Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. May 19, 2022; 12(5): 739-765
Published online May 19, 2022. doi: 10.5498/wjp.v12.i5.739
Mental health impact of the Middle East respiratory syndrome, SARS, and COVID-19: A comparative systematic review and meta-analysis
Gayathri Delanerolle, Yutian Zeng, Jian-Qing Shi, Xuzhi Yeng, Will Goodison, Ashish Shetty, Suchith Shetty, Nyla Haque, Kathryn Elliot, Sandali Ranaweera, Rema Ramakrishnan, Vanessa Raymont, Shanaya Rathod, Peter Phiri
Gayathri Delanerolle, Nuffield Department of Primary Health Care Science, University of Oxford, Oxford OX2 6ED, United Kingdom
Yutian Zeng, Jian-Qing Shi, Xuzhi Yeng, Southern University of Science and Technology, Shenzhen 518055, Guangdong Province, China
Jian-Qing Shi, The Alan Turing Institute, London NW1 2DB, United Kingdom
Will Goodison, Ashish Shetty, University College London Hospital NHS Foundation Trust, London NW1 2PG, United Kingdom
Ashish Shetty, University College London, London WC1E 6BT, United Kingdom
Suchith Shetty, Kathryn Elliot, Shanaya Rathod, Peter Phiri, Department of Research and Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
Nyla Haque, Vanessa Raymont, Department of Psychiatry, University of Oxford, Oxford OX2 6ED, United Kingdom
Sandali Ranaweera, Department of BioSystems Technology, University of Sri Jayewardenepura, Nugegoda 10100, Sri Lanka
Rema Ramakrishnan, National Perinatal Epidemiology Unit, University of Oxford, Oxford OX3 7JX, United Kingdom
Peter Phiri, Faculty of Environmental and Life Sciences, Psychology Department, University of Southampton, Southampton SO17 1PS, United Kingdom
Author contributions: Delanerolle G and Phiri P developed the systematic review protocol and embedded this within the EPIC project’s evidence synthesis phase; Delanerolle G and Goodison W wrote the first draft of the manuscript; The statistical analysis plan was developed by Delanerolle G and was conducted by Shi JQ, Yeng X and Zeng Y; The data was critically appraised by Shetty A, Phiri P, Zeng Y, Yeng X, Shi JQ, Goodison W, Ramakrishnan R, Ranaweera S and Raymont V; The SARS-CoV data was extracted by Chau SWH and his team; The SARS-CoV-2 data was extracted by Phiri P/Delanerolle G and their team; Yeng X and Zeng Y extracted the MERS dataset which was reviewed by Delanerolle G, Phiri P, Shetty S, Shi JQ and Shetty A; Yeng X, Zeng Y and Shi JQ conducted the analysis; Shetty S designed and developed the original illustration; Delanerolle G, Phiri P, Shetty A, Zeng Y, Yeng X, Shetty S, Shi JQ, Goodison W, Ramakrishnan R, Elliot K, Ranaweera S and Raymont V critically appraised and finalised the manuscript; All authors approved the final version of the manuscript.
Supported by Southern Health NHS Foundation Trust.
Conflict-of-interest statement: Dr Phiri has received research grant from Novo Nordisk, and other, educational from Queen Mary University of London, other from John Wiley & Sons, other from Otsuka, outside the submitted work. Dr Rathod reports other from Janssen, Boehringer outside the submitted work. All other authors report no conflict of interest. The views expressed are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health and Social Care or the Academic institutions. The study sponsor had no further role in the study design, data collection, analysis and interpretation of data, in the writing of the report and in the decision to submit the paper for publication.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Peter Phiri, BSc, PhD, RN, Academic Fellow, Department of Research and Innovation, Southern Health NHS Foundation Trust, Clinical Trials Facility, Moorgreen Hospital Botley Road, West End, Southampton SO30 3JB, United Kingdom. peter.phiri@southernhealth.nhs.uk
Received: October 28, 2021
Peer-review started: October 28, 2021
First decision: December 12, 2021
Revised: December 24, 2021
Accepted: April 9, 2022
Article in press: April 9, 2022
Published online: May 19, 2022
Processing time: 201 Days and 7.2 Hours
ARTICLE HIGHLIGHTS
Research background

The severe acute respiratory syndrome (SARS) virus has been present for centuries in different forms. Whilst civilisation has evolved, so has the virus, including its' ability to transmit. Thus, the comparison of the three most recent severe acute respiratory syndrome coronavirus (SARS-CoV) viruses in terms of the mental health implications infused to patients, healthcare professionals (HCPs) and patients is an important facet both clinically and scientifically. As a result, our study explores an important component that hasn't been addressed from a potential disease sequalae perspective.

Research motivation

Our motivation was to demonstrate the trends associated with the mental health prevalence in terms of specific conditions due to the last three virulent strands of SARS-CoV across patient, HCPs and the general public. The specified cohorts have specific behavioural patterns and differing levels of exposure to the virus, thus the risk of infection varies that influences the mental health impact. This would aid in assessing the true mental health impact that health care systems require to support those needing mental health support. The comparison also allows us to predict the trends in mental health impact due to infectious transmissions which ultimately should be addressed as a public health hazard, globally.

Research objectives

The study has three primary aims of identifying and reporting: (1) Mental health conditions commonly observed across all three pandemics; (2) Impact of mental health outcomes across patients, the general public and HCPs associated with all 3 pandemics; and (3) The prevalence of the mental health impact and clinical epidemiological significance.

Research methods

A systematic methodology was developed and published on PROSPERO (CRD42021228697). The databases PubMed, EMBASE, ScienceDirect and the Cochrane Central Register of Controlled Trials were used as part of the data extraction process, and publications from January 1, 1990 to August 1, 2021 were searched. MeSH terms and keywords used included Mood disorders, PTSD, Anxiety, Depression, Psychological stress, Psychosis, Bipolar, Mental Health, Unipolar, Self-harm, BAME, Psychiatry disorders and Psychological distress. The terms were expanded with a ‘snowballing’ method. Cox-regression and the Monte-Carlo simulation method was used in addition to I2 and Egger’s tests to determine heterogeneity and publication bias.

Research results

The results indicated that there is a mental health impact observed among patients, HCPs and the general public at varying levels. This study analysed the prevalence of some mental health outcomes to the outbreaks of Middle East respiratory syndrome (MERS), SARS-CoV and SARS-CoV-2 and compared the prevalence of the participants and the prevalence of different occupational groups and age groups. In terms of mental illness like anxiety, depression and post-traumatic stress disorder (PTSD), the prevalence of depression [33.65% with 95% confidence interval (CI): 22.02-51.42] and PTSD (35.97% with 95%CI: 29.6-43.72) is higher during MERS, while the prevalence of anxiety (33.16% with 95%CI: 25.99-34.5) is higher during SARS-CoV-2. Patients and healthcare workers are the first and second most likely groups to suffer from mental health problems. Young people are more likely to be caught up in depressive and anxiety emotions than older people.

Research conclusions

Developing evidence-based and cohort-specific mental health (MH) interventions could be a useful way to optimise MH support. HCPs in particular may benefit from this as it could promote better well-being for staff, increasing the efficiency within the work environment. As vaccines are rolled out globally, it is hoped that pressures on acute medical services due to the SARS-CoV-2 will slowly improve. The aim of this study is to understand and build on our knowledge of the viruses’ impact on mental health, both previously and now, so that we may better manage and prepare to deal with the hidden consequences of this and any future outbreaks. Whilst there are cultural, economic and environmental differences between the countries affected in each pandemic, drawing similarities between the lasting effects on mental health will be important in highlighting where resources and support are needed as we contemplate our recovery–physically, mentally and socially–from this pandemic. The mortality impact of seasonal influenza and a pandemic on the mental health of the general public, patients and HCPs vary.

Research perspectives

Studies relating to SARS-CoV and MERS-CoV are limited by several aspects, including the geographical constraints and sample sizes. The majority of studies were published in languages other than English. Psychological symptomatologies associated with depression, anxiety, distress, insomnia and fatigue, as well as comorbidities such as PTSD and neuro-psychiatric syndromes such as psychosis, have been reported in patients and HCWs more during the SARS-CoV-2 pandemic which could be due to the scope and scale of the incidence and high transmission rates. The effects of mass lock-downs, economic downturns and mass uncertainty and fear within the general population are harder to characterise and assess, but early evidence suggests that rates of mental health disorders within the population will be higher during and following the pandemic. We need more comprehensive and longitudinal studies to be conducted to determine the mental health impact in multiple populations globally. This would also aid us to develop better pandemic preparedness frameworks and policies within healthcare systems.