{"doi":"10.64898/2026.01.22.26344371","title":"Mental health symptom changes by sex or gender during COVID-19 compared to pre-pandemic: a systematic review and meta-analysis update","abstract":"<jats:title>ABSTRACT</jats:title>\n                <jats:sec>\n                  <jats:title>KEY POINTS</jats:title>\n                  <jats:sec>\n                    <jats:title>Question</jats:title>\n                    <jats:p>Did changes in mental health symptoms from pre-COVID-19 to during the pandemic differ by sex or gender?</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings</jats:title>\n                    <jats:p>In this systematic review and meta-analysis study of findings from 27 unique cohorts, changes from before to during the COVID-19 pandemic in mental health symptoms, including general mental health, anxiety, depression, and stress, were not statistically significantly different by sex or gender.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Meaning</jats:title>\n                    <jats:p>There were not likely substantial sex and gender differences in mental health symptom changes during the COVID-19 pandemic.</jats:p>\n                  </jats:sec>\n                </jats:sec>\n                <jats:sec>\n                  <jats:title>Importance</jats:title>\n                  <jats:p>Concerns remain about whether COVID-19 affected mental health differently across sex or gender groups. We previously reported that changes in general mental health and anxiety symptoms, but not depression or stress, worsened more for females or women than males or men, but that was based on 12 studies published up to August 2021.</jats:p>\n                </jats:sec>\n                <jats:sec>\n                  <jats:title>Objective</jats:title>\n                  <jats:p>To investigate the sex or gender differences in mental health symptoms before and during the COVID-19 pandemic with updated evidence.</jats:p>\n                </jats:sec>\n                <jats:sec>\n                  <jats:title>Data Sources</jats:title>\n                  <jats:p>MEDLINE, PsycINFO, CINAHL, EMBASE, Web of Science, China National Knowledge Infrastructure, Wanfang, medRxiv, Open Science Framework Preprints searched to August 31, 2023.</jats:p>\n                </jats:sec>\n                <jats:sec>\n                  <jats:title>Study Selection</jats:title>\n                  <jats:p>Eligible studies included change data for general mental health, anxiety symptoms, depression symptoms, or stress from pre-to during COVID-19 by sex or gender. Two independent reviewers reviewed citations for eligibility.</jats:p>\n                </jats:sec>\n                <jats:sec>\n                  <jats:title>Data Extraction and Synthesis</jats:title>\n                  <jats:p>Standardized mean differences (SMDs) were extracted for changes of continuous outcomes and proportions for dichotomous outcomes. Two independent reviewers completed data extraction and risk of bias assessment with an adapted Joanna Briggs Institute Checklist for Prevalence Studies. Data were pooled by random-effects models.</jats:p>\n                </jats:sec>\n                <jats:sec>\n                  <jats:title>Main Outcomes and Measures</jats:title>\n                  <jats:p>Difference in change of SMDs and proportions between sex or gender groups pre-COVID-19 to COVID-19.</jats:p>\n                </jats:sec>\n                <jats:sec>\n                  <jats:title>Results</jats:title>\n                  <jats:p>\n                    We included data from 27 unique cohorts (N = 102 to 18,127). Change differences by sex or gender were minimal and not statistically significant: general mental health (SMD change\n                    <jats:sub>women-men</jats:sub>\n                    = 0.01, 95% confidence interval [CI]:-0.07 to 0.10; proportion change\n                    <jats:sub>women-men</jats:sub>\n                    = −0.03, 95% CI: −0.08 to 0.03), anxiety (SMD change\n                    <jats:sub>women-men</jats:sub>\n                    = 0.09, 95% CI −0.04 to 0.22; proportion change\n                    <jats:sub>women-men</jats:sub>\n                    = −0.05, 95% CI: −0.20 to 0.11), depression (SMD change\n                    <jats:sub>women-men</jats:sub>\n                    = 0.10, 95% CI: −0.00 to 0.20; proportion change\n                    <jats:sub>women-men</jats:sub>\n                    = −0.13, 95% CI: −0.81 to 0.55), and stress (SMD change\n                    <jats:sub>women-men</jats:sub>\n                    = −0.08, 95% CI −0.16 to 0.01, proportion change\n                    <jats:sub>women-men</jats:sub>\n                    = 0.04, 95% CI −0.10 to 0.17). No studies reported eligible mental health outcomes for gender minorities.\n                  </jats:p>\n                </jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion and Relevance</jats:title>\n                  <jats:p>We found no significant sex or gender differences in mental health changes. Future research should report outcomes for gender minority groups, even if small numbers, to support evidence synthesis.</jats:p>\n                </jats:sec>\n                <jats:sec>\n                  <jats:title>Registration</jats:title>\n                  <jats:p>PROSPERO (CRD42020179703)</jats:p>\n                </jats:sec>","journal":null,"year":null,"id":638392,"datarank":0.10397207708399181,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"self_citation_contribution":0.10397207708399181,"citation_network_contribution":0.0,"self_endowment_contribution":0.10397207708399181,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":2039,"name":"Yin Wu","orcid":"0000-0001-5527-1746","position":1,"is_corresponding":false},{"id":5979,"name":"Suiqiong Fan","orcid":"0000-0002-4240-4164","position":2,"is_corresponding":false},{"id":59287,"name":"Tiffany Dal Santo","orcid":"0000-0001-8505-3969","position":3,"is_corresponding":false},{"id":1658085,"name":"Nadia P. González-Domínguez","orcid":null,"position":4,"is_corresponding":false},{"id":419815,"name":"Ying Sun","orcid":"0000-0002-8379-0591","position":5,"is_corresponding":false},{"id":1256922,"name":"Letong Li","orcid":null,"position":6,"is_corresponding":false},{"id":816175,"name":"Kexin Li","orcid":"0000-0002-4955-3832","position":7,"is_corresponding":false},{"id":873747,"name":"Xiaowen Jiang","orcid":"0000-0003-1618-4265","position":8,"is_corresponding":false},{"id":1658092,"name":"Amina Tasleem","orcid":null,"position":9,"is_corresponding":false},{"id":478460,"name":"Yutong Wang","orcid":"0000-0001-7796-7779","position":10,"is_corresponding":false},{"id":2084,"name":"Jill Boruff","orcid":"0000-0002-0338-7322","position":11,"is_corresponding":false},{"id":946567,"name":"Palak Desai","orcid":null,"position":12,"is_corresponding":false},{"id":1658096,"name":"Brienne Tougas","orcid":null,"position":13,"is_corresponding":false},{"id":1658098,"name":"Monica D’Onofrio","orcid":null,"position":14,"is_corresponding":false},{"id":2042,"name":"Ankur Krishnan","orcid":"0000-0001-8671-7421","position":15,"is_corresponding":false},{"id":1091339,"name":"Claire Adams","orcid":"0000-0003-3871-9267","position":16,"is_corresponding":false},{"id":478859,"name":"Chen He","orcid":"0000-0003-1452-8511","position":17,"is_corresponding":false},{"id":1102556,"name":"Richard S. Henry","orcid":"0000-0002-7388-1254","position":18,"is_corresponding":false},{"id":1658100,"name":"Afra Alkan","orcid":"0000-0002-9734-4138","position":19,"is_corresponding":false},{"id":2046,"name":"Danielle B. Rice","orcid":"0000-0001-5615-7005","position":20,"is_corresponding":false},{"id":5048,"name":"Sarah Markham","orcid":"0000-0002-8755-5935","position":21,"is_corresponding":false},{"id":2047,"name":"Marleine Azar","orcid":null,"position":22,"is_corresponding":false},{"id":59301,"name":"Elsa‐Lynn Nassar","orcid":"0000-0001-5398-0899","position":23,"is_corresponding":false},{"id":268014,"name":"Sophie Hu","orcid":"0000-0002-2904-8804","position":24,"is_corresponding":false},{"id":1658103,"name":"Mara Cañedo-Ayala","orcid":null,"position":25,"is_corresponding":false},{"id":747943,"name":"Dipika Neupane","orcid":null,"position":26,"is_corresponding":false},{"id":2083,"name":"Andrea Benedetti","orcid":"0000-0002-8314-9497","position":27,"is_corresponding":false},{"id":2034,"name":"Brett D. Thombs","orcid":"0000-0002-5644-8432","position":28,"is_corresponding":false},{"id":1658084,"name":"Gabriel Chun Yin Sung","orcid":"0000-0001-7284-3347","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Mental health symptom changes by sex or gender during COVID-19 compared to pre-pandemic: a systematic review and meta-analysis update","abstract":"<jats:title>ABSTRACT</jats:title>\n                <jats:sec>\n                  <jats:title>KEY POINTS</jats:title>\n                  <jats:sec>\n                    <jats:title>Question</jats:title>\n                    <jats:p>Did changes in mental health symptoms from pre-COVID-19 to during the pandemic differ by sex or gender?</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings</jats:title>\n                    <jats:p>In this systematic review and meta-analysis study of findings from 27 unique cohorts, changes from before to during the COVID-19 pandemic in mental health symptoms, including general mental health, anxiety, depression, and stress, were not statistically significantly different by sex or gender.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Meaning</jats:title>\n                    <jats:p>There were not likely substantial sex and gender differences in mental health symptom changes during the COVID-19 pandemic.</jats:p>\n                  </jats:sec>\n                </jats:sec>\n                <jats:sec>\n                  <jats:title>Importance</jats:title>\n                  <jats:p>Concerns remain about whether COVID-19 affected mental health differently across sex or gender groups. We previously reported that changes in general mental health and anxiety symptoms, but not depression or stress, worsened more for females or women than males or men, but that was based on 12 studies published up to August 2021.</jats:p>\n                </jats:sec>\n                <jats:sec>\n                  <jats:title>Objective</jats:title>\n                  <jats:p>To investigate the sex or gender differences in mental health symptoms before and during the COVID-19 pandemic with updated evidence.</jats:p>\n                </jats:sec>\n                <jats:sec>\n                  <jats:title>Data Sources</jats:title>\n                  <jats:p>MEDLINE, PsycINFO, CINAHL, EMBASE, Web of Science, China National Knowledge Infrastructure, Wanfang, medRxiv, Open Science Framework Preprints searched to August 31, 2023.</jats:p>\n                </jats:sec>\n                <jats:sec>\n                  <jats:title>Study Selection</jats:title>\n                  <jats:p>Eligible studies included change data for general mental health, anxiety symptoms, depression symptoms, or stress from pre-to during COVID-19 by sex or gender. Two independent reviewers reviewed citations for eligibility.</jats:p>\n                </jats:sec>\n                <jats:sec>\n                  <jats:title>Data Extraction and Synthesis</jats:title>\n                  <jats:p>Standardized mean differences (SMDs) were extracted for changes of continuous outcomes and proportions for dichotomous outcomes. Two independent reviewers completed data extraction and risk of bias assessment with an adapted Joanna Briggs Institute Checklist for Prevalence Studies. Data were pooled by random-effects models.</jats:p>\n                </jats:sec>\n                <jats:sec>\n                  <jats:title>Main Outcomes and Measures</jats:title>\n                  <jats:p>Difference in change of SMDs and proportions between sex or gender groups pre-COVID-19 to COVID-19.</jats:p>\n                </jats:sec>\n                <jats:sec>\n                  <jats:title>Results</jats:title>\n                  <jats:p>\n                    We included data from 27 unique cohorts (N = 102 to 18,127). Change differences by sex or gender were minimal and not statistically significant: general mental health (SMD change\n                    <jats:sub>women-men</jats:sub>\n                    = 0.01, 95% confidence interval [CI]:-0.07 to 0.10; proportion change\n                    <jats:sub>women-men</jats:sub>\n                    = −0.03, 95% CI: −0.08 to 0.03), anxiety (SMD change\n                    <jats:sub>women-men</jats:sub>\n                    = 0.09, 95% CI −0.04 to 0.22; proportion change\n                    <jats:sub>women-men</jats:sub>\n                    = −0.05, 95% CI: −0.20 to 0.11), depression (SMD change\n                    <jats:sub>women-men</jats:sub>\n                    = 0.10, 95% CI: −0.00 to 0.20; proportion change\n                    <jats:sub>women-men</jats:sub>\n                    = −0.13, 95% CI: −0.81 to 0.55), and stress (SMD change\n                    <jats:sub>women-men</jats:sub>\n                    = −0.08, 95% CI −0.16 to 0.01, proportion change\n                    <jats:sub>women-men</jats:sub>\n                    = 0.04, 95% CI −0.10 to 0.17). No studies reported eligible mental health outcomes for gender minorities.\n                  </jats:p>\n                </jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion and Relevance</jats:title>\n                  <jats:p>We found no significant sex or gender differences in mental health changes. Future research should report outcomes for gender minority groups, even if small numbers, to support evidence synthesis.</jats:p>\n                </jats:sec>\n                <jats:sec>\n                  <jats:title>Registration</jats:title>\n                  <jats:p>PROSPERO (CRD42020179703)</jats:p>\n                </jats:sec>","is_dataset_classified":null,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"19767382","pmcid":null,"openalex_id":"https://openalex.org/W7125640176","authors":[],"funders":[],"total_grants":0,"fwci":null,"citation_percentile":null,"influential_citations":0,"citation_trend":[{"year":2026,"count":1}],"oa_status":"green","license":"cc-by-nc","oa_locations":[{"url":"https://www.medrxiv.org/content/medrxiv/early/2026/01/24/2026.01.22.26344371.full.pdf","host_type":"repository"},{"url":"https://www.medrxiv.org/content/medrxiv/early/2026/01/24/2026.01.22.26344371.full.pdf","host_type":"repository"},{"url":"https://syndication.highwire.org/content/doi/10.64898/2026.01.22.26344371","host_type":"publisher"},{"url":"https://doi.org/10.64898/2026.01.22.26344371","host_type":"repository"}],"fields_of_study":["COVID-19 and Mental Health","Mental Health Research Topics","Mental Health via Writing"],"mesh_terms":[],"keywords":["Mental health","Anxiety","Depression (economics)","Pandemic","MEDLINE","Sex characteristics"],"sdg_mappings":[],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-06T20:36:11.068981Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}