Long-term effects of COVID-19 on mental health: A systematic review

J Affect Disord. 2022 Feb 15:299:118-125. doi: 10.1016/j.jad.2021.11.031. Epub 2021 Nov 16.


Background: Acute effects of COVID-19 can be life-threatening. Alterations in mental health during the active infection have been documented, but the long-term consequences are less clear.

Method: A systematic review was undertaken to investigate the effect of COVID-19 infection on long-term mental health outcomes. Three databases [PubMed, Medline (Ovid) and Cochrane library] were searched between 1st October 2019 and 29th August 2021 with additional hand searching to identify all published studies reporting symptoms of generalised anxiety, depression, post-traumatic stress disorder (PTSD), or sleep disturbance in participants at least one month after COVID-19 infection. The prevalence and mean symptom score of each were assessed.

Results: Eight hundred and eighty five studies were found, of which 33 were included in the review involving a total of 6743 participants. The studies' risk of bias were typically fair quality. The median study age of participants was 57.8 years (IQR 49.3-60.7), with 63.0% male (IQR 57.0%-73.0%). Participants typically experienced no or mild symptoms of long-term anxiety (GAD-7, STAI-S, HADS) and depression (PHQ-9, BDI, PHQ-2, HADS). Prevalence varied depending on the measurement tool. Sleep disturbances (primarily insomnia) were most commonly reported as mild. PTSD prevalence was similar to anxiety and depression.

Conclusion: The overall effect of the pandemic has been linked with worsening psychiatric symptoms. However, the long-term effect from direct COVID-19 infection has been associated with no or mild symptoms. Studies exhibited the long-term prevalence of anxiety, depression, PTSD, and sleep disturbances to be comparable to general population levels.

Keywords: Anxiety; COVID-19; Depression; Mental health; PTSD; Sleep disturbance.

Publication types

  • Systematic Review

MeSH terms

  • Anxiety / epidemiology
  • COVID-19*
  • Depression
  • Female
  • Humans
  • Male
  • Mental Health*
  • Middle Aged
  • Pandemics
  • SARS-CoV-2