Background COVID-19 physical distancing measures can potentially increase the likelihood of mental disorders. It is unknown whether these measures are associated with depression and anxiety. Objectives To investigate meta-analytic global levels of depression and anxiety during the COVID-19 pandemic and how the implementation of mitigation strategies (i.e. public transportation closures, stay-at-home orders, etc.) impacted such disorders. Data sources PubMed, MEDLINE, Web of Science, BIOSIS Citation Index, Current Content Connect, PsycINFO, CINAHL, medRxiv, and PsyArXiv databases for depression and anxiety prevalences; Oxford Covid-19 Government Response Tracker for the containment and closure policies indexes; Global Burden of Disease Study for previous levels of depression and anxiety. Study eligibility criteria Original studies conducted during COVID-19 pandemic, which assessed categorical depression and anxiety, using PHQ-9 and GAD-7 scales (cutoff ⩾10). Participants and interventions General population, healthcare providers, students, and patients. National physical distancing measures. Study appraisal and synthesis methods Meta-analysis and meta-regression. Results In total, 226 638 individuals were assessed within the 60 included studies. Global prevalence of both depression and anxiety during the COVID-19 pandemic was 24.0% and 21.3%, respectively. There were differences in the prevalence of both anxiety and depression reported across regions and countries. Asia (17.6% and 17.9%), and China (16.2% and 15.5%) especially, had the lowest prevalence of both disorders. Regarding the impact of mitigation strategies on mental health, only public transportation closures increased the prevalence of anxiety, especially in Europe. Limitations Country-level data on physical distancing measures and previous anxiety/depression may not necessarily reflect local (i.e. city-specific) contexts. Conclusions and implications of key findings Mental health concerns should not be viewed only as a delayed consequence of the COVID-19 pandemic, but also as a concurrent epidemic. Our data provide support for policy-makers to consider real-time enhanced mental health services, and increase initiatives to foster positive mental health outcomes.

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In pregnancy, uterine natural killer cells (uNK) play essential roles in coordinating uterine angiogenesis, blood vessel remodeling and promoting maternal tolerance to fetal tissue. Deviances from a normal uterine microenvironment are thought to modify uNK function(s) by limiting their ability to establish a healthy pregnancy. While maternal obesity has become a major health concern due to associations with adverse effects on fetal and maternal health, our understanding into how obesity contributes to poor pregnancy disorders is unknown. Given the importance of uNK in pregnancy, this study examines the impact of obesity on uNK function in women in early pregnancy. We identify that uNK from obese women show a greater propensity for cellular activation, but this difference does not translate into increased effector killing potential. Instead, uNK from obese women express an altered repertoire of natural killer receptors, including an imbalance in inhibitory KIR2DL1 and activating KIR2DS1 receptors that favors HLA-C2-directed uNK activation. Notably, we show that obesity-related KIR2DS1 skewing potentiates TNFα production upon receptor crosslinking. Together, these findings suggest that maternal obesity modifies uNK activity by altering the response toward HLA-C2 antigen and KIR2DL1/2DS1-controlled TNFα release. Furthermore, this work identifies alterations in uNK function resulting from maternal obesity that may impact early developmental processes important in pregnancy health.