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Introduction The COVID-19 pandemic has posed a serious health risk, especially in vulnerable populations. Even before the pandemic, people with mental disorders had worse physical health outcomes compared to the general population. This umbrella review investigated whether having a pre-pandemic mental disorder was associated with worse physical health outcomes due to the COVID-19 pandemic. Methods Following a pre-registered protocol available on the Open Science Framework platform, we searched Ovid MEDLINE All, Embase (Ovid), PsycINFO (Ovid), CINAHL, and Web of Science up to the 6th of October 2021 for systematic reviews on the impact of COVID-19 on people with pre-existing mental disorders. The following outcomes were considered: risk of contracting the SARS-CoV-2 infection, risk of severe illness, COVID-19 related mortality risk, risk of long-term physical symptoms after COVID-19. For meta-analyses, we considered adjusted odds ratio (OR) as effect size measure. Screening, data extraction and quality assessment with the AMSTAR 2 tool have been done in parallel and duplicate. Results We included five meta-analyses and four narrative reviews. The meta-analyses reported that people with any mental disorder had an increased risk of SARS-CoV-2 infection (OR: 1.71, 95% CI 1.09–2.69), severe illness course (OR from 1.32 to 1.77, 95%CI between 1.19–1.46 and 1.29–2.42, respectively) and COVID-19 related mortality (OR from 1.38 to 1.52, 95%CI between 1.15–1.65 and 1.20–1.93, respectively) as compared to the general population. People with anxiety disorders had an increased risk of SAR-CoV-2 infection, but not increased mortality. People with mood and schizophrenia spectrum disorders had an increased COVID-19 related mortality but without evidence of increased risk of severe COVID-19 illness. Narrative reviews were consistent with findings from the meta-analyses. Discussion and conclusions As compared to the general population, there is strong evidence showing that people with pre-existing mental disorders suffered from worse physical health outcomes due to the COVID-19 pandemic and may therefore be considered a risk group similar to people with underlying physical conditions. Factors likely involved include living accommodations with barriers to social distancing, cardiovascular comorbidities, psychotropic medications and difficulties in accessing high-intensity medical care.

Supplementary Material 1

The COVID-19 pandemic has led to world-wide human suffering, which may include negative effects on mental health (United Nations, 2020). A great number of research projects have assessed the mental health impacts of COVID-19, which have been integrated into systematic reviews (SRs) with or without meta-analyses (MAs). Although some authors have reported direct and indirect negative effects of COVID-19 on specific mental health problems (e.g., depression or post-traumatic stress symptoms) and elevated generic psychological distress due to pandemic control measures (e.g., Dong et al., 2021; Xiong et al., 2020), other population-based studies indicated that most people are resilient and do not experience an increase in distress despite exposure to stressors (Pierce et al., 2021). Generally, findings from SRs and MAs are inconsistent and highly diverse in quality. Hence, proper understanding of the evidence on the impacts of COVID-19 on mental health is needed to correctly inform the global mental health response and to identify gaps in knowledge for further scientific research. The aim of this umbrella review is to synthesize the existing evidence of the impact of COVID-19 on mental health. To this end, the proposed umbrella review will answer the following questions: (1) What is the impact of COVID-19 on prevalence of mental health symptoms and mental health disorders among the general population, health care workers, and vulnerable groups and what is the mental health impact of COVID-19 over time during the pandemic? (2) What is the impact of COVID-19 on suicidal behaviour and suicidal thoughts prevalence in any population? (3) Are people living with pre COVID-19 existing mental health disorders at (increased) risk of severe illness and mortality and/or of contracting SARS-CoV-2 compared to any other population? (4) What is the impact of COVID-19 on access and delivery of mental health services and how have mental health services changed during the pandemic? (5a) What is the effectiveness of psychological interventions aimed to prevent and reduce mental health problems (depression, anxiety, posttraumatic stress, substance use, suicidal behaviours) and improve well-being and resilience related to COVID-19 and the epidemic control measures? (5b) What is the effectiveness of psychological interventions and strategies adapted to be delivered during the COVID-19 pandemic compared to psychological interventions as usual on the reduction of mental health problems and on access to mental health services during the pandemic?

Additional file 1: Procedures for model identification. Fig. S1. Flowchart of sample identification. Table S1. Descriptive statistics of resilience indicators across the survey waves (N = 1052)*. Table S2. Frequency of each chronic medical condition in the whole sample. Table S3. Comparison between participants with and without chronic medical conditions at baseline*. Table S4. Descriptive statistics at the first wave of socio-demographic and clinical characteristics of participants with a chronic condition included vs excluded (because did not fill at least three waves of the survey). Table S5. Gender distribution of participants.

The dataset that supports the findings of this study are archived in the Universidad Autónoma de Madrid data repository e‐cienciaDatos in https://doi.org/10.21950/HN1HNO, Background and aims: The coronavirus disease 2019 pandemic has challenged health services worldwide, with a worsening of healthcare workers’ mental health within initial pandemic hotspots. In early 2022, the Omicron variant is spreading rapidly around the world. This study explores the effectiveness and cost-effectiveness of a stepped-care programme of scalable, internet-based psychological interventions for distressed health workers on self-reported anxiety and depression symptoms. Methods: We present the study protocol for a multicentre (two sites), parallel-group (1:1 allocation ratio), analyst-blinded, superiority, randomised controlled trial. Healthcare workers with psychological distress will be allocated either to care as usual only or to care as usual plus a stepped-care programme that includes two scalable psychological interventions developed by the World Health Organization: A guided self-help stress management guide (Doing What Matters in Times of Stress) and a five-session cognitive behavioural intervention (Problem Management Plus). All participants will receive a single-session emotional support intervention, namely psychological first aid. We will include 212 participants. An intention-to-treat analysis using linear mixed models will be conducted to explore the programme's effect on anxiety and depression symptoms, as measured by the Patient Health Questionnaire – Anxiety and Depression Scale summary score at 21 weeks from baseline. Secondary outcomes include post-traumatic stress disorder symptoms, resilience, quality of life, cost impact and cost-effectiveness. Conclusions: This study is the first randomised trial that combines two World Health Organization psychological interventions tailored for health workers into one stepped-care programme. Results will inform occupational and mental health prevention, treatment, and recovery strategies. Registration details: ClinicalTrials.gov Identifier: NCT04980326, The RESPOND project was funded under Horizon 2020 -the Framework Programme for Research and Innovation (2014– 2020) (grant number: 101016127), and the work of MF-N was supported by a postdoctoral fellowship of the ISCIII (CD20/ 00036)

Supplemental material, sj-doc-1-dhj-10.1177_20552076221129084 for Effectiveness of a stepped-care programme of internet-based psychological interventions for healthcare workers with psychological distress: Study protocol for the RESPOND healthcare workers randomised controlled trial by Roberto Mediavilla, Kerry R McGreevy, Mireia Felez-Nobrega, Anna Monistrol-Mula, María-Fe Bravo-Ortiz, Carmen Bayón, Beatriz Rodríguez-Vega, Pablo Nicaise, Audrey Delaire, Marit Sijbrandij, Anke B. Witteveen, Marianna Purgato, Corrado Barbui, Federico Tedeschi, Maria Melchior, Judith van der Waerden, David McDaid, A-La Park, Raffael Kalisch, Papoula Petri-Romão, James Underhill, Richard A. Bryant, Josep Maria Haro, José Luis Ayuso-Mateos and in Digital Health