eTable 1. Extraction table for survey studies on psychological effects of the SARS-CoV-2 pandemic (as of April 16, 2020).
| Country; participants; female (%); age (M ± SD) [alternative information] | Subgroup; assessment; survey period | Assessment tools or questions asked | Psychological distress | Stress/ other outcomes | Moderating factors | ||||
| Anxiety, fear, worries | Depressive symptoms | Posttraumatic stress | Sleep-related symptoms | ||||||
| General Population | |||||||||
| Cao et al. (2020) (e16) | China; 7,143; 4,975 (69.65%); NR | Medical students from Changzhi Medical College; Internet, no details on recruitment, cross-sectional; NR | GAD-7 | 24.9% affected; 0.9% severe, 2.7% moderate, 21.3% mild symptoms | NR | NR | NR | NR | for anxiety: infection of loved ones (+); worries about economic impact of the epidemic (+); concerns about study related disadvantages (+); influence of the epidemic on daily life (+); stability of family income (–); living in a urban area (–); living with parents (–); social support (–) |
| Liu et al. (2020) (e7) | China; 285; 155 (54.4%); NR [47.7%<35] | Current (n=124) or previous (n=188) stay in Wuhan; internet, no details on recruitment; January 30 - February 08, 2020 | PCL-5, PSQI | NR | NR | 7% according to PCL-5 (higher than norm data1) | NR | NR | For PTSD: Female sex (+); Risk groups (+); no current / previous stay in Wuhan (–); poor subjective sleep quality (+); sleep latency (+) |
| Qiu et al. (2020) (e4) | China, Hong Kong, Taiwan, Macao; 52,730; 34,131 (64.73%), NR | GP; internet, recruitment with QR code via Siuvo Intelligent Psychological Assessment Platform, cross-sectional; January 31 – February 10, 2020 | CPDI | NR | NR | NR | NR | 35% CPDI>27 | for psychological distress: female (+); age < 18 (–); migrant workers (+); being from hubei (+) |
| Roy et al. (2020) (e17) | India; 662; 339 (51.2%); 29.09±8.83 | GP; internet, snowball sampling method via e-mail, WhatsApp, other social media, cross-sectional; March 22 – 24, 2020 | multiple-choice-questions on awareness, attitudes, fear | 82.2% preoccupations about COVID-19; 37.8 % hypochondriac fear | NR | NR | 12.5% sleep disorders due to worries | NR | NR |
| Wang, C. et al. (2020) (16) | China; 1,210; 814 (67.3%); NR [53.1% age 21.4-30.8] | GP; internet, via snowball sampling to students, cross-sectional; January 31 - February 2, 2020 | IES-R, DASS-21 | 28.8% >9 in DASS-21 anxiety subscale | 16.5% >12 in DASS-21 depression subscale | 53.8% > 33 im IES-R; M±SD: 32.98± 15.42 | NR | Stress: 8.1%>18 in DASS-21stress subscale | For PTSD: male sex (–); students (+); respiratory symptoms (+); chronic diseases (+); discontent with information about COVID-19 (+); concerns about children (+); hygiene behavior (–); For stress: students (+); reduced perceived health (+); chronic diseases (+); discontent with information on COVID-19 (+); information about increase in cured (–); no trust in the doctor (+); low perceived risk of infection (–); perceived risk of death from infection (+); concerns about family (+); hygiene behavior (–) For fear: students (+); doctor's visits (+); hospital stays (+); reduced perceived health (+); chronic diseases (+); contact to person with COVID-19 (+); no confidence in the doctor (+); low perceived risk (–) of infection; concerns about children (+); hygiene behavior (–) for depressive symptoms: low educational level (+); reduced perceived health (+); chronic diseases (+); discontent with information on COVID-19 (+); information about increase in the number of people cured (–); no trust in the doctor (+); hygiene behavior (–) |
| Wang, Y et al. (2020) (e18) | China; 600; 333 (55.5%); 34 ± 12 | GP; internet, no details on recruitment, cross-sectional; February 6 - 9, 2020; | SAS, SDS | 0.67% SAS> 59 (36.92 ± 7.33) | 2.83% SDS>62 (40.50 ± 11.31) | NR | NR | NR | for anxiety: female sex (+); age > 40 (+) |
| Zhang, Y. et al. (2020) (e19) | China; 263; 157 (60%); 37.7± 14.0 | GP from Liaoning; internet, recruitment via WeChat, cross-sectional; January 28 – 5, 2020 | i. a. IES | NR | NR | 7.6% IES > 25 (13.6±7.7) | NR | NR | for PTSS: (–) rest |
| Healthcare Workers | |||||||||
| Cai et al. (2020) (e1) | China; 534; 367 (68.7%); 36.4 (16.18) | physicians (n=233), nurses (n=248) in Hunan; no details on recruitment, cross-sectional; January –March, 2020 | Custom-built: emotions during COVID-19 outbreak, stressors, protective factors, coping and others | 40.6% > 1 (anxious+ nervous) | NR | NR | NR | NR | for stress: concerns about infecting family |
| Huang, JZ. et. al. (2020) (e9) | China; 230; 187 (81.30%); NR [53% age 30-39] | physicians (n=70), nurses (n=160) (all in frontline position); institutional survey, no details on recruitment, cross-sectional; February 7- 14, 2020 | SAS, PTSD-SS | 11.63% of the 43 men, 25.67% of the 187 women SAS>49; (together 23.04 %) |
NR | 18.60% of the 43 men, 29.41% der 187 women PTSD-SS>49; (together 27.39%) | NR | NR | for anxiety: male sex (–); medical profession (–); low professional position (+) for post-traumatic stress: male sex (–) |
| Kang et al. (2020) (e20) | China; 994; 850 (85.5%); NR [63.4% age 30-40] | physicians (n=183), nurses (n=811); interent, recruitment via Wenjuanxing, cross-sectional; January 29 - February 04, 2020 | PHQ-9, GAD-7, ISI, IES-R; K-means-clustering-method for all of the measuring tools > mental health | 22.4% with GAD-7 mean value 8.2; 6.2% with GAD-7-M 15.1 | 22.4% with PHQ-9 mean value 9; 6.2% PHQ-9-M 15.1 | 22.4% with IES-R-mean value 39.9; 6.2% with IES-R mean value 60.0 | 22.4% with ISI mean value 10.4; 6.2% with ISI mean value 15.6 | NR | For mental health: exposure to COVID-19 (+); use of psychoeducational materials (–) |
| Lai et al. (2020) (6) | China; 1,257; 964(76.7%); NR[64.7% age 26 - 40] | subgroups: nurses (n= 764), physicians (n=493), from Wuhan (n=760), direct contact with COVID-19 patients (n=522); no details on recruitment, cross-sectional; January 29 – March 1, 2020 | PHQ-9, GAD-7, ISI, IES | 44.6% GAD-7 > 6 | 50.4% PHQ-9 > 8 | 71.5% IES-R > 25 | 34% ISI > 14 | NR | for depressive symptoms: Nursing staff(+); female sex (+); work at secondary hospital(+); middle professional position(+); direct patient contact(+) for fear: female sex (+); middle professional position (+); work at secondary hospital (+); direct patient contact (+) for sleep-related symptoms: direct patient contact (+) for stress: female sex (+); middle professional position(+); direct patient contact (+); work outside Hubei (–) |
| Mo et al. (2020) (e2) | China; 180; 162 (90%); 129 (71.7%); 32.71 ± 6.52 | nurses from Guangxi in Wuhan; internet, via computer/ smartphone, QR-Code, cross-sectional; end of February, 2020 | SOS, SAS | SAS: M±SD 32.19±7.56 | NR | NR | NR | SOS: stress: 22.22%> 50; (M±SD 39.91±12.92) |
for stress: siblings (–); workload(+) anxiety (+); high professional qualification(+); poor sleep quality (+); severity of the patient's condition (+); lack of adaptation to daily diet (+) |
| Xiao et al. (2020) (e3) | China; 180; 129 (71.7%); 32.31±4.88 | physicians (n=82), nurses (n=98) from Wuhan; no details on recruitment, cross-sectional; January –February, 2020 | SAS, GSES, SASR, PSQI, SSRS | SAS: M±SD 55.256± 14.183 (SAS) |
NR | NR | PSQI: M±SD 8.583±4.567 (higher than norm data2) | stress: M±SD 77.589± 29.525 (SASR) self-efficacy: GSES: M±SD 2.267±0.767 social support: SSRS: M±SD 34.172 ± 10.263 |
for sleep-related symptoms: anxiety (+); stress (+); self-efficacy (–); for anxiety: social support (–); for stress: social support (–); anxiety (+) |
| Mixed Groups | |||||||||
| Huang, Y. et al. (2020) (e6) | China; 7,236; 3,952 (54.6%); 35.3 ± 5.6 | GP, subgroup HCW (n = 2,250); internet, recruitment via WeChat, cross-sectional; February 3 - 17, 2020 | GAD-7, CES-D, PSQI, knowledge about COVID-19 and time spent thinking about COVID-19 | 35.1% GAD-7 > 9 (higher than norm data3); healthcare workers 35.6% (34.9% = mean of the remaining) | 20.1% CES-D > 28 (higher than norm data); HCW 19.8% (GP 20.2% =mean of the remaining) | NR | 18.2% PSQI > 7; HCW 23.8% (GP 15.67% = mean of the remaining) |
NR | for depressive symptoms: age <35 (+); health profession+ >3h/d thinking about COVID-19(+) for sleep related symptoms: health profession(+); health profession+>3h/d thinking about COVID-19(+) |
| Li et al. (2020) (e8) | China; 740; 128 (59.81%); 25 [IQR: 22–38.3] | GP (n=214) + nurses (n= 526), contact with COVID-19 (n=234); App-based, recruitment via WeChat, cross-sectional; February 17 - 21, 2020 | Vicarious Traumatization Questionnaire | NR | NR | Vicarious Traumatization Questionnaire: Median (IQR) GP 75.5 (62–88.3), nurses with contact 64 (52–75), without contact 75.5 (63–92) | NR | NR | for vicarious traumatization: general population or nursing staff without direct contact with COVID-19 (+) |
| Lu et al. (2020) (e21) | China; 2,299; 1,785 (77.6%); NR [78% age <40] | HCW (n=2,042), administrative staff (n=257); internet, no details on recruitment, cross-sectional; February 25 – 26, 2020 | NRS on fear, HAMA, HAMD | HCW: 70.6%>3 in NRS on fear, 25.5% >6 in HAMA; administrative staff: 58.4%> 3 in NRS on fear; 18.7% >6 in HAMA | HCW: 12.1% >6 in HAMD; administrative staff: 8.2% >6 in HAMD |
NR | NR | NR | for fear: health professional (+); high risk contact (+); for depressive symptoms: high-risk contact (+) |
| Yuan et al. (2020) (e22) | China; 939; 582 (61.98%); NR [71.5% age 18-39] | HCW (n=249); students (n=312); internet, no details on recruitment, longitudinal; 2 assessments in February, 2020 | SRQ, PSQI | NR | NR | NR | NR (change in M of the PSQI-items: –0.148) | NR (SRQ: change in M of the emotional state: 0.392; M-change in somatic responses: 0.014) | NR |
| Zhang, W. et al. (2020) (e23) | China; 2,182; 1,401 (64.2%); NR [96.3% age 18-60] | HCW (n=927), GP (n=1,255); internet, recruitment via Wenjuanxing, cross-sectional; February 19 – March 6, 2020 | ISI, SCL-90-R, PHQ-4(GAD-2+PHQ-2) | 10.4% GAD-2>2; HCW 13%; GP 8.5% | 10.6% PHQ-2>2; HCW 12.2%; GP 9.5% | NR | 33.9% ISI>7 (9.5%>14); HCW: 38.4% (10.5%); GP 30.5% (8.8%) | somatization: 0.9% SCL-90-R subscore>2; HCW 1.6%, GP 0.4% Zwang: 3.5% SCL-90-R subscore>2; HCW 5.3%; GP 2.2% phobic anxiety: 2.9% SCL-90-R subscore>2; HCW 3.6%; GP 2.4% |
for anxiety: health profession (+); female sex (+); being married (+); risk of contact with COVID-19 patients in the hospital (+); organic diseases (+); for depressive symptoms: health profession (+); living in rural areas (+); living with family (+); organic diseases (+) for sleep related symptoms: health profession (+); living in rural areas (+); living with family (+); risk of contact with COVID-19 patients in the hospital (+); organic diseases (+) |
Abbreviations:
GP: general population; HCW: healthcare workers; M: mean value; NR: not reported; SD: standard deviation
(+): positive correlation; (-): negative correlation; CES-D: Center for Epidemiologic Studies Depression Scale to assess depressive symptoms; CPDI: COVID-19 Peritraumatic Distress Index; DASS-21: Depression, Anxiety and Stress Scale; GAD-7: Generalized Anxiety Disorder Scale-7 to assess generalized anxiety disorders; GSES: General Self-Efficacy Scale to assess self-efficacy; HAMA: Hamilton Anxiety Scale to assess anxiety symptoms; HAMD: Hamilton Depression Scale to assess depressive symptoms; IES-R: Impact of Event Scale - Revised to assess post-traumatic symptoms; ISI: Insomnia Severity Index to assess sleep disorders; NRS: Numeric Rating Scale; PCL-5: Posttraumatic Stress Disorder Checklist for DSM-5 for post-traumatic stress symptoms; PCL-C: Posttraumatic Stress Disorder Checklist- Civialians for posttraumatic stress symptoms; PHQ-4: Personal Health Questionnaire-4 to assess anxiety and depressive symptoms; PHQ-9: Personal Health Questionnaire 9 to assess depressive symptoms; PSQI: Pittsburgh Sleep Quality Index to assess sleep quality; PTSD: PTSD-SS: PTSD Self-rating Scale to assess post-traumatic stress symptoms; SAS: Self-Rating Anxiety Scale for recording anxiety symptoms; SASR: Stanford Acute Stress Reaction Questionnaire to assess stress reactions; SCL-90-R: Symptom Checklist 90-Revised to assess mental stress; SDS: Self-Rating Depression Scale; SE: Self-developed questionnaire; SOS: Stress Overload Scale to assess stress; SRQ: Stress Response Questionnaire to assess emotional situation, somatic reactions and behavior; SSRS: Social Support Rate Scale to assess social support; Vicarious Traumatization Questionnaire to assess secondary traumatization, based on TSIB (Traumatic Stress Institute Belief Scale), VTS (Vicarious Trauma Scale) and IES
1 prevalence: 7% vs 3.7%
2 M ± SD: 32.19±7.56 vs 29.78±0.46; t=4.27; p<0.001
3 prevalence: 35.1% vs 5.0%
4 prevalence: 20.3% vs 3.6%