Post-viral mental health sequelae: Systematic review and meta-analysis of prevalence proportions

Zuercher, S. J.; Banzer, C.; Adamus, C.; Lehmann, A. I.; Richter, D.; Kerksieck, P.

Background: Mental health problems (MHP) in COVID-19 patients and survivors were anticipated already during early stages of this pandemic. We aimed to synthesize the prevalence of anxiety, depression, post-traumatic and general distress of major virus epidemics since 2002. Methods: In this systematic review and meta-analysis, we searched PubMed, PsycINFO, and Embase from 2002 until April 14, 2021 for peer-reviewed studies reporting prevalence of MHP in adults with laboratory-confirmed or suspected SARS-CoV-1, H1N1, MERS-CoV, H7N9, Ebolavirus, or SARS-CoV-2 infection. We included studies that assessed MHP with well-validated and frequently used scales. A three-level random-effects meta-analysis for dependent sizes was conducted to account for multiple outcome reporting. We pooled MHP jointly and separately for mild or moderate-to-severe severity by acute (one month), ongoing (one to three month), and post-illness phase (longer than three months). A meta-regression was conducted to test for moderating effects. PROSPERO registration: CRD42020194535. Findings: We identified 59 studies providing a total of 187 effect sizes. Range for sample size (n=14-n=1002), females (22-79%), and mean age (32-72 years). MHP prevalence was higher for mild (35.5-46.3%) compared to moderate-to-severe MPH (17.3-22.3). MHP, in general, decreased from acute to post-illness from 46.3% to 38.8% and for mild and moderate-to-severe from 22.3% to 18.8%, respectively. We found no evidence of moderating effects except for non-random sampling and H1N1 showing higher proportions. Interpretation: MHP decreased over time but were still on a substantial level at post-illness. This highlights a need for rapid access to mental health care and rehabilitation planning in affected individuals.