Comparison of Mental Health Symptom Changes from pre-COVID-19 to COVID-19 by Sex or Gender: A Systematic Review and Meta-analysis (preprint)

Background: Women and gender-diverse individuals face disproportionate socioeconomic burden during COVID-19. We compared mental health symptom changes since pre-COVID-19 by sex or gender. Methods: We searched MEDLINE, PsycINFO, CINAHL, EMBASE, Web of Science, China National Knowledge Infrastructure, Wanfang, medRxiv, and Open Science Framework December 31, 2019 to March 22, 2021 for studies that reported mental health outcomes prior to and during COVID-19 by sex or gender. We conducted restricted maximum-likelihood random-effects meta-analyses. Results: All 11 included studies (9 unique cohorts) compared females or women to males or men; none included gender-diverse individuals. Continuous symptom change differences were not statistically significant for depression (standardized mean difference [SMD]= 0.15, 95% CI -0.09 to 0.39; 3 studies, 4,159 participants; I2=77%) and stress (SMD= -0.09, 95% CI -0.21 to 0.02; 3 studies, 1,217 participants; I2=0%), but anxiety (SMD= 0.14, 95% CI 0.01 to 0.26; 3 studies, 4,028 participants; I2=34%) and general mental health (SMD= 0.15, 95% CI 0.12 to 0.18; 2 studies, 15,590 participants; I2=0%) worsened more among females or women than males or men. There were no significant differences in changes in proportion above a cut-off: anxiety (difference= 0.00, 95% CI -0.01 to 0.02; 2 studies, 6,684 participants; I2=0%), depression (difference= 0.12, 95% CI -0.04 to 0.28; 1 study, 217 participants), general mental health (difference= -0.03, 95% CI -0.09 to 0.04; 3 studies, 18,985 participants; I2=94%), stress (difference= 0.04, 95% CI -0.11 to 0.18; 1 study, 217 participants). Interpretation: Mental health outcomes did not differ or were somewhat worse among women than men.

Comparison of Mental Health Symptoms prior to and during COVID-19: Evidence from a Living Systematic Review and Meta-analysis (preprint)

ABSTRACT Objectives The rapid pace, high volume, and limited quality of mental health evidence being generated during COVID-19 poses a barrier to effective decision-making. The objective of the present report is to compare mental health outcomes assessed during COVID-19 to outcomes prior to COVID-19 in the general population and other population groups. Design Living systematic review. Data Sources MEDLINE (Ovid), PsycINFO (Ovid), CINAHL (EBSCO), EMBASE (Ovid), Web of Science Core Collection: Citation Indexes, China National Knowledge Infrastructure, Wanfang, medRxiv (preprints), and Open Science Framework Preprints (preprint server aggregator). The initial search was conducted on April 13, 2020 with ongoing weekly updates. Eligibility criteria for selecting studies For this report, we included studies that compared general mental health, anxiety symptoms, or depression symptoms, assessed January 1, 2020 or later, to the same outcomes collected between January 1, 2018 and December 31, 2019. We required ≥ 90% of participants pre-COVID-19 and during COVID-19 to be the same or the use of statistical methods to address missing data. For population groups with continuous outcomes for at least three studies in an outcome domain, we conducted restricted maximum-likelihood random-effects meta-analyses. Results As of March 22, 2021, we had identified 36 unique eligible studies with data from 33 cohorts. All reported COVID-19 outcomes between March and June 2020, and 3 studies also reported outcomes between September and November 2020. Estimates of changes in general mental health were close to zero in the general population (standardized mean difference [SMD] = 0.02, 95% CI -0.11 to 0.16, I 2 = 94.6%; 4 studies, N = 19,707) and among older adults (SMD = 0.02, 95% CI -0.11 to 0.16, I 2 = 90.4%; 4 studies, N = 5,520) and university students (SMD = -0.01, 95% CI -0.33 to 0.30, I 2 = 92.0%; 3 studies, N = 3,372). Changes in anxiety symptoms were close to zero and not statistically significant in university students (SMD = 0.00, 95% CI - 0.35 to 0.36, I 2 = 95.4%; 5 studies, N = 1,537); women or females (SMD = 0.02, 95% CI -0.35 to 0.39, I 2 = 92.3%; 3 studies, N = 2,778); and men or males (SMD = 0.07, 95% CI -0.01 to 0.15; I 2 = 0.01%; 3 studies, N = 1,250); anxiety symptoms increased, however, among people with pre-existing medical conditions (SMD = 0.27, 95% CI 0.01 to 0.54, I 2 = 91.0%; 3 studies, N = 2,053). Changes in depression symptoms were close to zero or small and not statistically significant among university students (SMD = 0.19, 95% CI -0.08 to 0.45, I 2 = 91.8%; 5 studies, N = 1,537); people with pre-existing medical conditions (SMD = 0.01, 95% CI -0.15 to 0.17, I 2 = 14.9%; 3 studies, N = 2,006); women or females (SMD = 0.21, 95% CI -0.14 to 0.55, I 2 = 91.2%; 3 studies, N = 2,843); and men or males (SMD = 0.00, 95% CI -0.21 to 0.22; I 2 = 92.3%; 4 studies, N = 3,661). In 3 studies with data from both March to June 2020 and September to November 2020, symptoms were unchanged from pre-COVID-19 at both time points or there were increases at the first assessment that had largely dissipated by the second assessment. Conclusions Evidence does not suggest a widespread negative effect on mental health symptoms in COVID-19, although it is possible that gaps in data have not allowed identification of changes in some vulnerable groups. Continued updating is needed as evidence accrues. Funding Canadian Institutes of Health Research (CMS-171703; MS1-173070); McGill Interdisciplinary Initiative in Infection and Immunity Emergency COVID-19 Research Fund (R2-42). Registration PROSPERO (CRD42020179703); registered on April 17, 2020.

Effects of COVID-19 Mental Health Interventions among Community-based Children, Adolescents, and Adults: A Living Systematic Review of Randomised Controlled Trials (preprint)

Background: Scalable interventions to address COVID-19 mental health are needed. Our objective was to assess effects of mental health interventions for community-based children, adolescents, and adults. Methods: We searched 9 databases (2 Chinese-language) from December 31, 2019 to March 22, 2021. We included randomised controlled trials with non-hospitalised, non-quarantined participants of interventions to address COVID-19 mental health challenges. We synthesized results descriptively but did not pool quantitatively due to substantial heterogeneity of populations and interventions and concerns about risk of bias. Findings: We identified 9 eligible trials, including 3 well-conducted, well-reported trials that tested interventions designed specifically for COVID-19 mental health challenges, plus 6 trials of standard interventions (e.g., individual or group therapy, expressive writing, mindfulness recordings) minimally adapted for COVID-19, all with risk of bias concerns. Among the 3 COVID-19-specific intervention trials, one (N = 670) found that a self-guided, internet-based cognitive-behavioural intervention targeting dysfunctional COVID-19 worry significantly reduced COVID-19 anxiety (standardized mean difference [SMD] 0.74, 95% CI 0.58 to 0.90) and depression symptoms (SMD 0.38, 95% CI 0.22 to 0.55) in Swedish general population participants. A lay-delivered telephone intervention for homebound older adults in the United States (N = 240) and a peer-moderated education and support intervention for people with a rare autoimmune condition from 12 countries (N = 172) significantly improved anxiety (SMD 0.35, 95% CI 0.09 to 0.60; SMD 0.31, 95% CI 0.03 to 0.58) and depressive symptoms (SMD 0.31, 95% CI 0.05 to 0.56; SMD 0.31, 95% CI 0.07 to 0.55) 6-weeks post-intervention, but these were not significant immediately post-intervention. No trials in children or adolescents were identified. Interpretation: Internet-based programs for the general population and lay- or peer-delivered interventions for vulnerable groups may be effective, scalable options for public mental health in COVID-19. More well-conducted trials, including for children and adolescents, are needed.

Study on the expression levels of antibodies against SARS-CoV-2 at different period of disease and its related factors in 192 cases of COVID-19 patients (preprint)

Background: In 2020 the current outbreak of Coronavirus Disease 2019(COVID-19) has constituted a global pandemic. But the question about the immune mechanism of patients with COVID-19 is unclear and cause particular concern to the world. Here, we launched a follow-up analysis of antibodies against SARS-CoV-2 of 192 COVID-19 patients, aiming to depict a kinetics profile of antibodies against SARS-CoV-2 and explore the related factors of antibodies expression against SARS-CoV-2 in COVID-19 patient. Methods: A total of 192 COVID-19 patients enrolled in the designated hospital of Guangzhou , Guangzhou Eighth People's Hospital, from January to February 2020 were selected as the study cohort. A cohort of 130 COVID-19 suspects who had been excluded from SARS-CoV-2 infected by negative RT-PCR result and 209 healthy people were enrolled in this study. Detection of IgM and IgG against SARS-CoV-2 were performed by Chemiluminescence immunoassay in different groups . Results: It has been found that the seroconversion time of IgM against SARS-CoV-2 in most patients was 5-10 days after the symptoms onset , and then rose rapidly, reaching a peak around 2 to 3 weeks, and the median peak concentration was 2.705 AU / mL. The peak of IgM maintained within one week, and then enters the descending channel. IgG seroconverted later than or synchronously with IgM, reaching peaks around 3 to 4 weeks.The median peak concentration was 33.998AU / ml,which was higher than that of IgM . IgM titers begins to gradually decrease after reaching the peak in the 4th week, after the 8th week, a majority of IgM in patient's serum started to turn negative. On the contrary, titers of IgG began to decline slightly after the fifth week, and more than 90% of results of patients were positive after 8 weeks. Additionally, the concentration of antibodies positively correlated with the severity of the disease and the duration of virus exist in host. Conclusion: We depict a kinetics profile of antibodies against SARS-CoV-2 in COVID-19 patients and found out that the levels of antibodies were related to the disease severity,age, gender and virus clearance or continuous proliferation of COVID-19 patients.