Impact of COVID-19 mitigations on anxiety and depression amongst students: A systematic review

Usher Network for COVID-19 Evidence Reviews (UNCOVER) group, Bohee Lee, Prerna Krishan, Lara Goodwin, Damilola Iduye, Emma Farfan de los Godos, Jodie Fryer, Kate Gallagher, Kaitlyn Hair, Eimear O'Connell, Kristen Ogarrio, Theresa King, Shifa Sarica, Eileen Scott, Xue Li, Peige Song, Marshall Dozier, Emilie McSwiggan, Kristefer Stojanovski, Evropi TheodoratouRuth McQuillan*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract / Description of output

Background While much research has addressed mental health concerns related to the COVID-19 pandemic, there remains a scarcity of studies specifically exploring the changes in anxiety and depression among university students before and after the implementation of COVID-19 mitigation measures.
Methods In this systematic review and meta-analysis, we searched databases including MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), CINAHL (EBSCO), ERIC (EBSCO), the WHO COVID-19 database, Scopus, and Science Citation Index (Web of Science) as of February 15, 2023. We included studies that used a validated tool to measure changes in anxiety or depression at two distinct time points—before (T1) and during (T2); during (T2) and after (T3); or before (T1) and after (T3) COVID-19 mitigation. The quality of studies was assessed using an adapted Joanna Briggs Institute Checklist for longitudinal studies. Utilizing random-effects models, we synthesized changes in continuous outcomes as standardized mean difference (SMD) with 95% CI and binary outcomes as risk difference (RD) with 95% CI.
Results In total, 15 studies were included in this review, with eight of moderate and seven of high quality. In most of the included studies (n=13), the majority of participants were women. Eleven studies analysed mental health outcomes between T1 and T2 of COVID-19 mitigations. Continuous symptom changes were a minimal or small improvement for anxiety (SMD=-0.03, 95% CI=-0.24 to 0.19, I2=90%); but worsened for depression (SMD=0.26, 95% CI=-0.01 to 0.62). However, the proportions of students reporting moderate-to-severe symptoms, defined by specific cut-offs, increased during COVID-19 mitigation measures for both anxiety (RD=0.17, 95% CI=-0.04 to 0.38, I2=95%) and depression (RD=0.12, 95% CI=0.03 to 0.22, I2=72%). Sensitivity analyses, which distinguished between baseline periods based on awareness of COVID-19, demonstrated an exacerbation of both symptoms when comparing the period before the global awareness of the COVID-19 outbreak (before December 2019) with the period during the implementation of mitigation measures.
Conclusions Mental health outcomes, especially depressive symptoms, were observed to worsen in university students during COVID-19 mitigations. Despite considerable heterogeneity requiring careful interpretation of results, the impact of COVID-19 mitigations on mental health in university students is evident.
Original languageEnglish
Article number06035
Number of pages14
JournalJournal of Global Health
Publication statusPublished - 1 Sept 2023


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