Mental Health Symptom Changes by Sex or Gender Before and During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis.

Abstract

A previous systematic review reported that general mental health and anxiety symptoms, but not depression or stress, worsened more for females or women than for males or men from before to during the COVID-19 pandemic based on 12 studies published up to August 2021. To update a systematic review on sex or gender differences in mental health symptom changes from before to during the COVID-19 pandemic. Medline, PsycINFO, CINAHL, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, medRxiv, and Open Science Framework Preprints were searched from December 31, 2019, to August 31, 2023. Eligible studies included data to calculate changes in general mental health, anxiety symptoms, depression symptoms, or stress from before to during the COVID-19 pandemic by sex or gender. Standardized mean differences (SMDs) for continuous changes and proportions for dichotomous changes were used. Two independent reviewers extracted data and evaluated risk of bias. Data were pooled via random-effects models on March 21, 2024. The main outcome was the differences in SMD changes and proportions between women or females and men or males of mental health symptoms from before the COVID-19 pandemic to during the COVID-19 pandemic. The study included 27 unique cohorts from 14 countries (n = 102-18 127; 31 155 women or females and 30 737 men or males). Differences in SMD change between men and women were minimal and not statistically significant for continuous outcomes of general mental health (0.01 [95% CI, -0.07 to 0.10 and 95% prediction interval (PI), -0.23 to 0.25]; 8 cohorts; 21 762 participants; heterogeneity [I2] = 81.4%), anxiety (0.09 [95% CI, -0.04 to 0.22 and 95% PI, -0.27 to 0.45]; 7 cohorts; 6039 participants; I2 = 68.7%), depression (0.10 [95% CI, -0.00 to 0.20 and 95% PI, -0.23 to 0.43]; 12 cohorts; 9750 participants; I2 = 65.4%), and stress (-0.08 [95% CI, -0.16 to 0.01 and 95% PI, -0.18 to 0.02]; 8 cohorts; 2994 participants; I2 = 0%). Substantial heterogeneity, high risk of bias, or both were present across analyses. No studies reported changes for gender minority groups (eg, transgender, nonbinary). In this systematic review and meta-analysis of sex or gender differences in mental health changes from before to during the COVID-19 pandemic, no significant differences were found. However, findings should be interpreted cautiously and may not apply in all settings due to heterogeneity and methodological limitations of included studies.