Fear of COVID-19 and its association with mental health-related factors: systematic review and meta-analysis

Abstract

Background: The severity of COVID-19 remains high worldwide. Therefore, millions of individuals are likely to suffer from fear of COVID-19 and related mental health factors.

Aims: The present systematic review and meta-analysis aimed to synthesize empirical evidence to understand fear of COVID-19 and its associations with mental health-related problems during this pandemic period.

Method: Relevant studies were searched for on five databases (Scopus, ProQuest, EMBASE, PubMed Central, and ISI Web of Knowledge), using relevant terms (COVID-19-related fear, anxiety, depression, mental health-related factors, mental well-being and sleep problems). All studies were included for analyses irrespective of their methodological quality, and the impact of quality on pooled effect size was examined by subgroup analysis.

Results: The meta-analysis pooled data from 91 studies comprising 88 320 participants (mean age 38.88 years; 60.66% females) from 36 countries. The pooled estimated mean of fear of COVID-19 was 13.11 (out of 35), using the Fear of COVID-19 Scale. The associations between fear of COVID-19 and mental health-related factors were mostly moderate (Fisher's z = 0.56 for mental health-related factors; 0.54 for anxiety; 0.42 for stress; 0.40 for depression; 0.29 for sleep problems and -0.24 for mental well-being). Methodological quality did not affect these associations.

Conclusions: Fear of COVID-19 has associations with various mental health-related factors. Therefore, programmes for reducing fear of COVID-19 and improving mental health are needed.

Keywords: COVID-19; anxiety disorders; depressive disorders; fear; sleep disorders.

Fig. 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart of selected studies.

Fig. 2

Results of quality assessment.

Fig. 3

Forest plot displaying the pooled estimated mean of fear of COVID-19.

Fig. 4

Funnel plot assessing publication bias in studies regarding pooled estimated mean of fear of COVID-19.

Fig. 5

Sensitivity analysis plot assessing small study effect in pooled estimated mean of fear of COVID-19.

Fig. 6

Corrected funnel plot assessing publication bias in pooled estimated mean of fear of COVID-19.

Fig. 7

Forest plot displaying the estimated pooled Fisher's z-score in the association between fear of COVID-19 and depression.

Fig. 8

Funnel plot assessing publication bias in studies regarding the association between fear of COVID-19 and depression.

Fig. 9

Sensitivity analysis plot assessing small study effect in the estimated pooled Fisher's z-score in the association between fear of COVID-19 and depression.

Fig. 10

Forest plot displaying the estimated pooled Fisher's z-score in the association between fear of COVID-19 and anxiety.

Fig. 11

Funnel plot assessing publication bias in studies regarding the association between fear of COVID-19 and anxiety.

Fig. 12

Sensitivity analysis plot assessing small study effect in the estimated pooled Fisher's z-score in the association between fear of COVID-19 and anxiety.

Fig. 13

Forest plot displaying the estimated pooled Fisher's z-score in the association between fear of COVID-19 and stress.

Fig. 14

Funnel plot displaying the estimated pooled Fisher's z-score in the association between fear of COVID-19 and stress.

Fig. 15

Corrected funnel plot assessing publication bias in the association between fear of COVID-19 and stress.

Fig. 16

Sensitivity analysis plot assessing small study effect in the estimated pooled Fisher's z-score in the association between fear of COVID-19 and stress.

Fig. 17

Forest plot displaying the estimated pooled Fisher's z-score in the association fear of COVID-19 and sleep problems.

Fig. 18

Funnel plot displaying the estimated pooled Fisher's z-score in the association between fear of COVID-19 and sleep problems.

Fig. 19

Sensitivity analysis plot assessing small study effect in the estimated pooled Fisher's z-score in the association between fear of COVID-19 and sleep problems.

Fig. 20

Forest plot displaying the estimated pooled Fisher's z-score in the association fear of COVID-19 and mental health-related factors. Arrow indicates that the CI does not fit the range of the x-axis.

Fig. 21

Funnel plot displaying the estimated pooled Fisher's z-score in the association between fear of COVID-19 and mental health-related factors.

Fig. 22

Corrected funnel plot assessing publication bias in the association between fear of COVID-19 and mental health-related factors.

Fig. 23

Sensitivity analysis plot assessing small study effect in the estimated pooled Fisher's z-score in the association between fear of COVID-19 and mental health-related factors.

Fig. 24

Forest plot displaying the estimated pooled Fisher's z-score in the association fear of COVID-19 and mental well-being.

Fig. 25

Funnel plot displaying the estimated pooled Fisher's z-score in the association between fear of COVID-19 and mental well-being.

Fig. 26

Sensitivity analysis plot assessing small study effect in the estimated pooled Fisher's z-score in the association between fear of COVID-19 and mental well-being.