Table 1.

Included studies.

Country and authors	World bank income level	Theme of violation	Type of population	Key findings	Study design
Colombia (29)	Upper-middle income	Mobility restrictions and lack of adequate resources for mental health support and suicide intervention	General (ages 18–76)	•7.6% of participants reported a high suicide risk. 1 out of 13 Colombians in a non-probability sample reports a high suicide risk during COVID-19 •association between perceived stress related to COVID-19, risk of depressive episode, insomnia, and suicidal behavior in the context of a restriction on the mobility	Cross-sectional
Pakistan (30)	Lower-middle income	Economic hardships including unemployment due to mobility restrictions without access to financial support caused by lockdown	Suicide cases (ages 24–68)	•Most of the suicide cases occurred due to the lockdown-related economic recession •24% of population lives below poverty line and 20.5% is undernourished, both issues exacerbated by lockdown	Retrospective cohort suicide research
India (31)	Lower-middle income	Misinformation and fear or stigma related to possible COVID-19 infection were primary causes of suicide	Suicide attempts and cases (ages 18 and above)	•Rise in the number of suicide cases, which coincides with an increase in confirmed cases of COVID-19 and mitigation efforts (e.g., countrywide lockdown) •Social, financial insecurity, loss of employment or business, increase in family disputes, and pre-existing mental illness or medical illness might be predisposing and precipitating factors for an increase in suicide cases	Retrospective suicide research
United Kingdom (32)	High income	Significant psychological symptoms caused by lockdown but majority could not or did not receive formal or informal support indicating need for intervention and support especially for vulnerable populations and victims of gender based violence	General	•9% surveyed reported experiencing psychological or physical abuse, 18% reported experiencing thoughts of suicide or self-harm in the first month of lockdown and 5% reported harming themselves at least once •The reported frequency of abuse, self-harm and thoughts of suicide/self-harm was higher among women, black, Asian and minority ethnic groups and people experiencing socioeconomic disadvantage, unemployment, disability, chronic physical illnesses, mental disorders and COVID-19 diagnosis •Psychiatric medications most common type of support, but fewer than half of those affected were accessing formal or informal support	Analysis of COVID-19 Social Study: a non-probability sample weighted to population proportions
United States (33)	High income	Worse health outcomes in part due to knowledge gaps in effective prevention methods and inability to adhere to prevention methods due to crowding and work conditions	General, minority	•Black and Hispanic populations bear a disproportionate burden of medical conditions across their lifespans, including obesity, diabetes, and heart disease •COVID-19 disparities exacerbated by structural racism, which impacts housing, economic opportunities, education, transportation, food availability, and health care access	Cross-sectional survey
India (34)	Lower middle income	Misinformation, rumormongering, and negative perceptions influenced by media worsen marginalization, prejudice and stigma harming both targets and those with prejudiced viewpoints	General (ages 18–83)	•Fear of COVID-19, age, collectivism, and generalized xenophobia are closely linked with well-being •Significant negative relationship between fear of COVID-19 and well-being indicating holding xenophobic attitudes may be harmful not just for target of prejudice but also for those holding such attitudes •Critical to prevent marginalization and lessen COVID-19 stigma via proper information being distributed and combating misinformation	Cross-sectional survey
India (35)	Lower-middle income	Worry of length of lockdown and impacts on livelihood including financial troubles due to inadequate and unclear support	Migrant workers	•Difficulties in following precautions such as frequent hand washing, maintaining social distancing within shelter-mates and wearing masks •Uncertainty about the duration of lockdown, eagerness to travel and meet family, fear of being abandoned/deserted by employers, insecurity over income and job, substance use–related concerns •Pregnant women and children particularly feared inattention to their health issues	Qualitative—in person visits by mental health professionals
Jordan (36)	Upper-middle income	Strict lockdown, spread of misinformation, fear of contracting and spreading COVID and lack of PPE contributed to anxiety symptoms	General population, HCWs (ages 18 and above)	•Anxiety prevalent by health care professionals was 11.3% compared to general population 8.8% •Females among health care professionals, pulmonologists and ENT specialists at front lines, at higher risk of developing depression •Contributing factors are physician burnout, isolation from family, and feeling helpless due to the nature of this disease	cross-sectional survey
Lebanon (37)	Upper-middle income	Heavy psychological stress due to isolation from family support due to possible COVID infection, worry over stigma, and frustration over unclear information and health policy	HCWs: 13 quarantined health care professionals, 9 (69.2%) nurses 4 (30.8%) physicians	•HCWs being psychologically challenged through quarantine and need clear health communication from nursing managers, leaders, and policymakers •Proper health communication should be provided to the public so that they can know the reality of the situation and bypass any misconceptions and stigmatization •Moral and financial support should be offered to the quarantined personnel from governmental and non-governmental health policymakers	Qualitative design
Singapore (38)	High income	Perceived stigma against HCWs due to increased risk of infection lead to avoidance of public and worsening mental health outcomes indicating need for combatting stigma and stress	HCWs: residents with 61.7% junior and 38.3% senior	•No differences found between junior and senior residents in psychological and coping responses to pandemic •Those deployed to high-risk areas had lower perceived stress as those not deployed to high-risk areas had anticipatory anxiety contributing to higher stress levels •Higher perceived stigma level associated with higher levels of perceived stress and post-traumatic stress symptoms	Cross-sectional survey
Egypt (39)	Lower-middle income	Insufficient protection in workplaces leading to potentially higher chance of infection among HCWs and therefore increased stigma	HCWs: (60.2%) working at university hospital, (25.6%) general hospitals, primary health care or centers (14.2%)	•Most common statements as causes of perceptions of fear of COVID-19 infection: fear of transmission of infection to families (98.5%), disease being highly transmissible (90.4%), no available vaccine (78.6%) or treatment (87%), fatality of the disease (82.1%), fear of entering COVID-19 isolation hospitals (86.5%), and stigma related to COVID-19 (66.3%) •Most common reasons stated by HCWs explaining higher susceptibility to COVID-19 infection than others were: PPE shortages (83.6%), crowded workplaces (61.4%) and ill ventilation (72%)	Cross-sectional survey
China (40)	Upper-middle income	Stigma around former COVID patients worsened mental health outcomes	Former COVID-19 patients including 13.3% medical staff (physicians and nurses who had been ill)	•Perceived discrimination associated with clinically significant PTSD symptoms, severe depression, and severe anxiety •Perceived discrimination was strong risk factor for all anxiety, depression, and PTSD and was always an important variable in predicting anxiety, depression, or PTSD	Cross-sectional survey
Ghana (41)	Lower-middle income	Lockdown measures including ban on social gatherings and lack of PPE for caregivers worsens mental health of cancer patents	Cancer patients	•Ban on social gatherings including religious activities important for support likely to worsen their mental health •Socializing and spirituality play a significant role in the health and well-being of cancer patients in Ghana	Case study
Italy (42)	High income	Social restrictions and limitations on mobility lead to worsening of symptoms for OCD patients	OCD patients	•Significant changes on severity of total OCD symptoms, obsessions, and compulsions from before the quarantine to quarantine period, suggesting overall worsening on all these outcomes •Those who could not work/study remotely during the quarantine, those living with a parent in the same house during the quarantine and those with contamination symptoms had a significantly stronger worsening on the severity of total OCD symptoms, obsessions, and compulsions from before quarantine to the quarantine period	Preliminary naturalistic study with semi-structured interviews
China (43)	Upper middle income	Insufficient knowledge among insomniacs leading to worsening symptoms caused by lockdown induced confinement	Insomnia patients (ages 18–65)	•Sleep latency, sleep duration, sleep efficiency and daytime function affected •During isolation period, patients have irregular work schedules and rest time. Patients sleep poorly at night and their social functions are affected during the day •During home isolation, patients worried and panicked which was mostly attributed to a lack of knowledge about disease prevention and control	Cross-sectional survey
China (44)	Upper-middle income	Due to strict lockdown measures, severe negative psychological impact on psychiatric patients with need to intervene and provide support and monitor and prevent increased suicide ideations	Psychiatric patients (ages 18 and above)	•Psychiatric patients scored significantly higher on the total IES-R, DASS-21 anxiety, depression, and stress subscales and, total ISI scores •More than one-quarter of psychiatric patients reported PTSD-like symptoms and moderate to severe insomnia. •Psychiatric patients were significantly more likely to report worries about their physical health, anger, impulsivity, and suicidal ideation •Improved access to telepsychiatry services, home delivery of psychotropic medications, online psychiatric first-aid resources, and infectious disease outbreak preparedness play a pivotal role in minimizing the severity of psychiatric symptoms experienced by psychiatric patients	Cross-sectional survey
India (45)	Lower-middle income	Inadequate knowledge among severely mentally ill and due to lockdown, decreased access to medication. Caregivers do not receive enough financial support and are overburdened	Severely mentally ill patients clinically stable before covid-19 and their caregivers (family): patients were from lower socioeconomic status (60.6%) with diagnoses being schizophrenia (59.1%), bipolar affective disorder (25%), major depressive disorder (12.1%), and schizoaffective disorder (3.8%). Ages were 18–55 years old	•Around 80%of patients missed appointments with mental health professionals in previous month and 22% stopped psychiatric medication due to the non-availability of medication and mental health professionals, lack of transportation, due to strict legal enforcement of lockdown •Two-third of patients lacked adequate knowledge of precautionary measures against COVID-19. Patients from lower socioeconomic status, low literacy levels, with inadequate social support showed less knowledge related to COVID-19 •Impairment was noted in sleep (37.9%), food intake (23%), and personal care (20%) and 29.5% showed re-emergence of previous psychiatric symptoms. •63.6% reported that they were experiencing verbal and physical aggression from others •30.3% caregivers reported increase in the burden of taking care of patients in addition to the burden related to other reasons, like the lockdown. •45.5% caregivers perceived inadequate social support during this period and 62.9% were facing financial difficulties during lockdown	Cross-sectional survey
Italy (46)	High income	Increased lockdown restrictions worsening mental state of severely mentally ill	Severely mentally ill and control subjects. the following diagnosis were included: schizophrenia spectrum; bipolar disorder; recurrent major depression (ages 18–70)	•Patients were four times more likely to perceive high COVID-19 pandemic-related stress and had 2–3 times higher risk of severe anxiety and depressive symptoms. •Patients with serious mental illness had lower economic status and higher rates of concomitant medical diseases. Actual perceived stress from COVID-19 outbreak and lockdown restrictions appears a strong predictor and mediator of the heightened risk of suffering from severe anxiety in patients with serious mental illness	Case–control
United States (47)	High income	Lockdown and home confinement increasing cases of gender-based violence with traditional support venues cut	Orthopedic trauma patients	•In 2019, 76 patients (26%) had a mental health diagnosis compared with 110 patients (43%) in 2020 •In 2019, 34 patients (11%) reported interpersonal violence vs. 51 patients (20%) in 2020 •Proportion of women presenting with fracture was higher in the 2020 group	Retrospective cohort study
Spain (48)	High income	Lockdown and home confinement lead to social isolation potentially worsening cognition and functioning due to limits on exercise and social interaction	Elderly (community dwelling with mild cognitive impairment or mild dementia)	•Living alone reported greater negative psychological effects and sleeping problems and some elderly changed living situation to have family as support network •Measures adopted to address negative experiences of lockdown included keeping informed, accessing health and social services, having support network that prevents risk of exposure to COVID-19 and guarantees food and medical supplies, daily routine with maintained sleeping habits and leisure activities, staying physically and mentally active with exercise, and preventing social isolation via technology	Cross-sectional
France (49)	High income	Lockdown limiting mobility and ban on social gatherings restricting ability to socially stimulate and physically workout—both critical to health	Elderly	•Despite decline in participation in group physical activities before quarantine, older adults expressed need to perform physical activity at home •Physical activity important for elderly to maintain level of independence, mental health, and well-being	Qualitative inquiry with semi-structured interviews
Spain (50)	High income	Lockdown limits community and family support for elderly and crucial for adequate resources for mental health available for elderly	Elderly (ages 60–80)	•Oldest of elderly and youngest of elderly showed no difference in psychological well-being and age only a negative impact on personal growth •Perceived-health, family functioning, resilience, gratitude, and acceptance had significant associations with both personal growth and purpose in life	Cross-sectional
China (51)	Upper-middle income	Lockdown measures including ban on social gatherings leads to reduction of outdoor activities and social interaction which are important for development	Children/students in grades 2 through 6	•Students who were slightly or not worried about being affected by COVID-19 had significantly lower CDI-S scores than those who were quite worried, with a decreased risk of depressive symptoms •Those who were not optimistic, compared with those who were quite optimistic, had significantly higher CDI-S scores, with an increased risk of depressive symptoms	Cross-sectional
China (52)	Upper-middle income	Lockdown interrupted education and increased pressure and stress especially on students preparing for entrance exams	Children/adolescents	•With increasing grade, proportion of students with depressive and anxiety symptoms increased •Scores for COVID-19 knowledge, prevention and control measures, and projections of COVID-19 trend higher among students without depressive and anxiety symptoms •Female students suffered greater psychological impact, and higher levels of stress, anxiety, and depressive symptoms	Cross-sectional