by depression (17%), and anxiety (12%).
Infected/recovered individuals and healthcare providers were the most affected
The prevalence of psychiatric morbidity and PTSD was highest among infected/recovered adults, followed by healthcare providers, adults in the community, and quarantined adults.
Among infected/recovered adults, the prevalence of psychiatric morbidity and PTSD ranged from 25% to 56%. Among healthcare providers, the prevalence of psychiatric morbidity was 29% and PTSD was 21%.
Among adults in the community, the prevalence of depression and PTSD was 19% and 15%, respectively.
Across all mental disorders, the highest prevalence was again found among infected/recovered adults (30%), followed by healthcare providers (20%), community adults (16%), and quarantined adults (12%).
Future research is needed to help plan interventions
Boden and colleagues say the study provides useful data for understanding and potentially intervening to alleviate the mental health impact of COVID-19 and future coronavirus pandemics.
It will be important to investigate whether mental disorder prevalence increases in countries with prolonged periods of SARS-CoV-2 infection and economic hardship (e.g., United States, Brazil,” they write.
The researchers hypothesize that such countries may experience increased rates of the disorders examined in this study.
"Future research that examines the potentially manifold pathways to individual outcomes among subpopulations most at-risk will be instrumental in intervening in a cost-effective, effective and equitable manner," concludes the team.
Boden M, et al. Mental Disorder Prevalence Among Populations Impacted by Coronavirus Pandemics: A Multilevel Meta-Analytic Study of COVID-19, MERS & SARS. medRxiv, 2020. doi: https://doi.org/10.1101/2020.12.18.20248499, https://www.medrxiv.org/content/10.1101/2020.12.18.20248499v1