Uncovering COVID-19’s impact on mental health

In a recent study published in the journal BMJ, a team of researchers from Canada and the United Kingdom conducted a systematic review of current research and meta-analysis to compare the symptoms of anxiety and depression and overall mental health among the general population before and after the onset of the coronavirus disease 2019 (COVID-19) pandemic.

Study: Comparison of mental health symptoms before and during the covid-19 pandemic: evidence from a systematic review and meta-analysis of 134 cohorts. Image Credit: dbayan / Shutterstock


The COVID-19 pandemic caused an unprecedented number of deaths worldwide. In addition, the drastic social changes associated with the disease mitigation measures and the fear of the disease have taken a significant toll on the mental health of people across the globe. As a result, a growing number of studies have reported that the pandemic has resulted in a substantial decline in mental health in large proportions of the population.

However, most of these studies have been cross-sectional, involving respondents who are above the mental health measure thresholds and have not made comparisons to the mental health levels before the onset of the pandemic. These mental health thresholds are generally used for screening and are not a good indicator of prevalence in a population.

Furthermore, the two systematic reviews that examined mental health quality before and after the COVID-19 pandemic reported that depression, anxiety, and overall mental health symptoms worsened during the early stages of the pandemic. There have been various other relevant studies published since, which could provide a better and more current understanding of the impact of COVID-19 on mental health.

About the study

In the present study, the team conducted a series of systematic reviews and meta-analyses to determine the impact of COVID-19 on mental health. The reviews included some studies that compared pre- and post-COVID-19 mental health levels in the same cohort and examined all studies that compared outcomes between January 2018 to December 2019 period and after January 2020. The included studies had to compare the outcomes in pre- and post-COVID-19 cohorts that had at least a 90% overlap of participants.

The outcomes included in the study were continuous scores based on questionnaires on mental health symptoms as well as the proportion of individuals above the threshold or meeting a mental disorder criteria based on validated questionnaires on symptoms and diagnostic reviews. For the living systematic reviews, the measured outcomes included general mental health, symptoms of depression and anxiety, loneliness, stress, grief, burnout, and anger.


The results indicated that over 94,000 studies were reviewed by April 2022, of which 137 were unique studies from 134 cohorts. Of these, 77% were from high-income countries, and 20% were from upper-middle-income countries. The study found no changes among the general population for general mental health measures and anxiety symptoms, but symptoms related to depression were seen to worsen a little.

The general mental health status and symptoms related to depression and anxiety were seen to minimally worsen among female participants. Furthermore, other studies that examined subgroups other than women also reported only minimally worse symptoms of anxiety and depression after the onset of the COVID-19 pandemic. Interestingly, two studies suggested that the anxiety symptoms, general mental health, and symptoms of depression had improved minimally.

The meta-analysis findings reported that no other subgroups showed any significant worsening of symptoms across all the domains of examined outcomes. Three studies that included data between March 2020 and late 2020 reported that while mental health-associated symptoms had worsened initially during the COVID-19 pandemic, they soon returned to the levels before the onset of the pandemic.

These findings indicated that the general population displayed high levels of resilience during the pandemic. However, the authors mentioned that a few robust studies indicated that specific population groups experienced significant worsening of mental health conditions that were different from the mental health levels of the general population. The COVID-19 pandemic has undeniably altered lives, and many individuals are experiencing emergent mental health problems. The authors believe that the long-term impacts of COVID-19 on mental health need to be assessed continuously, and governments should ensure that adequate resources and support are available to individuals experiencing mental health issues.


Overall, the findings indicated that many of the studies that examined the impact of COVID-19 on mental health had a high-risk bias, and caution is required when interpreting these results for the general population. The findings indicated that the general population was not undergoing a mental health crisis due to the COVID-19 pandemic and instead exhibited significant resilience. While female participants displayed minimal worsening of symptoms across all outcome domains, the overall changes were insignificant across all the subgroups.

Journal reference:

  • Sun, Y., Wu, Y., Fan, S., Santo, D., Li, L., Jiang, X., Li, K., Wang, Y., Tasleem, A., Krishnan, A., He, C., Bonardi, O., Boruff, J. T., Rice, D. B., Markham, S., Levis, B., Azar, M., Thombs-Vite, I., Neupane, D., & Agic, B. (2023). Comparison of mental health symptoms before and during the covid-19 pandemic: evidence from a systematic review and meta-analysis of 134 cohorts. BMJ, 380.,

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