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Meta-Analysis
. 2023 Feb 4;20(4):2765.
doi: 10.3390/ijerph20042765.

The Association of Social Support and Loneliness with Symptoms of Depression, Anxiety, and Posttraumatic Stress during the COVID-19 Pandemic: A Meta-Analysis

Aina Gabarrell-Pascuet  1   2   3   4 , Helena García-Mieres  5   6 , Iago Giné-Vázquez  1   2   3 , Maria Victoria Moneta  1   2   3 , Ai Koyanagi  1   2   3   7 , Josep Maria Haro  1   2   3   4 , Joan Domènech-Abella  1   2   3
Affiliations
Meta-Analysis

The Association of Social Support and Loneliness with Symptoms of Depression, Anxiety, and Posttraumatic Stress during the COVID-19 Pandemic: A Meta-Analysis

Aina Gabarrell-Pascuet et al. Int J Environ Res Public Health. .

Abstract

Background: Research suggests that changes in social support and loneliness have affected mental disorder symptoms during the COVID-19 pandemic. However, there are a lack of studies comparing the robustness of these associations.

Aims: The aims were to estimate the strength of the associations of loneliness and social support with symptoms of depression, anxiety, and posttraumatic stress during the COVID-19 pandemic (2020-2022) in the general population.

Method: The method entailed a systematic review and random-effects meta-analysis of quantitative studies.

Results: Seventy-three studies were included in the meta-analysis. The pooled correlations of the effect size of the association of loneliness with symptoms of depression, anxiety, and posttraumatic stress were 0.49, 0.40, and 0.38, respectively. The corresponding figures for social support were 0.29, 0.19, and 0.18, respectively. Subgroup analyses revealed that the strength of some associations could be influenced by the sociodemographic characteristics of the study samples, such as age, gender, region, and COVID-19 stringency index, and by methodological moderators, such as sample size, collection date, methodological quality, and the measurement scales.

Conclusions: Social support had a weak association with mental disorder symptoms during the COVID-19 pandemic while the association with loneliness was moderate. Strategies to address loneliness could be highly effective in reducing the impact of the pandemic on social relationships and mental health.

Keywords: COVID-19; anxiety symptoms; depressive symptoms; loneliness; posttraumatic stress symptoms; social support.

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Conflict of interest statement

The authors declare that they have no potential conflict of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
PRISMA flow diagram outlining results of the study selection process.
Figure 2
Figure 2
Forest plot of the Omnibus Test for the correlations of loneliness with mental disorder symptoms. References: Banik, 2022 [56]; Boursier, 2020 [59]; Boyraz, 2020 [60]; Bulut, 2021 [61]; Ciccarelli, 2022 [63]; Cordaro, 2021 [64]; Deimel, 2022 [65]; Gilbar, 2022 [70]; Gonçalves, 2020 [71]; González-Sanguino, 2020 [72]; Gregory, 2021 [73]; Grey, 2020 [74]; Groarke, 2021 [75]; Hajduk, 2022 [77]; Hesse, 2021 [78]; Hettich, 2022 [79]; Hoffart, 2020 [80]; Horigian, 2021 [81]; Kiernan, 2021 [87]; Kim, 2021 [88]; Kobos, 2022 [89]; Kochel, 2022 [90]; Kohls, 2021 [91]; Lim, 2022 [94]; Liu, 2020 [4]; Lv, 2022 [95]; MacDonald, 2022 [98]; Mann, 2022 [99]; McQuaid, 2021 [100]; Megalakaki, 2021 [101]; Orozco-Vargas, 2022 [104]; Owczarek, 2022 [106]; Rossi, 2020 [108]; Rufarakh, 2021 [109]; Stevens, 2021 [115]; Stickley, 2022 [116]; Torres, 2022 [119]; Vallières, 2022 [120]; Varma, 2021 [121]; Velotti, 2021 [122]; Wu, 2022 [84].
Figure 2
Figure 2
Forest plot of the Omnibus Test for the correlations of loneliness with mental disorder symptoms. References: Banik, 2022 [56]; Boursier, 2020 [59]; Boyraz, 2020 [60]; Bulut, 2021 [61]; Ciccarelli, 2022 [63]; Cordaro, 2021 [64]; Deimel, 2022 [65]; Gilbar, 2022 [70]; Gonçalves, 2020 [71]; González-Sanguino, 2020 [72]; Gregory, 2021 [73]; Grey, 2020 [74]; Groarke, 2021 [75]; Hajduk, 2022 [77]; Hesse, 2021 [78]; Hettich, 2022 [79]; Hoffart, 2020 [80]; Horigian, 2021 [81]; Kiernan, 2021 [87]; Kim, 2021 [88]; Kobos, 2022 [89]; Kochel, 2022 [90]; Kohls, 2021 [91]; Lim, 2022 [94]; Liu, 2020 [4]; Lv, 2022 [95]; MacDonald, 2022 [98]; Mann, 2022 [99]; McQuaid, 2021 [100]; Megalakaki, 2021 [101]; Orozco-Vargas, 2022 [104]; Owczarek, 2022 [106]; Rossi, 2020 [108]; Rufarakh, 2021 [109]; Stevens, 2021 [115]; Stickley, 2022 [116]; Torres, 2022 [119]; Vallières, 2022 [120]; Varma, 2021 [121]; Velotti, 2021 [122]; Wu, 2022 [84].
Figure 3
Figure 3
Forest plot of the Omnibus Test for the correlations of social support with mental disorder symptoms. References: Ao, 2020 [55]; Barros, 2021 [57]; Bourion-Bédès, 2021 [58]; Chen, 2021 [62]; Domènech-Abella, 2021 [66]; Fu, 2021 [67]; Gambin, 2021 [68]; Gan, 2022 [69]; González-Sanguino, 2020 [72]; Gregory, 2021 [73]; Grey, 2020 [74]; Guo, 2021 [76]; Horigian, 2021 [81]; Hu, 2022 [82]; Huang, 2021 [83]; Jané-Llopis, 2021 [85]; Jiang, 2022 [86]; Kohls, 2021 [91]; Lelisho, 2022 [92]; Li, 2021 [93]; Liu, 2020 [4]; Ma, 2020 [97]; Mei, 2022 [102]; Oginni, 2021 [103]; Oryan, 2021 [105]; Özmete, 2020 [107]; Sahin, 2022 [110]; Samuelson, 2021 [111]; Schmitt, 2021 [112]; Shu, 2022 [113]; Simon, 2021 [114]; Sun, 2021 [117]; Yu, 2022 [118]; Torres, 2022 [119]; Yang, 2021 [123]; Yu, 2021 [96]; Zhang, 2022 [124]; Zhou, 2020 [125]; Zhuo, 2021 [126].
Figure 3
Figure 3
Forest plot of the Omnibus Test for the correlations of social support with mental disorder symptoms. References: Ao, 2020 [55]; Barros, 2021 [57]; Bourion-Bédès, 2021 [58]; Chen, 2021 [62]; Domènech-Abella, 2021 [66]; Fu, 2021 [67]; Gambin, 2021 [68]; Gan, 2022 [69]; González-Sanguino, 2020 [72]; Gregory, 2021 [73]; Grey, 2020 [74]; Guo, 2021 [76]; Horigian, 2021 [81]; Hu, 2022 [82]; Huang, 2021 [83]; Jané-Llopis, 2021 [85]; Jiang, 2022 [86]; Kohls, 2021 [91]; Lelisho, 2022 [92]; Li, 2021 [93]; Liu, 2020 [4]; Ma, 2020 [97]; Mei, 2022 [102]; Oginni, 2021 [103]; Oryan, 2021 [105]; Özmete, 2020 [107]; Sahin, 2022 [110]; Samuelson, 2021 [111]; Schmitt, 2021 [112]; Shu, 2022 [113]; Simon, 2021 [114]; Sun, 2021 [117]; Yu, 2022 [118]; Torres, 2022 [119]; Yang, 2021 [123]; Yu, 2021 [96]; Zhang, 2022 [124]; Zhou, 2020 [125]; Zhuo, 2021 [126].
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