Effects of COVID-19 Mental Health Interventions Among Children, Adolescents, and Adults Not Quarantined or Undergoing Treatment Due to COVID-19 Infection: A Systematic Review of Randomised Controlled Trials

  1. Olivia Bonardi
  2. Yutong Wang
  3. Kexin Li
  4. Xiaowen Jiang
  5. Ankur Krishnan
  6. Chen He
  7. Ying Sun
  8. Yin Wu
  9. Jill T. Boruff
  10. Sarah Markham
  11. Danielle B. Rice
  12. Ian Thombs-Vite
  13. Amina Tasleem
  14. Tiffany Dal Santo
  15. Anneke Yao
  16. Marleine Azar
  17. Branka Agic
  18. Christine Fahim
  19. Michael S. Martin
  20. Sanjeev Sockalingam
  21. Gustavo Turecki
  22. Andrea Benedetti
  23. Brett D. Thombs

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Abstract

Our objective was to assess the effects of mental health interventions for children, adolescents, and adults not quarantined or undergoing treatment due to COVID-19 infection.

Methods

We searched 9 databases (2 Chinese-language) from December 31, 2019, to March 22, 2021. We included randomised controlled trials of interventions to address COVID-19 mental health challenges among people not hospitalised or quarantined due to COVID-19 infection. We synthesized results descriptively due to substantial heterogeneity of populations and interventions and risk of bias concerns.

Results

We identified 9 eligible trials, including 3 well-conducted, well-reported trials that tested interventions designed specifically for COVID-19 mental health challenges, plus 6 other trials with high risk of bias and reporting concerns, all of which tested standard interventions (e.g., individual or group therapy, expressive writing, mindfulness recordings) minimally adapted or not specifically adapted for COVID-19. Among the 3 well-conducted and reported trials, 1 ( N  =  670) found that a self-guided, internet-based cognitive-behavioural intervention targeting dysfunctional COVID-19 worry significantly reduced COVID-19 anxiety (standardized mean difference [SMD] 0.74, 95% confidence interval [CI], 0.58 to 0.90) and depression symptoms (SMD 0.38, 95% CI, 0.22 to 0.55) in Swedish general population participants. A lay-delivered telephone intervention for homebound older adults in the United States ( N  =  240) and a peer-moderated education and support intervention for people with a rare autoimmune condition from 12 countries ( N  =  172) significantly improved anxiety (SMD 0.35, 95% CI, 0.09 to 0.60; SMD 0.31, 95% CI, 0.03 to 0.58) and depressive symptoms (SMD 0.31, 95% CI, 0.05 to 0.56; SMD 0.31, 95% CI, 0.07 to 0.55) 6-week post-intervention, but these were not significant immediately post-intervention. No trials in children or adolescents were identified.

Conclusions

Interventions that adapt evidence-based strategies for feasible delivery may be effective to address mental health in COVID-19. More well-conducted trials, including for children and adolescents, are needed.

Article activity feed

  1. Version published to 10.1177/07067437211070648
  2. ScreenIT

    SciScore for 10.1101/2021.05.04.21256517: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    RandomizationEligible Studies: Our main systematic review of interventions included randomised or non-randomised trials of mental health interventions conducted in any population during COVID-19.
    Blinding19 The tool has 7 domains, including random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective outcome reporting, and other sources of bias.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We searched MEDLINE (
    MEDLINE
    suggested: (MEDLINE, RRID:SCR_002185)
    Ovid), PsycINFO (Ovid), CINAHL (EBSCO), EMBASE (Ovid), Web of Science Core Collection: Citation Indexes, China National Knowledge Infrastructure, Wanfang, medRxiv (preprints), and Open Science Framework Preprints
    PsycINFO
    suggested: (PsycINFO, RRID:SCR_014799)
    EMBASE
    suggested: (EMBASE, RRID:SCR_001650)
    We used the 2011 version of the Cochrane Collaboration risk of bias tool.
    Cochrane Collaboration
    suggested: None

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are also limitations. First, we identified only three trials designed specifically to address COVID-19 mental health challenges. Second, the quality and plausibility of results of many trials we encountered was concerning. We were not able to verify the accuracy of what was reported in many trials and thus only described results from those trials in appendices. Third, we are not able to rule out the possibility that publication bias, or even censorship,37 may have influenced our results. Fourth, the evidence base is rapidly evolving, and main results could change, although our living systematic review format will allow rapid updating as this occurs. In summary, we identified 3 trials of interventions designed specifically to meet the needs of the general public or vulnerable populations in COVID-19. Together, they suggest that self-guided online interventions targeted to challenges faced by the public in COVID-19 can effectively support mental health and that lay-or peer-delivered interventions may be an effective strategy for vulnerable populations. Additional trials are needed, particularly to address mental health challenges among children and adolescents and among diverse populations, both currently and as pandemic conditions reside.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.05.04.21256517 on medRxiv