Study selection
The search strategy identified 88 documents published as of April 15th, 2020, as the most relevant documents at the beginning of the pandemic. No duplicates were found (Fig. 1). In the eligibility phase, 26 documents fulfilled the inclusion criteria (Fig. 1). There was strong agreement between CGA and NA (kappa value = 0.787, p = 0.000; ICC = 0.881, p = 0.000).
Study Characteristics
General population is the target for almost all the documents (99.06%, Table 2), and the predominant format is a report (73.1%). The documents with more positive “YES” answers were 1 and 13 (85.19%), and documents 5 and 11 had the lower rate (25.93%). Documents 1 and 13 are the most complete ones (Table 3) and documents 5 and 11 are the most specific.
Table 2
Documents included in the review
Code | Authors (year) | Country1 | Target Population2 | Document Type3 |
1 | Australian Government [46] | 1 | 1 | 2 |
2 | Centre for Addiction and Mental Health [47] | 2 | 1 | 2 |
3 | Ireland's Health Services [48] | 8 | 1 | 2 |
4 | Mental Health Ireland [49] | 8 | 1 | 2 |
5 | Gobierno de México [50] | 10 | 1 | 2 |
6 | Mental Health America [51] | 16 | 1 | 2 |
7 | Centers for Disease Control and Prevention [52] | 16 | 1 | 2 |
8 | MindHK [53] | 3 | 1 | 1 |
9 | Centre for Health Protection [54] | 3 | 1 | 2 |
10 | New Zealand Government [55] | 11 | 1 | 2 |
11 | Spanish Society of Psychiatry [56] | 14 | 1 | 1 |
12 | Psychology General Council of Spain [57] | 14 | 1 | 2 |
13 | Gov.UK (United Kingdom Government) [58] | 4 | 1 | 2 |
14 | Mental Health Foundation [59] | 4 | 1 | 2 |
15 | Government of Canada [60] | 2 | 1 | 2 |
16 | Nidirect Government Services [61] | 8 | 1 | 2 |
17 | Santépsy.ch [62] | 6 | 1 | 2 |
18 | Confédération suisse [63] | 15 | 1 | 2 |
19 | Psychografimata [64] | 7 | 1 | 2 |
20 | Official College of Psychology of Catalonia [65] | 14 | 1 | 1 |
21 | Il post [66] | 9 | 1 | 2 |
22 | MIELI ry [67] | 5 | 1 | 2 |
23 | Ordem dos psicologos [68] | 13 | 2 | 1 |
24 | Beyond Blue [69] | 1 | 1 | 2 |
25 | Australian Psychological Society [70] | 1 | 1 | 1 |
26 | Mental Health Commission of Canada [71] | 2 | 1 | 2 |
1 Countries: (1) Australia, (2) Canada, (3) China: Hong Kong, (4) England, (5) Finland, (6) Germany, Switzerland and France; CORAASP and CLASS, (7) Greece, (8) Ireland, (9) Italy, (10) Mexico, (11) New Zealand, (12) Portugal, (13) Scotland, (14) Spain, (15) Switzerland and (16) United States of America. |
2 Target population: (1) General population and (2) Older adults. |
3 Document type: (1) Report and (2) Web page. |
Table 3
Number of positive (YES) answers in percentage (%) per document and Indicator Group (IG)
Code | IG1 | IG2 | IG3 | IG4 | IG5 | IG6 | IG7 | Total |
1 | 50.00 | 88.89 | 100.00 | 77.78 | 80.00 | 100.00 | 100.00 | 85.19 |
2 | 83.33 | 66.67 | 100.00 | 88.89 | 80.00 | 91.67 | 40.00 | 79.63 |
3 | 100.00 | 77.78 | 100.00 | 44.44 | 60.00 | 83.33 | 60.00 | 72.22 |
4 | 100.00 | 66.67 | 100.00 | 77.78 | 40.00 | 83.33 | 60.00 | 72.22 |
5 | 33.33 | 22.22 | 0.00 | 33.33 | 10.00 | 33.33 | 40.00 | 25.93 |
6 | 66.67 | 66.67 | 100.00 | 88.89 | 100.00 | 91.67 | 60.00 | 83.33 |
7 | 83.33 | 33.33 | 100.00 | 100.00 | 90.00 | 75.00 | 80.00 | 77.78 |
8 | 100.00 | 11.11 | 66.67 | 33.33 | 20.00 | 50.00 | 0.00 | 37.04 |
9 | 50.00 | 22.22 | 100.00 | 33.33 | 20.00 | 83.33 | 60.00 | 48.15 |
10 | 50.00 | 11.11 | 100.00 | 66.67 | 90.00 | 100.00 | 80.00 | 70.37 |
11 | 50.00 | 33.33 | 0.00 | 33.33 | 30.00 | 16.67 | 0.00 | 25.93 |
12 | 83.33 | 22.22 | 0.00 | 66.67 | 50.00 | 58.33 | 40.00 | 50.00 |
13 | 100.00 | 44.44 | 100.00 | 100.00 | 90.00 | 100.00 | 60.00 | 85.19 |
14 | 83.33 | 77.78 | 100.00 | 66.67 | 70.00 | 83.33 | 60.00 | 75.93 |
15 | 83.33 | 22.22 | 100.00 | 55.56 | 60.00 | 75.00 | 20.00 | 57.41 |
16 | 83.33 | 22.22 | 100.00 | 44.44 | 80.00 | 83.33 | 80.00 | 66.67 |
17 | 50.00 | 66.67 | 100.00 | 44.44 | 70.00 | 66.67 | 40.00 | 61.11 |
18 | 66.67 | 66.67 | 100.00 | 44.44 | 70.00 | 66.67 | 40.00 | 62.96 |
19 | 33.33 | 11.11 | 66.67 | 55.56 | 60.00 | 50.00 | 40.00 | 44.44 |
20 | 66.67 | 11.11 | 100.00 | 66.67 | 60.00 | 66.67 | 40.00 | 55.56 |
21 | 66.67 | 22.22 | 100.00 | 33.33 | 40.00 | 75.00 | 40.00 | 50.00 |
22 | 50.00 | 66.67 | 100.00 | 55.56 | 60.00 | 75.00 | 80.00 | 66.67 |
23 | 66.67 | 22.22 | 100.00 | 33.33 | 20.00 | 41.67 | 20.00 | 37.04 |
24 | 100.00 | 22.22 | 100.00 | 100.00 | 90.00 | 83.33 | 80.00 | 79.63 |
25 | 83.33 | 77.78 | 100.00 | 33.33 | 60.00 | 66.67 | 100.00 | 68.52 |
26 | 83.33 | 55.56 | 100.00 | 55.56 | 70.00 | 75.00 | 40.00 | 66.67 |
Note. Bold guides with higher percentages and shadowed guides with lower percentages. |
Results Of The Cluster Analysis
The cohesion and separation profile was excellent (greater than 0.5). No outlier document was found (Table 4). ANOVA showed significant results.
Table 4
Cluster analysis results for each Indicator Group (IG)
| Number of observations |
Indicator group (IG) | Cluster 1 | Cluster 2 | Cluster 3 | Cluster 4 | Cluster 5 | Cluster 6 |
IG1 Mental symptoms | 7 | 4 | 8 | 7 | | |
IG2 Mental disorders | 9 | 17 | | | | |
IG3 COVID-19 information | 23 | 3 | | | | |
IG4 MH strategies & MH topics | 8 | 6 | 6 | 6 | | |
IG5 MH strategies & MH-related topics | 3 | 6 | 5 | 5 | 4 | 3 |
IG6 MH recommendations & MH topics | 6 | 7 | 3 | 10 | | |
IG7 MH recommendations & MH-related topics | 4 | 8 | 8 | 3 | 3 | |
For IG1 (mental symptoms), almost 100% of the documents have information about stress and anxiety. Depression and loneliness are also widely covered (76.92% and 69.23% of the selected documents), and sleeping problems and bereavement are less frequently referenced (53.85% and 34.62%). Cluster 1 emphasizes anxiety and depression, cluster 2 highlights loneliness, anxiety and stress, cluster 3 adds to the previous depression, and cluster 4 focuses on sleeping problems, stress, bereavement and depression.
In IG2 (mental disorders), anxiety is the most highlighted disorder (96.15%), followed by depression and substance use (73.08% and 69.23%). The second most common disorders are eating disorders, bipolar and obsessive-compulsive disorders (42.31%, 30.77% and 30.77%). Finally, somatoform disorders are less relevant (7.69%). Cluster 1 highlights schizophrenia, anxiety, depression, substance use and eating disorder, and cluster 2 emphasizes anxiety, depression and substance use.
All the questions have a similar weight [80%, 90%] in IG3 (COVID-19 information), almost all the guides provide relevant information about COVID-19 (79.3%).
For IG4 (MH strategies & MH topics), all the guides include tips for maintaining good MH, describe some psychological skills to help people cope with their anxiety and worry about COVID-19, and promote social connection at home. Globally speaking (global layer, Fig. 2), question 26 (information on how to support a loved one who is very anxious about COVID-19) is the most relevant question (65.38% “YES”). It is followed by questions 28 (including information on how to manage stress in case of positive testing), 29 (how to reduce stigma) and 32 (how to manage stress and anxiety) (38.46% each). Question 27 (stress management while people are waiting for COVID-19 test results) is less relevant.
In IG4, Cluster 1 highlights maintaining good MH (Q4), descriptions of psychological skills to help people with anxiety and worries (Q6) and promotion of social connection at home (Q8). Cluster 2, in addition to the previous clusters, emphasizes Q26 again. Cluster 3 also focuses on reducing stigma (Q19) and Q26. Finally, Cluster 4 emphasizes Q26, including information on how to manage stress while people wait for results (Q27) and how to manage stress when they have a positive test (Q28) (Fig. 2).
IG5 shows a global pattern (global layer, Fig. 2) dominated by including information on how to maintain a healthy lifestyle (Q5) and including information for caregivers (Q35). In the second-layer position are the inclusion of information for healthcare workers (Q30), how to support them (Q31), developing advice on medication access (Q37), and working at home (Q38). Cluster 1 highlights information on how to maintain a healthy lifestyle (Q5), including special mention of people with disabilities (Q25), including information for caregivers (Q35), including information on financial support (Q36) and developing advice for medication access (Q37). Cluster 2 focuses ion Q5, Q25, including information and support for healthcare workers (Q30), including information on how to support health care workers Q31, Q35, Q37 and working at home (Q38). Cluster 3 highlights Q5, Q30, Q31 and Q35. Cluster 4 emphasizes Q5, Q25, information for people suffering from domestic violence (Q34) and Q38. Both Clusters 5 and 6 have only one relevant question each, Q5 and Q35, respectively (Fig. 2).
The global profile of IG6 highlights all its questions (from 76.92–100%), except: offer an online psychological assessment? (Q11, 23.08%), provide feedback on the psychological assessment results (Q12, 19.23%) and providing telephone or online contact with the general practitioner (Q14, 38.46%). Cluster 1 has the same pattern, but Q14 is less important. For Cluster 2, Q11 and Q12 are not relevant at all. Cluster 3 highlights providing emotional support (Q7) and providing a community forum (Q17). Cluster 4 emphasizes Q7 and describes how to access MH services (Q9).
Globally speaking, IG7 highlights include information for parents (Q19, 88.46%), how to explain the coronavirus to children (Q20, 76.92%) and providing alternatives for older adults to be connected (Q22, 61.54%). Cluster 1 emphasizes all the questions except including guidelines for COVID-19 outbreaks in residential care facilities (Q24). In Cluster 2, Q19 is the most relevant. Cluster 3 focuses on Q19 and Q22. Cluster 4 is dominated by questions Q19, Q20, Q22 and Q24. In Cluster 5, most answers are “NO”, except for Q22.
Some of the questions are linked in the documents, which means that when one question appears, the other question also appears (Yes&Yes answers). In IG1 (mental symptoms), most of the guides link loneliness and depression (54% of the documents), anxiety and stress (96%) and anxiety and sleeping problems (50%) symptoms, and the former two relationships are very strong. This is not the case for depression and bereavement (27%). The larger cluster (Cluster 3) shows a perfect link between loneliness-depression and anxiety-stress, with anxiety-sleeping problems also being strong.
In IG2 (mental disorders), there is a strong link between anxiety and substance use (65%) and anxiety and depression (69%), but anxiety and eating disorders and anxiety-obsessive and compulsive disorder have lower relevance (42% and 31%). Cluster 2 confirms the previous pattern, but both the anxiety and substance use and anxiety and depression links are less relevant.
In IG3 (COVID-19 information), very few documents (12%) do not link …include information related to the latest information on COVID-19 (Q1) and …include information on the latest news about the global response to the COVID-19 outbreak (Q3).
In IG4, most of the selected documents do not link include information on how to manage stress if they have tested positive (Q28) and include information on stigma and how to reduce it (Q29) (Fig. 3).
The conceptual maps (Fig. 4) show that the relationship between include psychological tips for maintaining good mental health and coping with COVID-19 (Q4), describe some psychological skills to help people cope with anxiety and worry about COVID-19 (Q6) and promote social connection at home (Q8) are very strong. Progressively, strong links between the previous questions and does the strategy include information on how to support a loved one who is very anxious about COVID-19 (Q26) and Q29 appear. Finally, the questions does the strategy include information on how to manage stress while people await test results (Q27), does the strategy include information on how to manage stress and anxiety (Q32) and are there any links for older people related to any symptoms or mental disorders (Q29) are less linked.
In IG5, there is a strong link between describing how to maintain a healthy lifestyle. (Q5) and develop advice on medication access during the COVID-19 pandemic (Q37) (A, Fig. 5) and between Q5 and contemplate working at home (Q38) (B). The relationships between include information for healthcare workers (Q30) and include information on how to support health care workers (Q31) (C) and between Q30 and develop a strategy for identifying healthcare staff needs as a result of the coronavirus pandemic (Q33) (D) are less relevant. Cluster 2 highlights Yes&Yes in all the analyzed links.
In IG6, most of the documents strongly link describe how to access MH services (Q9) and provide MH treatment/intervention alternatives (Q13, 84%) as well as Q9 and provide telephone or online contact with the psychologist (Q15, 81%). The relationship between provide any phone or online MH services (Q16) and provide an online community forum (Q17) is also important (52%).
In IG7 and from a global perspective, there is a strong link (77%) between include information for parents (Q19) and include information on how to explain the coronavirus to children (Q20). However, in clusters 2 and 3, Q19 alone is also relevant. All the documents without Q19 and Q20 are concentrated in cluster 5.