Access and use of general and mental health services before and during the COVID-19 pandemic: a systematic review and meta-analysis

Objectives: To quantify access to health services during the COVID-19 pandemic and measure the change in use between the prepandemic and the pandemic periods in a population with assessment of psychological distress or diagnosis of mental disorders. Data sources: We developed and piloted a search syntax and adapted it to enter the following databases from 1 January 2020 to 31 March 2023: PubMed/MEDLINE, PsycINFO, Web of Science, Epistemonikos and the WHO International Clinical Trials Registry Platform. We reran the searches from the end of the original search to 3 December 2024. Design: We systematically screened titles, abstracts and full texts of retrieved records. Eligibility criteria: We included observational studies on any populations and regions, covering health services such as doctor visits, hospital admissions, diagnostic examinations, pharmaceutical therapies and mental health (MH) services. Only studies using validated scales to assess psychological distress or mental disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders were included. Data extraction and synthesis: We extracted data using a purposefully designed form and evaluated the studies' quality with the Newcastle-Ottawa Scale. We measured the incidence rate (IR) of access to health services and the IR ratio (IRR) between the prepandemic and the pandemic periods. We calculated contacts days and catchment areas in the different periods. We used the random effects DerSimonian-Laird inverse-variance model and calculated heterogeneity with statistics I² and τ². We computed pooled IR and pooled IRR and tested the hypothesis of no variation (IRR=1). Results: We retrieved 10 014 records and examined the full text of 580 articles. We included 136 primary studies of which 44 were meta-analysed. The IR of access to services during the pandemic was 2.59 contact months per 10 000 inhabitants (IR=2.592; 95% CI: 1.301 to 5.164). We observed a reduction of 28.5% in the use of services with negligible differences by age group and type of services (IRR=0.715; 95% CI: 0.651 to 0.785). We observed significant differences in effect sizes across studies (τ2=5.44; p<0.001 and τ2=0.090; p<0.001). Conclusion: By considering MH, our study provides consolidated evidence and quantifies the reduction in the use of health services during the COVID-19 pandemic. Prospero registration number: CRD42023403778.