Bottom Line
The evidence suggests that the prevalence of depression, anxiety, and sleep disturbance is high among coronavirus disease 2019 (COVID-19) patients. The prevalence of depression, anxiety, and sleep disturbance were found to be 45%, 47% and 34% respectively.
Risk of Bias Assessment
Overall summary Low risk of bias in the review
The interpretation of findings addressed all concerns identified in the four domains. The identified studies were appropriate for the review's research question and the reviewers avoided emphasising results on the basis of their statistical significance.
| A. Did the interpretation of findings address all of the concerns identified in Domains 1 to 4? | Probably yes |
| B. Was the relevance of identified studies to the review's research question appropriately considered? | Probably yes |
| C. Did the reviewers avoid emphasizing results on the basis of their statistical significance? | Probably yes |
| Risk of bias in the review | Low |
Details of Review
| Number of studies | 31 |
|---|---|
| Number of participants | 5,153 |
| Last search date | 18 August 2020 |
| Review type | Epidemiological |
| Objective | To estimate the prevalence of depression, anxiety, and sleep disturbance among COVID-19 patients. |
| Population | Coronavirus disease 2019 patients. |
| Interventions | NA. |
| Comparator | NA. |
| Outcome | The prevalence of depression, anxiety, or sleep disturbance. |
| Study design | Observational studies. |
| Reference standard | NA. |
| Exposure | Coronavirus disease 2019. |
| PP factor | NA. |
Results
It was determined that the prevalence of depression among COVID-19 patients was 45% (95% confidence interval [CI]: 37–54%), the prevalence of anxiety was 47% (95% CI: 37–57%), and the prevalence of sleep disturbance was 34% (95% CI: 19–50%). There was no significant difference in the prevalence estimates based on gender. The prevalence estimates for depression and anxiety; however, differed when different screening tools were used.
Full Risk of Bias Assessment
The review adhered to the predefined objectives and eligibility criteria, which appeared appropriate and unambiguous for the review question. All restrictions in eligibility criteria based on study characteristics and sources of information were appropriate.
| 1.1 Did the review adhere to pre-defined objectives and eligibility criteria? | Probably yes |
| 1.2 Were the eligibility criteria appropriate for the review question? | Probably yes |
| 1.3 Were eligibility criteria unambiguous? | Probably yes |
| 1.4 Were all restrictions in eligibility criteria based on study characteristics appropriate (e.g. date, sample size, study quality, outcomes measured)? | Probably yes |
| 1.5 Were any restrictions in eligibility criteria based on sources of information appropriate (e.g. publication status or format, language, availability of data)? | Probably yes |
| Concerns regarding specification of study eligibility criteria | Low |
MEDLINE, EMBASE, PubMed, Web of Science, CINAHL, Wanfang Data, Wangfang Med Online, CNKI, and CQVIP databases were searched. References of included articles were handsearched for any additional relevant articles. The search terms and structure of the search strategy were likely to retrieve many eligible studies. The limitations based on date, and language were appropriate. Two reviewers were independently involved in the selection of studies and discrepancies were resolved by engaging a third researcher.
| 2.1 Did the search include an appropriate range of databases/electronic sources for published and unpublished reports? | Probably yes |
| 2.2 Were methods additional to database searching used to identify relevant reports? | Probably yes |
| 2.3 Were the terms and structure of the search strategy likely to retrieve as many eligible studies as possible? | Probably yes |
| 2.4 Were restrictions based on date, publication format, or language appropriate? | Probably yes |
| 2.5 Were efforts made to minimise error in selection of studies? | Probably yes |
| Concerns regarding methods used to identify and/or select studies | Low |
Two reviewers were independently involved in the data extraction process and risk of bias assessment. Ample study characteristics were extracted to allow the interpretation of results. Appropriate study results were extracted. The methodological quality assessment of included studies was done appropriately using a modified version of the Newcastle-Ottawa Quality Assessment Scale.
| 3.1 Were efforts made to minimise error in data collection? | Probably yes |
| 3.2 Were sufficient study characteristics considered for both review authors and readers to be able to interpret the results? | Probably yes |
| 3.3 Were all relevant study results collected for use in the synthesis? | Probably yes |
| 3.4 Was risk of bias (or methodological quality) formally assessed using appropriate criteria? | Probably yes |
| 3.5 Were efforts made to minimise error in risk of bias assessment? | Probably yes |
| Concerns regarding methods used to collect data and appraise studies | Low |
The synthesis included all relevant studies from the search. The analyses plans were well explained. The synthesis was appropriate given the degree of similarity in the research questions, study designs, and outcomes across the included studies. Assessment of heterogeneity was done using the Cochran’s Q-test and the I 2 statistics. Sensitivity analyses, subgroup analyses and meta-regression were also carried out. Assessment of publication bias was done using funnel plots and Egger’s regression tests.
| 4.1 Did the synthesis include all studies that it should? | Probably yes |
| 4.2 Were all pre-defined analyses reported or departures explained? | Probably yes |
| 4.3 Was the synthesis appropriate given the degree of similarity in the research questions, study designs and outcomes across included studies? | Probably yes |
| 4.4 Was between-study variation minimal or addressed in the synthesis? | Probably yes |
| 4.5 Were the findings robust, e.g. as demonstrated through funnel plot or sensitivity analyses? | Probably yes |
| 4.6 Were biases in primary studies minimal or addressed in the synthesis? | Probably yes |
| Concerns regarding synthesis and findings | Low |
Abstract
Evidence from previous coronavirus outbreaks has shown that infected patients are at risk for developing psychiatric and mental health disorders, such as depression, anxiety, and sleep disturbances. To construct a comprehensive picture of the mental health status in COVID-19 patients, we conducted a systematic review and random-effects meta-analysis to assess the prevalence of depression, anxiety, and sleep disturbances in this population. We searched MEDLINE, EMBASE, PubMed, Web of Science, CINAHL, Wanfang Data, Wangfang Med Online, CNKI, and CQVIP for relevant articles, and we included 31 studies (n = 5153) in our analyses. We found that the pooled prevalence of depression was 45% (95% CI: 37-54%, I2 = 96%), the pooled prevalence of anxiety was 47% (95% CI: 37-57%, I2 = 97%), and the pooled prevalence of sleeping disturbances was 34% (95% CI: 19-50%, I2 = 98%). We did not find any significant differences in the prevalence estimates between different genders; however, the depression and anxiety prevalence estimates varied based on different screening tools. More observational studies assessing the mental wellness of COVID-19 outpatients and COVID-19 patients from countries other than China are needed to further examine the psychological implications of COVID-19 infections. Copyright © 2020 New York Academy of Sciences.
