Mental health symptom changes by sex or gender during COVID-19 compared to pre-pandemic: a systematic review and meta-analysis update

KEY POINTSO_ST_ABSQuestionC_ST_ABSDid changes in mental health symptoms from pre-COVID-19 to during the pandemic differ by sex or gender? FindingsIn this systematic review and meta-analysis study of findings from 27 unique cohorts, changes from before to during the COVID-19 pandemic in mental health symptoms, including general mental health, anxiety, depression, and stress, were not statistically significantly different by sex or gender. MeaningThere were not likely substantial sex and gender differences in mental health symptom changes during the COVID-19 pandemic. ImportanceConcerns remain about whether COVID-19 affected mental health differently across sex or gender groups. We previously reported that changes in general mental health and anxiety symptoms, but not depression or stress, worsened more for females or women than males or men, but that was based on 12 studies published up to August 2021. ObjectiveTo investigate the sex or gender differences in mental health symptoms before and during the COVID-19 pandemic with updated evidence. Data SourcesMEDLINE, PsycINFO, CINAHL, EMBASE, Web of Science, China National Knowledge Infrastructure, Wanfang, medRxiv, Open Science Framework Preprints searched to August 31, 2023. Study SelectionEligible studies included change data for general mental health, anxiety symptoms, depression symptoms, or stress from pre-to during COVID-19 by sex or gender. Two independent reviewers reviewed citations for eligibility. Data Extraction and SynthesisStandardized mean differences (SMDs) were extracted for changes of continuous outcomes and proportions for dichotomous outcomes. Two independent reviewers completed data extraction and risk of bias assessment with an adapted Joanna Briggs Institute Checklist for Prevalence Studies. Data were pooled by random-effects models. Main Outcomes and MeasuresDifference in change of SMDs and proportions between sex or gender groups pre-COVID-19 to COVID-19. ResultsWe included data from 27 unique cohorts (N = 102 to 18,127). Change differences by sex or gender were minimal and not statistically significant: general mental health (SMD changewomen-men = 0.01, 95% confidence interval [CI]:-0.07 to 0.10; proportion changewomen-men = -0.03, 95% CI: -0.08 to 0.03), anxiety (SMD changewomen-men = 0.09, 95% CI -0.04 to 0.22; proportion changewomen-men = -0.05, 95% CI: -0.20 to 0.11), depression (SMD changewomen-men = 0.10, 95% CI: -0.00 to 0.20; proportion changewomen-men = -0.13, 95% CI: -0.81 to 0.55), and stress (SMD changewomen-men = -0.08, 95% CI -0.16 to 0.01, proportion changewomen-men = 0.04, 95% CI -0.10 to 0.17). No studies reported eligible mental health outcomes for gender minorities. Conclusion and RelevanceWe found no significant sex or gender differences in mental health changes. Future research should report outcomes for gender minority groups, even if small numbers, to support evidence synthesis. RegistrationPROSPERO (CRD42020179703)