Daily routine disruptions and psychiatric symptoms amid COVID-19: a systematic review and meta-analysis of data from 0.9 million individuals in 32 countries

Liu, Huinan; Tao, Tiffany Junchen; Chan, Selina Kit Yi; Ma, Jeremy Chi Him; Lau, Abby Yan Tung; Yeung, Ernest Tsun Fung; Hobfoll, Stevan E.; Hou, Wai Kai

doi:10.1186/s12916-024-03253-x

Table 3 Moderators of the associations between daily routine disruptions (combined across types) and psychiatric symptoms (53 studies, 51 independent samples)

From: Daily routine disruptions and psychiatric symptoms amid COVID-19: a systematic review and meta-analysis of data from 0.9 million individuals in 32 countries

Moderator		Psychiatric symptoms
	k	Statistic type	Statistic value [95% CI]	p
*Psychiatric symptoms*
Model 1 Psychiatric symptoms
Subgroup differences	–	Q-value	32.10	< 0.001
Depressive symptoms	62	Pearson’s r	0.13 [0.06; 0.20]	< 0.001
Anxiety symptoms	38	Pearson’s r	0.12 [0.06; 0.17]	< 0.001
Post-traumatic stress disorder (PTSD) symptoms	12	Pearson’s r	0.03 [− 0.09; 0.15]	0.56
Depressive and anxiety symptoms	6	Pearson’s r	0.01 [− 0.01; 0.02]	0.38
General psychological distress^a	27	Pearson’s r	0.09 [0.02; 0.16]	0.02
*Daily routine disruptions*
Model 2 Category^b
Subgroup differences	–	Q-value	1.03	0.31
Primary routines	31	Pearson’s r	0.07 [0.01; 0.14]	0.02
Secondary routines	75	Pearson’s r	0.04 [0.01; 0.07]	0.01
Model 3 Type
Subgroup differences	–	Q-value	31.76	< 0.001
Physical activity	19	Pearson’s r	0.06 [0.03; 0.10]	<0.01
Eating	7	Pearson’s r	0.11 [− 0.00; 0.21]	0.05
Sleep	14	Pearson’s r	0.10 [0.01; 0.20]	0.03
Social activities	16	Pearson’s r	0.04 [− 0.03; 0.10]	0.27
Leisure activities	16	Pearson’s r	0.06 [− 0.06; 0.17]	0.29
Work/Study	15	Pearson’s r	− 0.03 [− 0.09; 0.04]	0.41
Home activities	10	Pearson’s r	0.01 [− 0.13; 0.15]	0.86
Smoking	4	Pearson’s r	0.05 [0.00; 0.09]	0.05
Alcohol	5	Pearson’s r	0.08 [− 0.04; 0.20]	0.15
Combined multiple routines	11	Pearson’s r	0.21 [0.10; 0.32]	<0.01
Unspecified generic routines	28	Pearson’s r	0.26 [0.13; 0.38]	<0.001
Model 4 Definition
Subgroup differences	–	Q-value	38.74	< 0.001
Regularity	53	Pearson’s r	0.22 [0.15; 0.29]	< 0.001
Frequency change	71	Pearson’s r	0.00 [− 0.03; 0.03]	0.83
Capability change	21	Pearson’s r	0.14 [0.06; 0.22]	< 0.01
Model 5 Internet-related or not
Subgroup differences	–	Q-value	26.04	< 0.001
No	131	Pearson’s r	0.12 [0.08; 0.16]	< 0.001
Yes	14	Pearson’s r	− 0.05 [− 0.11; 0.01]	0.09
Model 6 Assessment method
Subgroup differences	–	Q-value	1.02	0.31
Non-validated scale	99	Pearson’s r	0.12 [0.07; 0.17]	< 0.001
Validated scale	46	Pearson’s r	0.08 [0.05; 0.12]	< 0.001
*Population demographics*
Model 7 Gender
Non-male [range: 42.06–100%]	145	Coefficient	− 0.00 [− 0.00; 0.00]	0.20
Model 8 Education level
Without tertiary education [range 0–100%]	80	Coefficient	0.00 [− 0.00; 0.00]	0.56
Model 9 Marital status
Non-married [range 4.98–98.32%]	53	Coefficient	− 0.00 [− 0.01; 0.00]	0.61
Model 10 Employment status
Non-employed [range 0–93.26%]	71	Coefficient	0.00 [− 0.00; 0.00]	0.44
Model 11 Physical comorbidity
ICD-defined physical comorbidity [range 19.66–100%]	29	Coefficient	− 0.00 [− 0.00; 0.00]	0.50
Model 12 Country-level income
Subgroup differences	–	Q-value	2.00	0.16
High	121	Pearson’s r	0.11 [0.07; 0.16]	< 0.001
Middle	24	Pearson’s r	0.07 [0.01; 0.12]	0.02
*Coronavirus-2019 features*
Model 13 Continent
Subgroup differences	–	Q-value	23.67	< 0.001
Europe	62	Pearson’s r	0.11 [0.06; 0.16]	< 0.001
Asia	58	Pearson’s r	0.12 [0.05; 0.19]	< 0.01
Oceania	12	Pearson’s r	0.03 [0.02; 0.04]	< 0.001
South America	6	Pearson’s r	− 0.01 [− 0.14; 0.11]	0.81
North America	5	Pearson’s r	0.18 [− 0.07; 0.41]	0.12
Multiple countries	2	Pearson’s r	0.33 [− 0.87; 0.97]	0.23
Model 14 Number of months since COVID-19 outbreak
Number of months since COVID-19 outbreak [range 3–29]	128	Coefficient	− 0.00 [− 0.00; 0.00]	0.86
Model 15 COVID-19 monthly incidence^a
Subgroup differences	–	Q-value	0.12	0.72
Low	68	Pearson’s r	0.11 [0.07; 0.15]	< 0.001
High	57	Pearson’s r	0.10 [0.05; 0.15]	< 0.001
Model 16 COVID-19 monthly death^c
Subgroup differences	–	Q-value	11.25	< 0.001
Low	63	Pearson’s r	0.06 [0.03; 0.09]	< 0.001
High	62	Pearson’s r	0.15 [0.10; 0.20]	< 0.001
Model 17 COVID-19 government response index^d
Subgroup differences	–	Q-value	3.35	0.07
Low	68	Pearson’s r	0.13 [0.09; 0.17]	< 0.001
High	57	Pearson’s r	0.08 [0.04; 0.12]	< 0.001
Model 18 COVID-19 containment and health index^d
Subgroup differences	–	Q-value	0.29	0.59
Low	70	Pearson’s r	0.11 [0.07; 0.15]	< 0.001
High	55	Pearson’s r	0.10 [0.06; 0.14]	< 0.001
Model 19 COVID-19 stringency index^d
Subgroup differences	–	Q-value	1.52	0.22
Low	60	Pearson’s r	0.12 [0.08; 0.17]	< 0.001
High	65	Pearson’s r	0.09 [0.05; 0.13]	< 0.001
Model 20 COVID-19 economic support index^d
Subgroup differences	–	Q-value	14.01	< 0.001
Low	53	Pearson’s r	0.17 [0.12; 0.21]	< 0.001
High	72	Pearson’s r	0.06 [0.02; 0.10]	< 0.01
*Study features*
Model 21 Study quality
Study quality [range 9–18]	145	Coefficient	0.01 [− 0.01; 0.03]	0.53
Model 22 Cross-sectional or prospective design
Subgroup differences	–	Q-value	6.67	< 0.01
Cross-sectional	140	Pearson’s r	0.10 [0.07; 0.14]	< 0.001
Prospective	5	Pearson’s r	0.24 [0.10; 0.36]	< 0.01
Model 23 Follow-up duration
Follow-up duration after intervention (months) [range 3–12]	4	Coefficient	0.01 [− 0.01; 0.04]	0.17
Model 24 Sample size
Subgroup differences	–	Q-value	0.59	0.44
Large sample^e (N = 6)	15	Pearson’s r	0.19 [− 0.07; 0.42]	0.14
Small sample (N = 47)	130	Pearson’s r	0.10 [0.07; 0.13]	< 0.001

k = Number of effect sizes
^a“General psychological distress” included distress (e.g., “Kessler Psychological Distress Scale–6 (K6)”) and stress (e.g., “Depression Anxiety Stress Scale-21 (DASS-21) Stress Subscale”)
^bPrimary routines included eating, sleep, and home activities; Secondary routines included physical activity, leisure activities, social activities, and work/studies [16, 20]
^cThe unit is monthly cumulative per million individuals. Information was extracted from official websites. “High” and “Low” categories were generated based on median split
^dThe unit is monthly average score. Information was extracted from Oxford Covid-19 Government Response Tracker (OxCGRT; [19]). “High” and “Low” categories were generated based on median split
^eBig sample studies refer to the six studies which accounting for over 80% of total respondents, namely Lee & Chu [36], Lee et al. [38], Cho et al. [75], Hampshire et al. [24], Sommerlad et al. [60], and Tondokoro et al. [66]

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