Mental Disorder Prevalence Among Populations Impacted by Coronavirus Pandemics: A Multilevel Meta-Analytic Study of COVID-19, MERS & SARS

Boden, M.; Cohen, N.; Froelich, J.; Hoggatt, K.; Abdel Magid, H.; Mushiana, S.

Coronavirus pandemics are associated with a number of well-documented threats, stressors and traumas that vary by impacted population and contribute to mental disorders. Through a systematic review and meta-analysis of research on COVID-19, severe acute respiratory syndrome (SARS) and middle east respiratory syndrome (MERS) pandemics, we investigated whether mental disorder prevalence: (a) was elevated among populations impacted by coronavirus pandemics (relative to unselected populations reported in the literature), and (b) varied by disorder (undistinguished psychiatric morbidity, anxiety, depressive, posttraumatic stress disorders [PTSD]) and impacted population (community, infected/recovered, healthcare provider, quarantined). From 60 publications (N=66,190 participants), 725 individual estimates were included in a series of multilevel meta-analyses/regressions including random effects to account for estimates nested within studies. Across disorder and population, the median summary point prevalence was 20% (95%CI=17-25%). Prevalence estimates were generally substantially higher than reported by prior research for unselected samples. Psychiatric morbidity and PTSD were most prevalent in most populations. The highest prevalence of each disorder was found among infected/recovered adults. Notably high prevalence was found for (a) psychiatric morbidity, PTSD and depression in infected/recovered adults (25-56%), (b) psychiatric morbidity and PTSD in healthcare providers (21-29%), (c) depression and PTSD in the adults in the community (15-19%), and (d) psychiatric morbidity in quarantined adults (28%). Sensitivity analyses demonstrated that overall prevalence estimates were higher for studies/estimates: (1) focused on SARS or MERS versus COVID-19, (2) conducted in Hong Kong or Korea versus other locations, obtained (3) via questionnaire versus clinician assessment and (4) with standard versus non-standard scoring, and (5) of moderate or very low versus low quality. The number of mental disorders attributable to COVID-19 will be substantial and magnitudes higher than attributable to MERS and SARS due to the vast scope and ongoing nature of the COVID-19 pandemic.