This work is the first systematic review and meta-analysis on the prevalence of stress, anxiety and depression in the general population following the COVID-19 pandemic. This study has followed the appropriate methods of secondary data analysis for examining 17 related research works. The articles used in this study were all cross-sectional. According to our analysis, the prevalences of stress, anxiety, and depression, as a result of the pandemic in the general population, are 29.6, 31.9 and 33.7% respectively.
The emergence of COVID-19, with its rapid spread, has exacerbated anxiety in populations globally, leading to mental health disorders in individuals. This has even caused cases of stereotyping and discrimination [37, 38]. Therefore, it is necessary to examine and recognize people’s mental states in this challenging, destructive and unprecedented time. Evidence suggests that individuals may experience symptoms of psychosis, anxiety, trauma, suicidal thoughts, and panic attacks [39, 40]. Recent studies have similarly shown that COVID-19 affects mental health outcomes such as anxiety, depression, and post-traumatic stress symptoms [22, 24, 31]. COVID-19 is novel and unexplored, and its rapid transmission, its high mortality rate, and concerns about the future can be the causes of anxiety [41]. Anxiety, when above normal, weakens body’s immune system and consequently increases the risk of contracting the virus [39].
Research shows that people who follow COVID-19 news the most, experience more anxiety [39]. Most of the news published on COVID-19 are distressing, and sometimes news are associated with rumors, which is why anxiety levels rise when a person is constantly exposed to COVID-19 news [21]. Misinformation and fabricated reports about COVID-19 can exacerbate depressive symptoms in the general population [23]. The latest and most accurate information, such as the number of people who have improved and the progress of medications and vaccines, can reduce anxiety levels [42]. In this regard, mental health professionals recommend promoting healthy behaviors, avoiding exposure to negative news, and using alternative communication methods such as social networks and digital communication platforms to prevent social isolation [41].
Such conditions are even more significant for populations with poorer health conditions. In the under-developed and developing countriesthe epidemic conditions of COVID-19 impose greater psychological effects on the population, given that these countries are also affected by many other infectious diseases. Uncertainty about health status, follow-up of patients, treatment care, and inefficiency in these communities can also increase the vulnerability of such communities to the psychological effects of COVID-19 [21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36].
The results of epidemiological studies show that women are at a higher risk of depression [43]. Women are more vulnerable to stress and post-traumatic stress disorder than men [44]. In recent studies, the prevalence of anxiety and depression and stress during COVID-19 pandemic is shown to be higher in women than in men [21, 23, 27, 31].
Aging increases the risk of COVID-19 infection and mortality, however, the results of existing studies show that during the pandemic, the levels of anxiety, depression and stress are significantly higher in the age group of 21–40 years. The main reason for this seems to be that this age group are concerned over the future consequences and economic challenges caused by the pandemic, as they are key active working forces in a society and are, therefore, mostly affected by redundancies and business closures [21, 22, 25]. Some researchers have argued that a greater anxiety among young people may be due to their greater access to information through social media, which can also cause stress [45].
During the COVID-19 pandemic, people with higher levels of education had greater levels of anxiety, depression, and stress. According to recent studies, during the COVID-19 pandemic, there is an association between education levels, and anxiety and depression levels [21, 31]. According to a study which was conducted in China, the higher prevalence of mental symptoms among people with higher levels of education is probably due to this group’s high self-awareness in relation to their own health [46]. In addition, anxiety levels are significantly higher in people with at least one family member, relative, or a friend with the COVID-19 disease [21, 24, 42].
Recent studies have revealed an association between medical history and increased anxiety and depression caused by the COVID-19 spread [36]. Previous research works had shown that medical history and chronic illnesses are associated with increased psychiatric distress levels [42, 47]. People who have a history of medical problems and are also suffering from poor health may feel more vulnerable to a new disease [48].
Governments and health officials must provide accurate information on the state of the pandemic, refute rumors in a timely manner, and reduce the impact of misinformation on the general public’s emotional state. These high level activities result in a sense of public security and potential psychological benefits. Governments and health authorities need to ensure that infrastructure is provided to produce and supply adequate amounts of personal protective equipment (PPE), e.g. masks, hand sanitizers and other personal hygiene products during the COVID-19 pandemic. Optimistic and positive thoughts and attitude toward the COVID-19 spread are also protective factors against depression and anxiety [23]. The use of electronic devices and applications to provide counseling can reduce the psychological damages caused by COVID-19, and can consequently promote social stability [31]. The rise in the number of infections and mortalities are likely to affect the symptoms of depression and anxiety. During the H1N1 epidemic, anxiety reached the highest point at the peak of the epidemic and decreased with its decline [49].
Our research has a few limitations; All of the studies in our analysis were periodic, which could reflect the psychological state of the population over a period of time. However, psychological states change with the passage of time and with the alterations in one’s surrounding environment. Therefore, it is necessary to portray the psychological impacts of the COVID-19 catastrophe over a longer and more forward-looking period. Follow-up studies can be helpful in clarifying the mental state of the population in future. Although several research works in this meta-analysis have used the same tests for population screening, yet there were a few studies that followed different scales to assess stress, anxiety and depression.
