A Systematic Review and Meta-Analysis on Prevalence of and Risk Factors Associated With Depression, Anxiety and Insomnia in Infectious Diseases, Including COVID-19: A Call to Action

Background: Infectious disease epidemics have become more frequent and more complex during the 21st century, posing a health threat to the general public and causing psychological symptoms. The current study was designed to investigate the prevalence of and risk factors associated with depression, anxiety and insomnia during epidemic outbreaks, including COVID-19. Methods: We systematically searched the PubMed, Embase, Web of Science, OVID, Medline, Cochrane databases, bioRxiv and medRxiv to identify studies that reported the prevalence of depression, anxiety or insomnia during infectious disease epidemics, up to August 14th, 2020. Prevalence of mental symptoms among different populations including the general public, health workers, university students, older adults, infected patients, survivors of infection, and pregnant women across all types of epidemics was pooled. The prevalence of mental symptoms during COVID-19 was estimated by time and across countries using meta-regression. Results: A total of 17,506 papers were initially retrieved, and a final of 284 studies met the inclusion criteria, representing a total of 948,882 individuals. The pooled prevalence of depression ranged from 23.1%, 95% confidential interval (95% CI: [13.9-32.2]) in survivors to 43.3% (95% CI: [27.1-59.6]) in university students, the pooled prevalence of anxiety ranged from 25.0% (95% CI: [12.0-38.0]) in older adults to 43.3% (95% CI: [23.3-63.3]) in pregnant women, and insomnia symptoms ranged from 29.7% (95% CI: [24.4-34.9]) in the general public to 58.4% (95% CI: [28.1-88.6]) in university students. Moderate-to-severe prevalence was lower but had substantial variation across different populations. The prevalence of mental problems increased over time during the COVID-19 pandemic among the general public, health workers and university students, and decreased among infected patients. Factors associated with all three mental health symptoms included female sex, and having physical disorders, psychiatric disorders, COVID infection, colleagues or family members infected, experience of frontline treatment work, close contact with infected patients, high exposure risk, quarantine experience and high concern about epidemics. Frequent exercise and good social support were associated with lower risk for these three mental symptoms. Conclusions: Mental symptoms are common, but vary across populations during epidemics. These variations can be helpful for policy making by providing a framework design of population-specific psychological crisis management strategies.Funding Information: This work was supported by the National Key Research and Development Program of China, and the National Natural Science Foundation of China.Declaration of Interests: All the authors declare no competing interests.