The global prevalence of depression, anxiety, and sleep disorder among patients coping with Post COVID-19 syndrome (long COVID): a systematic review and meta-analysis

Abstract

Background Post COVID-19 syndrome, also known as "Long COVID," is a complex and multifaceted condition that affects individuals who have recovered from SARS-CoV-2 infection. This systematic review and meta-analysis aim to comprehensively assess the global prevalence of depression, anxiety, and sleep disorder in individuals coping with Post COVID-19 syndrome. Methods A rigorous search of electronic databases was conducted to identify original studies until 24 January 2023. The inclusion criteria comprised studies employing previously validated assessment tools for depression, anxiety, and sleep disorders, reporting prevalence rates, and encompassing patients of all age groups and geographical regions for subgroup analysis Random effects model was utilized for the meta-analysis. Meta-regression analysis was done. Results The pooled prevalence of depression and anxiety among patients coping with Post COVID-19 syndrome was estimated to be 23% (95% CI: 20%—26%; I2 = 99.9%) based on data from 143 studies with 7,782,124 participants and 132 studies with 9,320,687 participants, respectively. The pooled prevalence of sleep disorder among these patients, derived from 27 studies with 15,362 participants, was estimated to be 45% (95% CI: 37%—53%; I2 = 98.7%). Subgroup analyses based on geographical regions and assessment scales revealed significant variations in prevalence rates. Meta-regression analysis showed significant correlations between the prevalence and total sample size of studies, the age of participants, and the percentage of male participants. Publication bias was assessed using Doi plot visualization and the Peters test, revealing a potential source of publication bias for depression (p = 0.0085) and sleep disorder (p = 0.02). However, no evidence of publication bias was found for anxiety (p = 0.11). Conclusion This systematic review and meta-analysis demonstrate a considerable burden of mental health issues, including depression, anxiety, and sleep disorders, among individuals recovering from COVID-19. The findings emphasize the need for comprehensive mental health support and tailored interventions for patients experiencing persistent symptoms after COVID-19 recovery.

Persistent symptoms and clinical findings in adults with post-acute sequelae of COVID-19/post-COVID-19 syndrome in the second year after acute infection: population-based, nested case-control study

“…We found sleep disorder, in particular insomnia, being reported as another frequent complaint among cases. Pooled data of previous studies[60] on >15,000 participants revealed a prevalence of 40 to 50% for sleep disorder among PCS cases, which is comparable to our data. The importance of pre-pandemic healthy sleep to prevent PCS has been demonstrated by us and others.…”

“…Symptom reports and rating data on depressive and anxiety symptoms generally fit in the meta-analyses[60,63] on neuropsychiatric manifestations in PCS. The difference among persistent cases in the proportion reporting depression as a symptom versus having a clinically significant PHQ-9 score might reflect perceived psychological strain rather than having developed a manifest depressive syndrome.…”

Online peer support for mental health in individuals with post-acute sequelae of COVID-19: A pre-post pilot study with mixed methods

“…Several studies have shown that individuals with PASC are more likely to experience mental health problems. A meta-analysis indicated that 23% of patients with PASC experienced mental health problems (Seighali et al, 2024). Several cross-sectional surveys have reported an association between the presence of PASC and mental health problems (Hazumi et al, 2022;Hejazian et al, 2024;Li et al, 2024;Malheiro et al, 2024).…”

Response to Letter to the Editor From Josef Finsterer: “Explaining Long COVID: A Pioneer Cross-Sectional Study Supporting the Endocrine Hypothesis”

“…The author highlighted the importance of considering chronic stress and its potential impact on the hypothalamic-pituitary-adrenal axis in long-COVID patients. In a recent meta-analysis, the pooled prevalence of depression and anxiety among patients with long-COVID syndrome was estimated to be 23% [ 3 ]. In this context, it is recognized that chronic stress would exacerbate the cortisol response, potentially leading to a pseudo-Cushing state [ 4 ].…”