Living Systematic Review of Mental Health in COVID-19

Coronavirus disease (COVID-19)

COVID-19 is a serious health threat, and the situation is evolving daily. The risk will vary between and within communities.

 

Mental health during the current COVID-19 outbreak may be negatively affected by fear of long-term personal, social, and societal implications of the crisis and from isolation due to social distancing and movement restrictions that have been put into place

What are living systematic reviews

Living systematic reviews are systematic reviews that are continually updated and provide ongoing access to results via online publication. They are logistically challenging, but would be expected to provide value beyond conventional systematic reviews in situations where (1) important decisions need to be made that merit the resources involved; (2) the certainty in existing evidence is low or very low, posing a barrier to decision-making; and (3) there is likely to be new research evidence emerging that would inform decisions.This is precisely the situation in COVID-19.

Objectives of our living systematic review

The objectives of our planned living systematic review are to evaluate (1) changes in mental health symptoms among the same participants from pre-COVID or across delineated events during COVID-19 (e.g., outbreak announcement versus peak, peak restrictions on movement versus post-restrictions); (2) factors associated with levels or changes in symptoms during COVID-19, and (3) the effect of interventions on mental health symptoms during COVID-19.

Our protocol for living systematic review

Mental Health during the COVID-19 Pandemic: Protocol for a Living Systematic Review of Symptom Levels, Factors Associated with Symptoms, and Intervention Effectiveness  [PDF]. Available on the Open Science Framework [Check]. The living systematic review is also described in an editorial in the Journal of Psychosomatic Research [Check].

Expert Comments on Available Evidence

Living Systematic Review Team Members

Brett Thombs
Andrea Benedetti
Jill Boruff
Danielle Rice
Sarah Markham
Yin Wu
Sheryl Sun
Ankur Krishnan
Chen He
Marleine Azar
Olivia Bonardi
Ian Thombs-Vite
Yutong Wang
Tiffany Dal Santo
Amina Tasleem
Anneke Yao
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 Continuous Update of COVID-19 Mental Health Evidence 

  Last update:  20 Oct 2020 

 Number of  Titles/Abstracts Reviewed

26,800

Number of Trial Registrations Reviewed 

300

RESEARCH QUESTION 1: SYMPTOM CHANGES

To evaluate changes in mental health symptoms prior to and after a delineated event related to COVID-19

Number of Articles to Undergo Full-text Review

194

Number of Fully Reviewed Articles

189

Number of Eligible Studies 

14

Number with Data Extracted

14

RESEARCH QUESTION 2:

FACTORS

To evaluate factors associated with levels or changes in symptoms during COVID-19

Number of Articles to Undergo Full-text Review

698

Number of Fully Reviewed Articles

691

Number of Eligible Studies 

43

Number with Data Extracted

42

RESEARCH QUESTION 3:

INTERVENTIONS

To evaluate the effect of interventions on mental health symptoms during COVID-19

Number of Articles to Undergo Full-text Review

79

Number of Fully Reviewed Articles

76

Number of Eligible Studies 

2

Number with Data Extracted

2

53

Number of Eligible Registered Trials

As of September 12th, 2020, the team has stopped reviewing new references for research question 2, “Factors Associated with Levels or Changes in Symptoms”. Questions 1 and 3, symptom changes and interventions, will remain living systematic reviews. 

       

Since the project’s beginning, question 2 has posed challenges, as it assesses findings from cross-sectional studies, not studies which evaluate changes over time. Even in well-conducted studies, it is impossible to ascertain the degree to which risk factors identified reflect COVID-19-specific factors or replicate associations present prior to the pandemic. Additionally, the very high volume of low-quality studies eligible for question 2 has posed a challenge to the team’s ability to keep evidence current. Since cross-sectional model-based studies are highly dependent on completeness and design of the models, many eligible studies have been at high risk of bias. This has negatively impacted our ability to highlight trends and report useful conclusions. Due to these concerns, including the rapidly expanding volume of potentially eligible studies for question 2 and our team’s limited resources, we will analyze studies published as of September 12, 2020, but will not maintain a living systematic review for question 2 after that date. 
 

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