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

Abstract

Objectives 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.

Characteristics of Living Systematic Review for COVID-19

“…The topic most studied (40.6%) was the treatment of COVID-19. 20 , 22 , 25 , 32 , 37 , 39 , 43 , 46 , 47 , 49 , 51 , 55 , 56 , 58 , 62–64 , 67–74 , 79 The population most studied (76.6%) was general COVID-19 patients, 18–23 , 26 , 27 , 29 , 31–34 , 36 , 37 , 39 , 42–44 , 46 , 47 , 49–65 , 67–76 , 79 but there were fewer (6.3%) studies concerning pregnant women 16 , 17 , 30 , 78 and children 28 , 30 , 77 , 78 with COVID-19, even no study concerning the elderly with COVID-19. ( Table 1 , Supplementary Material Table 1 )…”

“…In the production phase of LSR, most of the LSRs registered 16–22 , 25 , 26 , 28–33 , 35 , 37 , 39–42 , 45–62 , 65–67 , 69–73 , 76–79 (81.2%) and wrote the protocol 16–35 , 37 , 39–43 , 45–67 , 69–73 , 76–79 (92.2%) before the study started. Less than one third of the LSRs searched the Chinese database 16–18 , 23 , 25 , 34 , 35 , 43 , 46 , 48 , 57 , 62–64 , 70 , 79 (25%), and less than half of the LSRs searched the preprint database 16 , 20 , 21 , 23–26 , 28 , 37 , 39 , 40 , 43 , 45 , 46 , 48 , 51 , 53 , 57 , 62–64 , 67 , 68 , 73 , 76 , 77 , 79 (42.2%), and two-thirds of the LSRs searched 12 COVID-19 databases 16 , 17 , 20–23 , 27 , 30 , 32 , 33 , 37–42 , 44–46 , 48 , 49 ...…”

“…The topic most studied (40.6%) was the treatment of COVID-19. 20,22,25,32,37,39,43,46,47,49,51,55,56,58,[62][63][64][67][68][69][70][71][72][73][74]79 The population most studied (76.6%) was general COVID-19 patients, [18][19][20][21][22][23]26,27,29,[31][32][33][34]36,37,39,[42][43][44]46,47,[49][50][51][52][53]…”

Effects of mental health interventions among people hospitalized with COVID-19 infection: A systematic review of randomized controlled trials

“…This is especially the case in COVID-19 research among trials with time pressures and insufficient research infrastructure, particularly in the earlier phases of the pandemic, which contributed to the conduct and publication of many poorly designed studies with sample sizes too small to answer the research questions being posed [ 72 ]. The set of trials included in the present review exceed what we have seen prior to COVID-19 or in other areas of COVID-19 mental health (e.g., [ 13 ]) in terms of failing to provide minimally transparent reporting, verification of origin, overall study quality, and the unusually large effects reported. For comparison, over 50% of trials reported SMD effect sizes of 2.0 or greater versus only 1 of 11 (9%) trials in the most recent pre-COVID-19 systematic review of ICU-based interventions [ 7 ].…”

“…The objective of the present sub-study is to synthesize evidence from RCTs on the effects of mental health interventions for people hospitalized with COVID-19 infection. Results from trials of interventions for people not quarantined or undergoing treatment due to COVID-19 infection have been reported elsewhere [ 13 ].…”