The Impact of the COVID-19 Pandemic and Associated Control Measures on the Mental Health of the General Population : A Systematic Review and Dose-Response Meta-analysis.

Salanti, Georgia; Peter, Natalie; Tonia, Thomy; Holloway, Alexander; White, Ian R; Darwish, Leila; Low, Nicola; Egger, Matthias; Haas, Andreas D; Fazel, Seena; Kessler, Ronald C; Herrman, Helen; Kieling, Christian; De Quervain, Dominique J F; Vigod, Simone N; Patel, Vikram; Li, Tianjing; Cuijpers, Pim; Cipriani, Andrea; Furukawa, Toshi A; ... (2022). The Impact of the COVID-19 Pandemic and Associated Control Measures on the Mental Health of the General Population : A Systematic Review and Dose-Response Meta-analysis. Annals of internal medicine, 175(11), pp. 1560-1571. American College of Physicians 10.7326/M22-1507

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To what extent the COVID-19 pandemic and its containment measures influenced mental health in the general population is still unclear.


To assess the trajectory of mental health symptoms during the first year of the pandemic and examine dose-response relations with characteristics of the pandemic and its containment.


Relevant articles were identified from the living evidence database of the COVID-19 Open Access Project, which indexes COVID-19-related publications from MEDLINE via PubMed, Embase via Ovid, and PsycInfo. Preprint publications were not considered.


Longitudinal studies that reported data on the general population's mental health using validated scales and that were published before 31 March 2021 were eligible.


An international crowd of 109 trained reviewers screened references and extracted study characteristics, participant characteristics, and symptom scores at each timepoint. Data were also included for the following country-specific variables: days since the first case of SARS-CoV-2 infection, the stringency of governmental containment measures, and the cumulative numbers of cases and deaths.


In a total of 43 studies (331 628 participants), changes in symptoms of psychological distress, sleep disturbances, and mental well-being varied substantially across studies. On average, depression and anxiety symptoms worsened in the first 2 months of the pandemic (standardized mean difference at 60 days, -0.39 [95% credible interval, -0.76 to -0.03]); thereafter, the trajectories were heterogeneous. There was a linear association of worsening depression and anxiety with increasing numbers of reported cases of SARS-CoV-2 infection and increasing stringency in governmental measures. Gender, age, country, deprivation, inequalities, risk of bias, and study design did not modify these associations.


The certainty of the evidence was low because of the high risk of bias in included studies and the large amount of heterogeneity. Stringency measures and surges in cases were strongly correlated and changed over time. The observed associations should not be interpreted as causal relationships.


Although an initial increase in average symptoms of depression and anxiety and an association between higher numbers of reported cases and more stringent measures were found, changes in mental health symptoms varied substantially across studies after the first 2 months of the pandemic. This suggests that different populations responded differently to the psychological stress generated by the pandemic and its containment measures.


Swiss National Science Foundation. (PROSPERO: CRD42020180049).

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Salanti, Georgia, Tonia, Thomai, Holloway, Alexander Patrick, Low, Nicola, Egger, Matthias, Haas, Andreas


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services




American College of Physicians


[4] Swiss National Science Foundation




Pubmed Import

Date Deposited:

18 Oct 2022 09:30

Last Modified:

05 Dec 2022 16:26

Publisher DOI:


PubMed ID:


Additional Information:

Salanti, Peter, Tonia, and Holloway contributed equally to this work.




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