Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Apr;51(6):881-893.
doi: 10.1017/S0033291721000933. Epub 2021 Mar 2.

Investigating the effect of national government physical distancing measures on depression and anxiety during the COVID-19 pandemic through meta-analysis and meta-regression

João M Castaldelli-Maia  1 , Megan E Marziali  1 , Ziyin Lu  1 , Silvia S Martins  1
Affiliations
Meta-Analysis

Investigating the effect of national government physical distancing measures on depression and anxiety during the COVID-19 pandemic through meta-analysis and meta-regression

João M Castaldelli-Maia et al. Psychol Med. 2021 Apr.

Abstract

Background: COVID-19 physical distancing measures can potentially increase the likelihood of mental disorders. It is unknown whether these measures are associated with depression and anxiety.

Objectives: To investigate meta-analytic global levels of depression and anxiety during the COVID-19 pandemic and how the implementation of mitigation strategies (i.e. public transportation closures, stay-at-home orders, etc.) impacted such disorders.

Data sources: PubMed, MEDLINE, Web of Science, BIOSIS Citation Index, Current Content Connect, PsycINFO, CINAHL, medRxiv, and PsyArXiv databases for depression and anxiety prevalences; Oxford Covid-19 Government Response Tracker for the containment and closure policies indexes; Global Burden of Disease Study for previous levels of depression and anxiety.

Study eligibility criteria: Original studies conducted during COVID-19 pandemic, which assessed categorical depression and anxiety, using PHQ-9 and GAD-7 scales (cutoff ⩾10).

Participants and interventions: General population, healthcare providers, students, and patients. National physical distancing measures.

Study appraisal and synthesis methods: Meta-analysis and meta-regression.

Results: In total, 226 638 individuals were assessed within the 60 included studies. Global prevalence of both depression and anxiety during the COVID-19 pandemic was 24.0% and 21.3%, respectively. There were differences in the prevalence of both anxiety and depression reported across regions and countries. Asia (17.6% and 17.9%), and China (16.2% and 15.5%) especially, had the lowest prevalence of both disorders. Regarding the impact of mitigation strategies on mental health, only public transportation closures increased the prevalence of anxiety, especially in Europe.

Limitations: Country-level data on physical distancing measures and previous anxiety/depression may not necessarily reflect local (i.e. city-specific) contexts.

Conclusions and implications of key findings: Mental health concerns should not be viewed only as a delayed consequence of the COVID-19 pandemic, but also as a concurrent epidemic. Our data provide support for policy-makers to consider real-time enhanced mental health services, and increase initiatives to foster positive mental health outcomes.

Keywords: Anxiety; COVID-19; depression; public transport; social isolation.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
PRISMA Flow Diagram.
Fig. 2.
Fig. 2.
Global results of the meta-analysis for depression and a subgroup analysis by region of the world.
Fig. 3.
Fig. 3.
Global results of the meta-analysisfor anxiety and a subgroup analysis by region of the world.
See this image and copyright information in PMC

References

    1. Adolph, D., Schneider, S., & Margraf, J. (2016). German anxiety barometer-clinical and everyday-life anxieties in the general population. Frontiers in Psychology, 7, 1344. doi: 10.3389/fpsyg.2016.01344 - DOI - PMC - PubMed
    1. Ahmad, A., Rahman, I., & Agarwal, M. (2020). Factors influencing mental health during COVID-19 outbreak: An exploratory survey among Indian population. medRvix, Advance online publication. doi: 10.1101/2020.05.03.20081380 - DOI
    1. Ahn, M. H., Shin, Y.-W., Hye, K. J., Kim, H. J., Lee, K.-U., & Chung, S. (2020). High work-related stress and anxiety response to COVID-19 among healthcare workers in South Korea: SAVE study. PsyArXiv, Advance online publication. doi: 10.31234/osf.io/9nxth - DOI
    1. Ahorsu, D. K., Imani, V., Lin, C. Y., Timpka, T., Brostrom, A., Updegraff, J. A., … Pakpour, A. H. (2020). Associations between gear of COVID-19, mental health, and preventive behaviours across pregnant women and husbands: An actor-partner interdependence modelling. International Journal of Mental Health and Addiction, Epub ahead of print, 1–15. doi: 10.1007/s11469-020-00340-x. - DOI - PMC - PubMed
    1. Al-Qahtani, A. M., Elgzar, W. T., & Ibrahim, H. A. (2020). COVID-19 pandemic: Psycho-social consequences during the social distancing period among Najran City population. Psychiatria Danubina, 32(2), 280–286. doi: 10.24869/psyd.2020.280 - DOI - PubMed

Publication types