A Systematic Review and Meta-Analysis of Symptoms of Anxiety, Depression, and Insomnia in Spain in the COVID-19 Crisis

  1. Stephen X. Zhang
  2. Richard Z. Chen
  3. Wen Xu
  4. Allen Yin
  5. Rebecca Kechen Dong
  6. Bryan Z. Chen
  7. Andrew Yilong Delios
  8. Saylor Miller
  9. Roger S. McIntyre
  10. Wenping Ye
  11. Xue Wan

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Abstract

Background: General population, frontline healthcare workers (HCWs), and adult students in Spain are at risk of anxiety, depression, and insomnia symptoms during the COVID-19 crisis. A meta-analysis of the individual studies on these symptoms would provide systematic evidence to aid policymakers and researchers in focusing on prevalence, risk, and best interventions. Objective: This paper aims to be the first meta-analysis and systematic review to calculate the prevalence of anxiety, depression, and insomnia symptoms in Spain’s adult population (general population, frontline healthcare workers (HCWs), and adult students) during the Covid-19 epidemic. Method: Random-effect meta-analysis was used to estimate the prevalence of anxiety, depression, and insomnia. Results: The meta-analysis includes 28 studies with 38 individual samples in Spain. The pooled prevalence of anxiety symptoms in 22 studies comprising a sample population of 82,024 was 20% (95% CI: 15–25%), that of depression symptoms in 22 articles with a total sample comprising 82,890 individuals was 22% (95% CI: 18–28%), and that of insomnia symptoms in three articles with a sample population of 745 was 57% (95% CI: 48–66%. Conclusions: The accumulative evidence reveals that adults in Spain suffered higher prevalence rates of mental symptoms during the COVID-19 crisis, with a significantly higher rate relative to other countries such as China. Our synthesis also reveals a relative lack of studies on frontline and general HCWs in Spain.

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  1. Version published to 10.3390/ijerph19021018
  2. ScreenIT

    SciScore for 10.1101/2021.04.11.21255274: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableWe excluded studies that had populations of children, adolescents, or adult subpopulations (e.g., pregnant women).

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We searched the following databases for studies that fit our criteria: PubMed, Embase, PsycINFO, and Web of Science from Feb 2020 to Feb 6th, 2021.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    Embase
    suggested: (EMBASE, RRID:SCR_001650)
    PsycINFO
    suggested: (PsycINFO, RRID:SCR_014799)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    4.4 Limitations and future research: Our meta-analyses had several limitations. Among the 41 samples included in this meta-analysis, 32 samples (78.1%) investigated the prevalence of the general population in Spain with only 4 samples on frontline HCWs and 5 samples on students. The lack of sufficient data from HCWs and students limited the reliability of the pooled prevalence rates. Secondly, we found that articles using different instruments and inconsistent cut-off scores, which makes it difficult and often impossible to accumulate and compare research findings. For example, the prevalence of anxiety measured by GAD-7 (31%) and DASS-21 (15%), the two most popular scales, differed significantly in Spain (Appendix 2). Additionally, several articles reported an “overall” prevalence without indicating the cut-off points used which makes it impossible to know which outcome level they used. We suggest future research to specify the severity levels and the cut-off points used, especially to report overall prevalence. Third, non-English articles were not included and hence could create biases in our study.

    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.

    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 10.1101/2021.04.11.21255274 on medRxiv