# The Impact of Government Lockdowns on the Mental Health of the General Population: A Systematic Review and Meta-analysis

## TL;DR

This study reviews how government lockdowns during disease outbreaks like COVID-19 affect mental health, finding uncertain evidence of significant impacts.

## Contribution

The paper provides a systematic review and meta-analysis of lockdown effects on mental health during infectious disease outbreaks.

## Key findings

- Government lockdowns may have little to no effect on depressive symptoms, but evidence is very uncertain.
- Lockdowns may increase PTSD and insomnia symptoms, but evidence certainty is low.
- Little to no effect on anxiety and alcohol use was observed, but results remain uncertain.

## Abstract

Since December 2019, the COVID-19 pandemic has spread globally, prompting governments in many countries to implement lockdowns to control the transmission of the virus. Outbreaks of emerging infectious diseases, such as COVID-19, and the associated government lockdowns may have significant negative impacts on mental health. A comprehensive review of the available evidence on this topic can provide useful information for policymakers. This review aimed to assess the effects of government lockdowns on the mental health of the general population during emerging infectious disease outbreaks.

On April 11, 2022, we conducted a systematic search of CENTRAL, MEDLINE, PsycINFO Ovid, and two clinical trial registries, supplemented by reference checking and citation searching. We included non-randomized studies of interventions (NRSIs) involving adults and adolescents, regardless of comorbidities, that examined the effects of government-imposed lockdowns compared to no lockdown during outbreaks of emerging infectious diseases, including SARS, MERS, COVID-19, H1N1, equine influenza, avian influenza, and Ebola virus disease. Critical outcomes assessed were depressive symptom severity and suicide, while important outcomes included anxiety symptom severity, post-traumatic stress disorder (PTSD) symptom severity, insomnia symptom severity, and substance use. We used the ROBINS-I tool to assess the risk of bias and conducted a meta-analysis using a random-effects model. The certainty of evidence was evaluated using the GRADE approach.

We included 42 NRSIs, all conducted during the COVID-19 pandemic. Of the 27 studies reporting depressive symptoms, we pooled effect sizes from eight studies. The findings suggest that government lockdowns may have little to no effect on depressive symptom severity within the 12-month follow-up; however, the evidence was very uncertain (standardized mean difference (SMD) 0.00, 95% CI -0.08 to 0.09; I2 = 70%; 11,278 participants). Two studies reported on suicide outcomes, but both had an overall critical risk of bias due to confounding; therefore, we did not synthesize results and judged the evidence as very low certainty. For anxiety symptom severity, we pooled data from five of 20 studies and found that government lockdowns may have little to no effect within the 12-month follow-up (SMD 0.08, 95% CI -0.10 to 0.26; I2 = 91%; 11,006 participants). Regarding PTSD symptom severity, pooled data from one of two studies suggested that government lockdowns may increase the symptom severity within the 12-month follow-up (MD 0.18, 95% CI 0.08-0.28; 1,754 participants). We pooled data from two of eight studies on insomnia symptom severity and found that government lockdowns may increase the symptom severity within the 12-month follow-up (MD 1.28, 95% CI 0.62-1.94; I2 = 91%; 5,142 participants). In terms of alcohol use, data pooled from five of nine studies on alcohol use showed that government lockdowns may have little to no effect on alcohol consumption within the 12-month follow-up (SMD 0.03, 95% CI -0.05 to 0.11; I2 = 66%; 8,261 participants). Overall, the evidence regarding all important outcomes was of very low certainty.

At present, the impact of government lockdowns during emerging infectious disease outbreaks on mental health in the general population remains very uncertain. Future research should prioritize well-designed studies to better assess the mental health effects of lockdown measures during novel outbreaks.