key: cord-0814739-izv2jvdi authors: Zhang, S. X.; Batra, K.; Liu, T.; Dong, R. K.; Xu, W.; Yin, A.; Delios, A.; Chen, B. Z.; Chen, R. Z.; Miller, S.; Wan, X.; Chen, J. title: Meta-analytical evidence on mental disorder symptoms during the COVID-19 pandemic in Latin America date: 2021-06-28 journal: nan DOI: 10.1101/2021.06.21.21259299 sha: f7e0f15fbad5de3dccdd7ce1dddb7603c2cad27e doc_id: 814739 cord_uid: izv2jvdi Objective. There is a lack of evidence related to the prevalence of mental disorder symptoms as well as their heterogeneities during the COVID-19 pandemic in Latin America, a continent across the equators. The current study aims to provide meta-analytical evidence on mental disorder symptoms during COVID-19 among frontline healthcare workers, general healthcare workers, the general population, and university students in Latin America. Methods. Bibliographical databases, such as PubMed, Embase, Web of Sciences, PsycINFO, and medRxiv, were systematically searched to identify pertinent studies up to Februry 6, 2021. Two coders performed the screening using predefined eligibility criteria. Studies were assigned quality scores using the Mixed Methods Appraisal Tool. The double data extraction method was used to minimize data entry errors. Results. A total of 33 studies with 101,772 participants in Latin America were identified. The pooled prevalence of anxiety, depression, distress, and insomnia was 32%, 27%, 32%, and 35%, respectively. There was a higher prevalence of mental health symptoms in South America compared to Central America (33% vs. 27%, p <0.001). The pooled prevalence of mental health symptoms in the general population, general healthcare workers, frontline healthcare workers, and students in Latin America was 33%, 31%, 37%, and 36%, respectively. Conclusion. The high yet heterogenous level of prevalence of mental disorder symptoms emphasizes the need for appropriate identification of psychological interventions in Latin America. Eligibility Criteria 97 The search targeted observational studies that assessed the prevalence of psycho-morbid 98 symptoms of anxiety, depression, distress, and insomnia among frontline healthcare workers, 99 general healthcare workers, the general population aged 18 years or above, and university 100 students in Latin America. A priori inclusion criteria were established to identify eligible 101 studies that used established psychometric survey tools, used English language, and were 102 available as full-texts. Studies which targeted other populations, including children, 103 adolescents, and certain subgroups (e.g. pregnant women), were excluded. Other study 104 designs, such as reviews and meta-analyses, qualitative, mixed methods, case reports, studies 105 published only as abstracts, biochemical and experimental studies, or articles lacking the use 106 of psychometric robust instruments or with ambiguous methodology to identify prevalence 107 were also excluded. Studies based on non-Latin American countries were excluded. Studies 108 with unclear methodology and results were reviewed carefully and a researcher (WX) of our 109 study attempted to contact authors to seek the information in several instances: 1) if the study 110 reported estimates for both targeted and excluded populations, posing challenges for us to 111 delineate the prevalence rate for the population of interest to our study; 2) if the study did not 112 report the prevalence as proportions; 3) if the study did not specify cut-off sores for levels of 113 severity; or 4) if the study was missing crucial information such as response rate, duration of 114 data collection, and gender distribution. 115 This meta-analysis is part of a large project on meta-analysis of mental health symptoms 117 during COVID-19. Bibliographic databases, such as PubMed, Embase, PsycINFO, and Web 118 of Sciences, were searched on February 6, 2021. MedRxiv was also searched for preprints. 119 Search algorithms specific to each database were used to yield a comprehensive pool of 120 literature. A detailed search strategy appears in Table S1 . 121 studied insomnia among 11,088 respondents. The Insomnia Severity Index (ISI) was used 237 most often to measure insomnia followed by DSM. In the random-effects model, the pooled 238 prevalence of insomnia was 35% (95% CI: 24%-48%, I 2 = 99.6%) ( Figure 2D ). 239 The overall prevalence of mental health symptoms in frontline healthcare workers, general 241 healthcare workers, the general population, and students in Latin America was 37%, 31%, 242 33%, and 36%, respectively. The overall prevalence rates of mental health symptoms that 243 exceeded the cut-off values of mild, moderate, and severe symptoms were 53%, 28%, and 244 10%, respectively ( Table 2 ). The pooled prevalence rates of mental health symptoms in South 245 America, Central America, countries speaking Spanish, and countries speaking Portuguese 246 were 33%, 27%, 30%, and 36%, respectively (Table 2) . 247 Quality of the Studies 249 Of all studies, 13 studies (39.4%) were of high quality (score of 7), and 20 studies (60.6%) 250 were of medium quality 18 (Table 1) . There were no studies of low quality. The subgroup 251 analysis suggests the studies with high quality reported lower prevalence of mental health 252 issues in Latin America (Table 2) . Based on the evidence of individual studies, our study found a higher prevalence of mental 288 health symptoms among frontline healthcare workers (37%, p<0.001) and university students 289 (36%, p>0.001) than the general population and second-line responders 290 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 28, 2021. There are a few limitations that merit discussion. First our analysis reveals substantial 302 heterogeneities across studies in the type of survey instruments used and the cut-off scores, 303 both of which may affect the interpretation of the findings. Second, not all Latin American 304 countries have been well-studied, therefore our results may have limited generalizability for 305 the less studied nations. Third, a majority of the included studies were cross-sectional, which 306 provides no information on the prevalence over time during the pandemic. In addition, 307 studies included in this meta-analysis relied on self-reported data of psychological symptoms 308 by the participants and hence do not constitute mental health diagnosis from clinicians. 309 Fourth, other outcomes, such as Post-traumatic Stress Syndrome (PTSD), suicidal ideation, 310 and burnout, were not studied in this meta-analysis, leaving opportunities for prospective 311 studies. Last, a language bias is expected in the study because of the language restriction 312 (only English) applied in this study. 313 First, our systematic review and meta-analysis supports evidence-based medicine by 315 revealing a high proportion of mental health symptoms among the general population and 316 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 28, 2021. This meta-analysis, to our knowledge, provides the first pooled estimates of mental health 339 symptoms among key demographic groups during the COVID-19 crisis in Latin America. 340 The meta-analytical findings of this study underscore the high prevalence of mental health 341 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Chen, X., Chen, J., Zhang #One independent sample in a study may report anxiety, depression, and insomnia at the levels of mild 626 above, moderate above, and severe. Therefore, the total number of prevalence is larger than the total 627 number of independent samples. 628 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 28, 2021. ; https://doi.org/10.1101/2021.06.21.21259299 doi: medRxiv preprint Exposure/ Context "Coronavirus" OR "COVID-19" OR "SARS-CoV-2" OR "2019-nCoV" 2 Outcome of interest "depression" OR "depressive symptoms" OR "depressive disorder*" OR "anxiety" OR "social anxiety" or "social phobia" OR "anxiety disorder*" OR "insomnia" OR "sleep disorder" OR "depressive disorder*" OR "distress" 3 Epidemiological phenomenon "prevalence" OR "incidence" OR "rate*" OR "ratio*" OR "epidemiology*" OR "risk factor*" OR "relative risk" OR "odds ratio" OR "risk ratio" OR "disease burden" 4 Language English 5 Time 2020.2.1 -2021.2.6 Intersection of four topics 1 AND 2 AND 3 AND 4 AND 5 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 28, 2021. ; https://doi.org/10.1101/2021.06.21.21259299 doi: medRxiv preprint COVID-19: How to make between-country 347 comparisons COVID-19 pandemic and online learning: The 350 challenges and opportunities Mental health and mental health care in Latin America Early indicators and risk 355 factors associated with mental health problems during COVID-19 quarantine: Is there 356 a relationship with the number of confirmed cases and deaths? The International 357 Assessing the 359 Psychological Impact of COVID-19 among College Students: An Evidence of 15 360 Countries Investigating the 363 Psychological Impact of COVID-19 among Healthcare Workers: A Meta-Analysis Investigating the 367 Psychological Impact of COVID-19 among Healthcare Workers: A Meta-Analysis Healthcare Labor Market in the United States: Lower Paid Workers Experienced 372 Higher Vulnerability and Slower Recovery COVID-19 in Latin America Early Psychological Impact of the COVID-19 Pandemic in Brazil: A National 378 Symptoms related to mental disorder in healthcare workers during the 381 COVID-19 pandemic in Brazil. International Archives of Occupational and 382 Environmental Health Inequalities in health: living conditions and infant mortality in Northeastern Brazil Frequency and correlates of anxiety symptoms during the COVID-19 pandemic in 390 low-and middle-income countries: A multinational study The Mental Health Under the COVID-19 Mental Health During 545 the Covid-19 Outbreak in China: a Meta-Analysis Latin America: COVID-19 cases by country Mental health problems among healthcare workers involved with the COVID-19 553 outbreak Sintomatología 556 asociada a trastornos de salud mental en trabajadores sanitarios en Paraguay: efecto 557 COVID-19 Associations of moderate to 561 vigorous physical activity and sedentary behavior with depressive and anxiety 562 symptoms in self-isolating people during the COVID-19 pandemic: A cross-sectional 563 survey in Brazil Insomnia is associated with worry, 566 cognitive avoidance and low academic engagement in Argentinian university students 567 during the COVID-19 social isolation Exploratory study on 571 the psychological impact of COVID-19 on the general Brazilian population Sooner than you think: A very early affective reaction to the COVID-19 575 pandemic and quarantine in Argentina Pandemic-related 578 behaviours and psychological outcomes; A rapid literature review to explain COVID-579 19 behaviours Physical inactivity and elevated TV-viewing 583 reported changes during the COVID-19 pandemic are associated with mental health: 584 A survey with 43,995 Brazilian adults Global health estimates: Leading causes of death Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed Turnover Intention of Healthcare Workers in Peru by Their Distance to 596 the Epicenter during the COVID-19 Crisis Anxiety, distress, and turnover intention of healthcare workers in 601 Peru by their distance to the epicenter during the COVID-19 crisis Mental health 604 of healthcare professionals during the early stage of the COVID-19 pandemic in 605 Ethiopia Succumbing to the COVID-19 pandemic-Healthcare workers not 609 satisfied and intend to leave their jobs Predictors of Depression and Anxiety Symptoms in Brazil during COVID-19. 614 Early evidence and predictors of mental distress of adults one month in the COVID-617 19 epidemic in Brazil SXZ: Conceptualization, Methodology, Validation, Formal analysis, Investigation, Data curation, Visualization, Writing -original draft, Writing -review & editing, Supervision. KB: Writing -original draft, Writing -review & editing. TL: Investigation (Data) RKD: Investigation (Data) WX: Investigation (Data) AY: Investigation (Data) Writing -review & editing. BZC: Investigation (Data) RZC: Investigation (Data) SM: Investigation (Data) XW: Investigation (Data) JC: Methodology, Validation, Formal analysis, Investigation, Data curation, Visualization, Writing -original draft, Writing -review & editing, Supervision A systematic review and meta-analysis. Psychiatry Research, 291