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Meta-Analysis
. 2024 Jun;115(3):408-424.
doi: 10.17269/s41997-024-00865-x. Epub 2024 Mar 13.

Mental health of Canadian youth: A systematic review and meta-analysis of studies examining changes in depression, anxiety, and suicide-related outcomes during the COVID-19 pandemic

Marie-Claude Geoffroy  1   2 , Nicholas Chadi  3 , Samantha Bouchard  4 , Julia Fuoco  5   6 , Elise Chartrand  4 , Tianna Loose  4   7 , Anthony Sciola  4 , Jill T Boruff  8 , Srividya N Iyer  5   6   9 , Ying Sun  10 , Jean-Philippe Gouin  11 , Sylvana M Côté  12 , Brett D Thombs  5   9   10   13   14   15
Affiliations
Meta-Analysis

Mental health of Canadian youth: A systematic review and meta-analysis of studies examining changes in depression, anxiety, and suicide-related outcomes during the COVID-19 pandemic

Marie-Claude Geoffroy et al. Can J Public Health. 2024 Jun.

Abstract
in English, French

Objectives: This systematic review and meta-analysis aims to describe Canadian youth mental health during the COVID-19 pandemic, focusing on changes in anxiety and depressive symptoms and suicidality.

Methods: We searched four databases up to February 2023 for longitudinal or repeated cross-sectional studies reporting on changes in depressive and anxiety symptoms, suicidality, or related services utilization among young people under 25 years old residing in Canada during the COVID-19 pandemic. Random-effects meta-analyses were performed for studies comparing depressive and anxiety symptoms from before to during the first, second, and third COVID-19 waves (up to June 2021), and between COVID-19 waves. Other studies were described narratively. Risk of bias was assessed using an adapted Joanna Briggs Institute Checklist.

Synthesis: Of the 7916 records screened, 35 articles met inclusion criteria for this review. Included studies were highly heterogeneous in design, population, and type of change investigated, and many had a high risk of bias. The meta-analyses found that depressive symptoms worsened minimally from pre-pandemic to wave 1 but returned to pre-pandemic levels by wave 2. Anxiety symptoms were broadly comparable from pre-pandemic to waves 1 and 2 but worsened from waves 1 to 3 and from pre-pandemic to wave 1 for girls. The narrative review included several studies that provided inconclusive evidence of increases in services utilization.

Conclusion: The current evidence is limited and highly heterogeneous, making it insufficient to draw definitive conclusions regarding the short- to medium-term impact of the pandemic on youth mental health in Canada. Obtaining better mental health surveillance among Canadian youth is imperative.

RéSUMé: OBJECTIFS: Cette revue systématique et méta-analyse vise à décrire la santé mentale des jeunes Canadiens pendant la pandémie de COVID-19 en ce qui concerne les changements dans les symptômes d’anxiété et de dépression et la suicidalité. MéTHODES: Nous avons cherché dans quatre bases de données, jusqu’en février 2023, des études longitudinales ou transversales répétées portant sur l’évolution des symptômes dépressifs et anxieux, de la suicidalité ou de l’utilisation des services en santé mentale chez les jeunes de moins de 25 ans résidant au Canada pendant la pandémie de COVID-19. Des méta-analyses à effets aléatoires ont été réalisées pour les études comparant les symptômes dépressifs et anxieux avant et pendant les première, deuxième et troisième vagues du COVID-19 (jusqu’en juin 2021), ainsi qu’entre les vagues de COVID-19. Les autres études ont été décrites de manière narrative. Le risque de biais a été évalué à l’aide d’une liste de contrôle adaptée du Joanna Briggs Institute. SYNTHèSE: Sur les 7 916 dossiers examinés, 35 articles répondaient aux critères d’inclusion de la présente étude. Les études retenues sont très hétérogènes en termes de conception, de population et de type de changement étudié, et un grand nombre d’entre elles présentent un risque élevé de biais. Les méta-analyses révèlent que les symptômes dépressifs se sont légèrement aggravés entre la période prépandémique et la première vague, mais qu’ils sont revenus aux niveaux prépandémiques lors de la deuxième vague. Les symptômes d’anxiété sont globalement comparables entre la période prépandémique et les vagues 1 et 2, mais se sont aggravés entre les vagues 1 et 3 et entre la période prépandémique et la vague 1 pour les filles. La revue narrative porte sur plusieurs études qui ont fourni des preuves non concluantes de l’augmentation de l’utilisation des services en santé mentale. CONCLUSION: Les données actuelles sont limitées et très hétérogènes, ce qui ne permet pas de tirer des conclusions définitives quant à l’impact à court et moyen terme de la pandémie sur la santé mentale des jeunes au Canada. Il est impératif d’améliorer la surveillance de la santé mentale des jeunes Canadiens.

Keywords: Anxiety; COVID-19; Canada; Depression; Suicide; Youth.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram for studies included in systematic review
Fig. 2
Fig. 2
Forest plot of changes in depressive symptoms among Canadian youth aged 0–25 years per COVID-19 waves. Note: Data collection times. Before: before COVID-19 (if more than one data collection before COVID-19, the most recent point was selected); w1, wave 1 (Feb 2020–Aug 2020); w2, wave 2 (Sept 2020–Mid-Feb 2021); w3, wave 3 (Mid-Feb 2021–June 2021). When dates of data collection point covered more than one wave, the wave including the greater number of months was selected. This applied to the following studies: Gohari et al. (2023) (wave 2); Kwok et al. (2022) (wave 2); Spettigue et al. (2021) (wave 1); Rizeq et al. (2021) (wave 1). In one study (Raymond et al., 2022), two data collections were taken within a same wave; thus, the mean of scores was used (wave 2). For studies with more than two data collections, the authors’ names are followed by (1) before-COVID-19 data, (2) second point of data collection, or (3) third point of data collection. Comparisons between before COVID-19 vs wave 3 and wave 2 vs wave 3 were not possible because only one study was available, respectively
Fig. 3
Fig. 3
Forest plot of changes in anxiety symptoms among Canadian youth aged 0–25 years per COVID-19 waves. Note: Data collection times. Before: before COVID-19 (if more than one data collection before COVID-19, the most recent point was selected); w1, wave 1 (Feb 2020–Aug 2020); w2, wave 2 (Sept 2020–Mid-Feb 2021); w3, wave 3 (Mid-Feb 2021–June 2021). When dates of data collection point covered more than one wave, the wave including the greater number of months was selected. This applied to the following studies: Gohari et al. (2023) (wave 2); Kwok et al. (2022) (wave 2); Spettigue et al. (2021) (wave 1); Rizeq et al. (2021) (wave 1). In one study (Raymond et al., 2022), two data collections were taken within a same wave; thus, the mean of scores was used (wave 2). For studies with more than two data collections, the authors’ names are followed by (1) before-COVID-19 data, (2) second point of data collection, or (3) third point of data collection. Comparisons between before COVID-19 vs wave 3 and wave 2 vs wave 3 were not possible because only one study was available, respectively
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