Immediate psychological impact on healthcare workers, general population and affected individuals of SARS and COVID-19: A systematic review and meta-analysis (Preprint)

BACKGROUND Any infectious diseases outbreak may lead to negative detrimental psychological impact to individuals and community at large, however; there was no systematic review nor meta-analysis that examined the relationship between early stages of infectious disease outbreaks and mental health in Asia. OBJECTIVE This research gap gave us the impetus to conduct this study which aimed at disentangling the relationship between infectious disease outbreaks and psychological well-being of affected individuals (survivors/suspected cases), healthcare workers and the general public. METHODS A systematic search was conducted using PubMed, EMBASE, Medline, PsycINFO, and CINAHL databases from 1/1/2000 to 1/6/2020 following the PRISMA guidelines. Manual search was also performed to identify additional relevant studies. Due to heterogeneity, a subgroup analysis was also conducted. Joanna Briggs Institute (JBI) Critical Appraisal tools was used to appraise the quality for cohort studies. In this systematic review and meta-analysis, we analyzed the psychological impact on confirmed/suspected cases, healthcare workers and the general public during the Severe Acute Respiratory Syndrome (SARS) outbreak and Coronavirus disease (COVID-19) epidemics. Primary outcomes included prevalence of depression, anxiety, stress, post-traumatic stress disorder, aggression, sleeping problems and psychological symptoms. RESULTS Twenty-three eligible studies (N=27,325) were included. Random effect model was used to analyze the data using STATA. Of these studies, 11 were related to the SARS outbreak and 12 related to COVID-19 outbreaks. The overall prevalence rate of anxiety during SARS and COVID-19 was 37.8% (95% CI: 21.1- 54.5, P<0.001, I2 = 96.9%) and 34.8% (95% CI: 29.1- 40.4), respectively. For depression, the overall prevalence rate during SARS and COVID-19 was 30.9% (95% CI: 18.6-43.1, P<0.001, I2 = 97.3%) and 32.4% (95% CI: 19.8-45.0, P<0.001, I2 = 99.8%), respectively. The overall prevalence rate of stress was 9.4% (95% CI: -0.4 -19.2, P = 0.015, I2 = 83.3%) and 54.1% (95% CI: 35.7- 72.6, P<0.001, I2 = 98.8%) during SARS and COVID-19, respectively. The overall prevalence of PTSD was 15.1% (95% CI: 8.2-22.0, P < 0.001) during SARS epidemic, calculated by random-effects model (P < 0.05), with significant between-study heterogeneity (I2 = 93.5%). CONCLUSIONS The SARS and COVID-19 epidemics have brought about high levels of psychological distress to individuals. Psychological interventions and contingent digital mental health platform should be promptly established nationwide for continuous surveillance of the increasing prevalence of negative psychological symptoms. Health policymakers and mental health experts should jointly collaborate to provide timely, contingent mental health treatment and psychological support to those in need to reduce the global disease burden. CLINICALTRIAL This study was approved by the Human Subjects Ethics Sub-committee of the Hong Kong Polytechnic University (reference no: HSEARS20200227002-01). Participants provided their written informed consent prior to participation online. Participants were assured of their anonymity and confidentiality, and their rights of withdrawal were respected.