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1 Determinant Of Mental Health Disorders During The COVID-19

2 Pandemic : Systematic Review
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4 Article Category: Systematic Review

5 Abstract Word Count: 195 Words
6 Manuscript Word Count: 3145 Words
7 Number of References: 14 Articles
8 Number of Tables: 1 Table
9 Number of Figures: 1 Figure
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12 Abstract
13 Objective: Many people experienced mental health disorders due to the COVID-19
14 pandemic and if not treated immediately, it will cause serious problems. The aim of this
15 article was to determine the determinants of mental health disorders during a pandemic.
16 Methods: A systematic approach in this review used the PRISMA approach and journal
17 sources from several databases including Scopus, Science Direct, SAGE, NCBI, ProQuest in
18 the 3 last years from 2020 to 2022. Boolean operators within search process used AND and
19 OR. The inclusion criteria were the general public, aged more than 17 years. Exclusion
20 criteria were people with chronic disease and schizophrenia. Literature review, editorial,
21 critical synthesis, and the like were also exclusion criteria for this review.
22 Results: Overall, this review consisted of 13 articles and all of article designs were cross
23 sectional. Respondents in all articles were the general public, the age of 17-60 years. The
24 determinant of mental health disorders were female gender, older age, history of chronic
25 diseases, exposure to media reporting COVID-19, education, job loss and marital status,
26 especially those who were married.
27 Conclusion: Overall, the community experienced mental health problems during the
28 pandemic.
29 Keywords:
30 determinants; factors; mental health disorders; COVID-19
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33 Introduction
34 COVID-19 or Corona Virus Disease 2019 was a new type of virus that was originally
35 discovered in 2019 in the city of Wuhan, China. WHO declared the status of COVID-19 as a
36 pandemic or global epidemic so that it was necessary to implement and prevented the
37 massive spread of the virus (1). This was proven by the implementation of several rules in
38 various countries, including in Indonesia, namely the use of masks, hand sanitizers,
39 disinfectants, regular hand washing and the implementation of physical distancing. The
40 increasing number of positive cases of COVID-19 and the number of victims who died has
41 made people feel anxious, restless and afraid (2). This condition was happened a very long
42 time and caused mental health problems in the community. Mental health disorders for a long
43 time will cause disturbances in the individual's daily life (3).
44 Many factors caused that some people experienced mental health disorders. Based on
45 research conducted by Maroufizadeh et al., (2020) the factors that caused a person's mental
46 health disorders during the COVID-19 pandemic were losing his job, losing a family
47 member, carrying out several regulations from the government such as lockdown (5). Some
48 of these rules also made the community bored in dealing with the COVID-19 pandemic
49 because people's activities and mobility were very limited (6). The saturation experienced by
50 society changed lifestyle such as high alcohol use, increased smoking consumption and
51 increased consumption of fast food (7). Some of the factors above that caused mental health
52 disorders that were experienced by many people include anxiety, depression and sleep
53 disorders. Mental health disorders experienced by the community vary widely, ranging from
54 mild, moderate to severe (8).
55 Global data in 2020 cases of major depressive disorder and anxiety disorders increased
56 by 28% and 26%, respectively. Women were more affected than men and younger people
57 were more affected than older age groups. Other disturbances are in the form of post-
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58 traumatic stress symptoms of the pandemic which is 24.1%, other psychological disorders are
59 50% and for sleep problems it was 27.6% (WHO., 2020). Countries with high rates of
60 COVID-19 infection and restrictions on community movement, enforcement and school
61 closures had the greatest increases in the prevalence of major depressive disorder and anxiety
62 disorders. Based on data from The Lancet (2020 ) a survey in various countries in Europe
63 with a respondent of 220,800 states that the symptoms of severe insomnia were 36.7% and
64 17.4% for moderate insomnia disorders. Anxiety disorders 25.6% and 23.1% with depressive
65 symptoms. Insomnia symptoms by 40% and insomnia disorders (>25%) were significantly
66 higher in younger women.
67 Survey conducted on 2,364 respondents by Perhimpunan Dokter Spesialis Kedokteran
68 Jiwa Indonesia (PDSKJI) in May 2020, showed that 69% of respondents experienced
69 psychological problems during COVID-19. The most experienced psychological problems
70 were 67% experiencing depression, 68% experiencing anxiety, 77% experiencing post-
71 traumatic stress and 32% thinking of choosing death or hurting themselves in any way. Based
72 on data from the Ministry of Health (2020). There was an increase in cases of mental
73 disorders due to the COVID-19 pandemic from the previous year. In 2019 the number of
74 people with mental disorders was 197,000 people, while in 2020 it was 277,000 people.
75 Other data states that based on BPS data, people aged 17-30 years are easily angry in the face
76 of the COVID-19 situation, as many as 11.9%, in despair as many as 21%, in anxiety by
77 25.6% and in excessive fear by 5.5%.
78 The Corona virus has infected various countries must be concerned (9). The
79 characteristic of this virus which was easy to transform made this pandemic last for a long
80 time with uncertain conditions. Several policies in various countries have carried out
81 infection prevention and control to reduce the spread of the virus, such as in America, Italy,
82 France, Canada, India, of course, Indonesia (10). The Indonesian government has also
83 imposed policies on the Indonesian people in an effort to reduce the spread of the virus,
84 namely in the form of movement restrictions, stay at home, social distancing and lock down
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85 in various regions. This of course causes people to be psychologically depressed to the point
86 of being disturbedmental health in various societies. The COVID-19 pandemic has certainly
87 had many unusual impacts and influences on people's lives.
88 The impact experienced by the community were not only on the physical impact but also
89 on the psychological impact. Rossi et al., (2020) in his research mentioned that there were
90 several psychological impacts when a pandemic occured and was felt by the community,
91 namely post-traumatic stress disorder (post-traumatic stress disorder), confusion, anxiety,
92 frustration, fear of affection, insomnia, feeling helpless, anxious to depression. Anxiety was
93 basically a common response that occured in humans. Anxiety was a reaction from the
94 human instinct to survive (5). When a person feels anxious, then in fact he is facing
95 something that he perceives as something that endangers or threatens his life (3). The
96 emergence of this feeling of anxiety affects our biological condition. The body given various
97 reactions that warn that something was threatening (11). Physical reactions that can be felt
98 naturally when someone was in a state of anxiety are heart palpitations, sweating, and so
99 on(12).
100 Some of the factors that caused mental health problems in the community were when
101 several companies and factories close, so they have to reduce many of their employees. Based
102 on research conducted by Huang and Zhao (2020) unemployment was one of the factors that
103 caused mental health disorders. Other studies also suggested that the declined in opinion
104 during the pandemic can also caused people to experience mental health problems (13). Fear
105 of being infected with COVID-19 was also a very important factor in contributing to a
106 person's mental health disorder. This condition can trigger excessive anxiety in everyone
107 because they were afraid that they will be infected and experience terrible things to death (2).
108 The most traumatic factor was the loss of a family member due to COVID-19. Based on
109 research conducted by Burhamah et al., (2020) losing a family member was a very forgotten
110 moment, causing anxiety to depression, especially if you lose several members at almost the
111 same time.
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112 Understanding some of the factors that influence a person's mental health was important.
113 The COVID-19 pandemic has not only caused physical problems but also mental health
114 problems for sufferers and family members. Mental health was a problem that often arises
115 during the COVID-19 pandemic but was often neglected and does not receive special
116 attention. It was important for health workers, especially nurses, to understand the problem of
117 mental health disorders because the interventions that will be given will also have different
118 approaches. So this systematic review will discuss the factors that affected the mental health
119 disorders of the community during the pandemic.
120 Material And Methods

121 Guidelines used for achieving a systematic review. These guidelines cover the reasons
122 and objectives of the research, eligibility criteria for studies to be included in the article,
123 sources of information, search strategy used, article selection and data collection process,
124 results obtained, methods for assessing the results of data synthesis. This systematic review
125 followed the preferred reporting item guidelines for systematic reviews and meta-analyses
126 (PRISMA).

127 The literature searched in this study begins with obtaining research journals from
128 several databases including, SCOPUS, CINAHL/EBSCO, PubMed, SAGE and Science
129 Direct. The search for scientific journals or articles starts from the last 3 years from 2020 to
130 2022 with the equivalent keywords ('determinants', 'factors', mental health disorders', and
131 COVID-19). Boolean operators in the search process use AND and OR. Article search was
132 limited to types that provide full English text.

133 The inclusion criteria used the population, intervention, comparison, outcome and
134 timing (PICOT) framework, where the population the general public, both men and women,
135 aged 18-80 years who experienced mental health disorders during the COVID-19 pandemic.
136 The interventions provided were focused on population-based surveys. The main outcome of
137 this study was to determine the determinants that could lead to mental health disorders during
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138 a pandemic. The articles were taken from the last three years using a cross-sectional study
139 method.

PICOT Inclusion Criteria

the general public, both men and women, aged 18-80

Population years who experience mental health disorders during the
COVID-19 pandemic

Intervention population-based surveys

No comparison intervention
comparison

to determine the determinants of mental health disorders

Outcomes
during a pandemic.

time 2020-2022

Study Design cross-sectional study

Language English

Articles that did not discuss mental health disorders

during a pandemic, articles without full text and
Exclusion
abstracts without intervention details, and studies
criteria:
conducted in languages other than English, as well as
non-cross-sectional study designs were excluded.

140 Table-1 : PICOT Framework

141 According to PRISMA guidelines, the first step was to search for articles that match

142 the topic based on electronic data. After getting the article, it was selected and then the same

143 article will be deleted. titles and abstracts were screened for eligibility criteria. The entire text

144 of each selected article that met the inclusion criteria was taken for further examination. A
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145 secondary search was carried out from the reference list articles to identify additional records.

146 The final stage included articles that were relevant and met all inclusion criteria in the

147 systematic review.

148 The method used in this study uses data extraction and structured forms to extract

149 information from the articles included starting from the author, year, country, method,

150 sample, age, intervention, influencing factors, the purpose of the article results to evaluate the

151 effect. intervention.

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153 Results:
154 Study Selection

155 The total articles obtained from search results with keywords that have been
156 determined were 1914 articles from 5 databases, namely 319 articles from Scopus, 353
157 articles from PubMed, 396 from Ebsco/Chinalh, 374 from Science Direct and the last 472
158 articles from Sage. Then 255 were excluded because of duplication of articles and screening
159 based on the title, there were 126 articles that were not appropriate and 1533 were also
160 excluded because they did not match the topic and inclusion criteria, then a total of 78 articles
161 were also excluded because they did not match the abstract and content of the study. The total
162 of articles that have passed the screening were 13articles.
Study Identity through database Additional Studies Identified
Identification

163 SearchingScience Direct, Through other Sources

PubMed, CINAHL, SCOPUS (n=0)
164
and SAGE
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(n = 1914)
166 Studies after duplicate removed
167 (n=1659)
Screening

168

169 Title Screened Records excluded as

(n=126) not related to the
170
topic
171
(n = 1533 articles)
Elibility

172 Full-text articles

Studies excluded
assessed for reliability
173 (n=48) (n=78)
174

175
Studies included in the
Included

176 qualitative synthesis

(n=13)

Figures. 1 Flow chart of study selection

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177 Article Characteristics

178 Several parameters were used to assess mental health disorders during the pandemic in
179 various communities affected by COVID-19, almost entirely using a web-based approach
180 with a number of (n: 10 articles) 1, (14),3,4,6,8,9,11, 12,13,wechat (n : 3) 5,7,10 online (n :
181 12 )1,2,3,4,5,6,7,8,10,11,12,13, mixed online and face-to-face interview (n: 1) 9.

182 The methods that given was variation, the focus was given on social media platforms
183 using questionnaires (n: 10) , (1), (2), (3), (4), (6), (8), (9), (10), (12), (13), from the team or
184 hospital members (n: 3) (2), (4) and (7). Questionnaire measuring instrument PHQ-9 (n : 8)
185 (1), (2), (3), (4), (6), (8), (9), (10), GAD-7 (n: 8) , (4), (5), (3), (8), (10), (11), (13),
186 WEMWBS (n :1 ) (2), AUDIT (n :1 ) (2), BAI (n:1 ) (2), BDI (n:1 ) (2), COVID-19 Stressors
187 Score (n : 1) (3), NHANES (n : 1 ) (3), CLIMB (n : 1) (3), CES-D (n : 1) (5), DASS-21 (n :
188 2) (6) and (12), IES-R (n : 5 ) (6) (7) (9) (10) (12), SDS (n : 1) (7), PSQI (n : 1) (7), PTSS (n :
189 1) (7), PSS (n : 1) (8), IADQ (n : 1) (8), IES (n : 1) (3), ISI-7 (n : 1 ) (9), SCSQ (n : 1) (13),
190 AIS (n : 1) (13).

191 Of the overall identified younger people showed a much higher prevalence than older
192 people. Therefore, some of the main focus of research is age. From age 18 (n : 8 ) (3), (5),
193 (6), (7), (8), (9), (11) (12), age 19 (n : 1 ) (10), age 21 (n : 2) (1) , (2), age 26 (n : 1 ) (4), age
194 30 (n : 1) (13). Lockdown

195 Determinants Of Mental Health Disorders

196 Determinants that can lead to mental health disorders during a pandemic in the
197 community varies, age (n: 4) (1), (7), (8) (13), history of chronic disease (n: 4) (1), (6), (10)
198 (11) job loss (n: 6) (1), (3), (4), (8), (11), (13), students (n : 2) (1), (6), Exposure to excessive
199 media about COVID-19 news (n : 4) (1) (5) (6) (12), Living with family members infected
200 with COVID-19 (n : 5 ) (1), (9), (10), (11), (12) female (n: 8) (2), (4), (6), (8), (9), (10), (11)
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201 (12), Low education (n:1) (7), have family members infected with COVID-19 (n: 7) (1), (2)
202 (6), (9), (10), (3), (11) (12), lockdown (n : 5) (1), (2), (8), (9), (12)

203

204 Discussion:
205 The purpose of this systematic review was to find several articles that identify the
206 factors that influence someone with mental health disorders. The majority of the main factors
207 were gender, namely women. Almost all articles mentioned that women experienced mental
208 health problems more than men. That's because women were too heavy in thinking about
209 their health conditions (20). This statement was supported by research conducted by Luo
210 (2020) which was revealed that gender differences were very influential in stressful situations
211 such as COVID-19. In this study these women had significantly higher rates of depression
212 than men (15). In another article, it was stated that the burden of housework and loneliness
213 were triggers for women (12). Another factor was having a family member who was infected
214 with COVID-19. Almost all articles explain this, especially if there were family members
215 who live in the same neighborhood. This will lead to mental health disorders (4). This was in
216 accordance with the research statement from Jian (2021) that living with family members or
217 neighbors who have been infected with COVID-19 will trigger more anxiety and depression
218 for fear of being infected with COVID-19 (16). Another factor that was no less important
219 was a history of chronic disease. Individuals who have a history of chronic disease will easily
220 experience mental health disorders. This was because individuals with chronic diseases were
221 more vulnerable and dangerous if they were infected with COVID-19 (11). This was also
222 related to other factors, namely the news in the media. People who were often exposed to
223 media reports about COVID-19 will tend to be more prone to mental health disorders (8).
224 This means that the individual was not ready to face COVID-19. The interesting thing was
225 the education factor (6). People with higher education were actually more at risk of
226 experiencing mental health disorders, it was inversely proportional to people with low
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227 education who were not easy to experience mental health disorders (7). Loss of work, being
228 laid off, salary cuts and several things related to income were factors that were widely
229 discussed in the articles above. This will also aggravate a person's condition if the individual
230 was already married or married and has children (5).

231

232 Conclusion:
233 This systematic review showed that the factors that influence individuals experience health

234 problems mental were female gender, older age, history of chronic disease, exposure to media

235 reporting COVID-19, education, job loss and marital status, namely those who were married.

236 Acknowledgement: None

237 Disclaimer: None
238 Conflict of interest: None
239 Funding disclosure: None (15)
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