Factors Associated with Levels

or Changes in Symptoms

Methods Notes: All eligible studies must conduct multivariable evaluations of factors associated with mental health symptoms, which may include, for instance, pre-COVID-19 participant or community characteristics, pre-existing health characteristics, and aspects of participants’ experience during COVID-19 (e.g. infection, exposure to infected individuals, work status, lockdown status). Mental health outcomes must be based on validated diagnostic interviews, scales, or sets of items. Both cross-sectional and longitudinal designs are eligible, although cross-sectional designs will only be included if factors assessed were present prior to the outcome (e.g., sex, pre-existing medical condition) and not measured only concurrently. Thus, studies with multivariable analyses that include concurrent mental health or behavioural variables (e.g. information seeking, exercise) will be excluded, as these do not permit interpretation of directionality. Studies with < 100 participants will be excluded.


Summary of Results: Results from initial studies have been posted.


Comment: As of September 12th, 2020, the team has stopped reviewing new references for research question 2, “Factors Associated with Levels or Changes in Symptoms”. 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. 





Summary of

Study Outcomes


Study Quality







*Abbreviations: NR= Not Reported

*For study 21717, % female participants refers to participants with female sex assigned at birth



*Abbreviations: ASDS= Acute Stress Disorder Scale; BMI= Body Mass Index; CES-D= Center for Epidemiologic Studies Depression Scale; CoSS= Covid Stress Scale; DASS-21= Depression, Anxiety, and Stress Scale; DMSM= Distress Management Screening Measure; GAD-7= Generalized Anxiety Disorder; GHQ= General Health Questionnaire; GPS-PTSS= Global Psychotrauma Screen, Post-traumatic stress symptoms subscale; HADS= Hospital Anxiety and Depression Scale; HAM-A=Hamilton Anxiety Rating Scale; HAI= Health Anxiety Inventory; HEI= Huaxi Emotional-Distress Index; IADQ= International Adjustment Disorder Questionnaire; IES= Impact of Events Scale; ITQ=Impact of Events Scale; K6= Kessler Psychological Distress Scale; K10= Kessler Psychological Distress Scale; NR= Not Reported; NS= Not significant; OR= Odds Ratio; PANAS= Positive and Negative Affect Schedule; PCL-C= PTSD Checklist-Cuvukuab Version; PDI= Peritraumatic Distress Inventory; PHQ-9= Patient Health Questionnaire; PQEEPH= Psychological Questionnaires for Emergent Events of Public Health; PROMIS= Patient-Reported Outcomes Measurement Information System; PSS= Perceived Stress Scale; SCL-90= Symptom Check List; SF-12=Short-Form-12 Health Survey - Mental Health Component; WHO-5= WHO (Five) Wellbeing Index; ZSAS= Zung Self-Rating Anxiety Scale; ZSDS= Zung Self-rating Depression Scale

*Corrected results for study 7498 provided by the author.





Please contact us if you identify an error or if we have not included an eligible study