March 8, 2023

expert reaction to systematic review and meta-analysis on mental health before and during the COVID-19 pandemic

A systematic review and meta-analysis published in The BMJ looks at mental health symptoms before and during the covid-19 pandemic.

Prof Michael Sharpe, Emeritus Professor of Psychological Medicine, University of Oxford, said:

“This paper is a summary of all the 137 studies that measured psychological distress in the general population in a number of countries, before and during the Covid-19 pandemic. The overall finding is that, contrary to popular narratives, the average level of distress in the population did not substantially increase and the pandemic was not associated with a ‘tsunami of mental illness’. This finding is about population averages and does not mean that some individuals have not suffered greatly. It does however remind us however that the general population is more resilient to traumatic events than is often assumed.”

Prof Brenda Penninx, Professor of Psychiatric Epidemiology, and Prof Christiaan Vinkers, Professor of Psychiatry, Amsterdam UMC, said:

“This BMJ systematic literature review did a good job in evaluating longitudinal studies that examined mental health in diverse populations during the COVID pandemic and compared it to pre-pandemic levels. It indicates that the overall impact of the COVID pandemic on general mental health, anxiety and depression symptoms is either non-significant or significant but very small. This is very much in line with the conclusion from our literature review last year¹. This could suggest effective resilience and adaptation, but there is substantial heterogeneity among subgroups and time lag effects may also exist.”

1 Penninx, B.W.J.H., Benros, M.E., Klein, R.S. et al. How COVID-19 shaped mental health: from infection to pandemic effects. Nat Med 28, 2027–2037 (2022). https://doi.org/10.1038/s41591-022-02028-2

Dr Gemma Knowles, from the ESRC Centre for Society and Mental Health, King’s College London, said:

“The paper answers a broad question. In doing this, it risks obscuring important effects among the most affected and disadvantaged groups and, from that, obscuring possible widening of inequalities in mental distress that occurred because of the pandemic.

“There is evidence from other studies of considerable variation – with some people’s mental health improving and others’ deteriorating. This may mean no overall increase, but this shouldn’t be interpreted as suggesting the pandemic didn’t have major negative effects among some groups.

“The sub-group analyses are limited and don’t, for example, include analyses by SES, ethnic group, or by direct impacts of the pandemic on income, work, etc. Individual studies, including our recent study¹, that have considered these domains suggest quite marked effects in some of the most affected and disadvantaged groups.

“The paper also considers pre- and mid- pandemic, seemingly without considering a) the timing of measurement pre-pandemic matters and b) the impacts of the pandemic varied over time. The study has very little data on sub-groups, beyond gender and age and pre-existing conditions, and so the authors cannot conclude there was little deterioration in mental health without considering these differences.”

1 Moreno-Agostino, D., Fisher, H., Hatch, S., Morgan, C., Ploubidis, G., & Das-Munshi, J. (2022). Generational, sex, and socioeconomic inequalities in mental and social wellbeing during the COVID-19 pandemic: Prospective longitudinal observational study of five UK cohorts. Psychological Medicine, 1-12. doi:10.1017/S0033291722003348 

Dr Roman Raczka, Chair of the British Psychological Society’s Division of Clinical Psychology, said:

“The findings of the systematic review confirm what studies have indicated – that the mental health of the general population did not significantly worsen during the pandemic due to the high level of resilience.

“However, early studies indicated increasing mental health concerns for people who had existing problems, and there is evidence that the pandemic played a key role in worsening mental health for particular groups, including children and young people, women and parents living in poverty.

“We do not yet have the full picture, and further studies are needed into the impact of the pandemic on groups experiencing long-standing social and health inequities. We do know that overstretched and underfunded mental health services have been unable to meet soaring demand in recent years. With more people reaching out for support, it is vital that the government adequately funds services to deliver the support that is needed.”  

Prof Peter Tyrer, Emeritus Professor in Community Psychiatry, Imperial College London, said:

“This work is of good quality and reflects much of what we now know about the mental health impact of the COVID pandemic. The most important sentence in this paper that accurately predicted the outcome in advance of the COVID-19 pandemic is ‘war and pandemics have different characteristics, but in both there is a shared threat and common focus on collective action to tackle that threat.’  Social cohesion, despite the handicaps of lockdown and social distancing, improves when there is a common enemy. The COVID-19 virus is a vicious street-fighting international combatant in a war and, in opposing it on all fronts, mental illness is replaced by mental resilience in most people. The ones who are resilient make less noise, but we should still hear them.”

‘Comparison of mental health symptoms before and during the covid-19 pandemic: evidence from a systematic review and meta-analysis of 134 cohorts’ by Ying Sun et al. was published in The BMJ at 23:30 UK time on Wednesday 8 March.

DOI: 10.1136/bmj-2022-074224

Declared interests

Prof Brenda Penninx: “None.”

Prof Brenda Penninx: “None.”

Prof Peter Tyrer: “No conflicts of interest.”

For all other experts, no reply to our request for DOIs was received.