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 (Figure 1). In the eligibility phase, 26 documents fulfilled the inclusion criteria (Figure 1). There was a strong agreement between CGA and NA (kappa value = 0.787, p = 0.000; ICC = 0.881, p = 0.000).
The general population was the target for almost all the documents (99.06%, Table 2), and the predominant format was a report (73.1%). The documents with more positive “YES” answers were 1 and 13 (85.19%); documents 5 and 11 had a lower rate (25.93%). Documents 1 and 13 were the most complete documents (Table 3) and documents 5 and 11 were the most specific.
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.
Mental symptoms (Indicator group 1, IG1)
For IG1 (mental symptoms), almost 100% of the documents had information about stress and anxiety. Depression and loneliness were also widely covered (76.92% and 69.23% of the selected documents), and sleeping problems and bereavement were less frequently referenced (53.85% and 34.62%). Cluster 1 emphasized anxiety and depression; cluster 2 highlighted loneliness, anxiety and stress; cluster 3 added to the previous depression; cluster 4 focused on sleeping problems, stress, bereavement and depression.
Mental disorders (Indicator group 2, IG2)
In IG2 (mental disorders), anxiety was the most highlighted disorder (96.15%), followed by depression and substance use (73.08% and 69.23%). The second most common disorders were eating disorders, bipolar and obsessive-compulsive disorders (42.31%, 30.77% and 30.77%, respectively). Finally, somatoform disorders were less relevant (7.69%). Cluster 1 highlights schizophrenia, anxiety, depression, substance use and eating disorders; and cluster 2 emphasizes anxiety, depression and substance use.
COVID-19 information (Indicator group 3, IG3)
All the questions had a similar weight [80%, 90%] in IG3 (COVID-19 information), and almost all the guides provided relevant information about COVID-19 (79.3%).
MH strategies & MH topics (Indicator group 4, IG4)
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, Figure 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 highlighted 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, emphasized Q26 again. Cluster 3 also focused on reducing stigma (Q19) and Q26. Finally, Cluster 4 emphasized 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) (Figure 2).
MH strategies & MH-related topics (indicator group 5, IG5)
IG5 shows a global pattern (global layer, Figure 2) dominated by including information on how to maintain a healthy lifestyle (Q5) and including information for caregivers (Q35). Less relevant were 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 highlighted information on how to maintain a healthy lifestyle (Q5), including special mentions 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 focused on Q5 and Q25, including information and support for healthcare workers (Q30), including information on how to support health care workers Q31, Q35, and Q37 and working at home (Q38). Cluster 3 highlighted Q5, Q30, Q31 and Q35. Cluster 4 emphasized Q5, Q25, information for people suffering from domestic violence (Q34) and Q38. Clusters 5 and 6 had only one relevant question each, Q5 and Q35, respectively (Figure 2).
MH recommendations & MH topics (Indicator group 6, IG6)
The global profile of IG6 highlighted all the questions (from 76.92% to 100%), except: offer an online psychological assessment? (Q11, 23.08%), provide feedback on the psychological assessment results (Q12, 19.23%) and provide telephone or online contact with the general practitioner (Q14, 38.46%). Cluster 1 had the same pattern, but Q14 was less important. For Cluster 2, Q11 and Q12 were not relevant. Cluster 3 highlighted providing emotional support (Q7) and providing a community forum (Q17). Cluster 4 emphasized Q7 and describes how to access MH services (Q9).
MH recommendations & MH-related topics (indicator group 7, IG7)
Globally speaking, IG7 highlighted 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 emphasized all the questions except including guidelines for COVID-19 outbreaks in residential care facilities (Q24). In Cluster 2, Q19 was the most relevant. Cluster 3 focused on Q19 and Q22. Cluster 4 was dominated by questions Q19, Q20, Q22 and Q24. In Cluster 5, most answers were “NO”, except for Q22.
Linked questions in the documents
Some of the questions were linked in the selected documents, which means that when one question appeared, the other question also appeared (Yes & Yes answers). In IG1 (mental symptoms), most of the guides linked loneliness and depression (54% of the documents), anxiety and stress (96%) and anxiety and sleeping problems (50%) symptoms, and the former two relationships were very strong. This was not the case for depression and bereavement (27%). The larger cluster (Cluster 3) showed a perfect link between loneliness and depression and anxiety and stress, with the relationship between anxiety and sleeping problems also being strong.
In IG2 (mental disorders), there was a strong link between anxiety and substance use (65%) and anxiety and depression (69%), but anxiety and eating disorders and anxiety and obsessive-compulsive disorder had lower relevance (42% and 31%). Cluster 2 confirmed the previous pattern, but both the anxiety and substance use and anxiety and depression links were less relevant.
In IG3 (COVID-19 information), very few documents (12%) did not link …includes information related to the latest information on COVID-19 (Q1) and …includes information on the latest news about the global response to the COVID-19 outbreak (Q3).
In IG4, most of the selected documents did not include information on how to manage stress if they have tested positive (Q28) and include information on stigma and how to reduce it (Q29) (Figure 3).
The conceptual maps (Figure 4) show that the relationships between including psychological tips for maintaining good mental health and coping with COVID-19 (Q4), describing some psychological skills to help people cope with anxiety and worry about COVID-19 (Q6) and promoting social connection at home (Q8) were 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 appeared. Finally, the questions do 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) were less linked.
In IG5, there was 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, Figure 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) were less relevant. Cluster 2 highlighted Yes & Yes in all the analysed links
In IG6, most of the documents strongly linked 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 providing any phone or online MH services (Q16) and providing an online community forum (Q17) was also important (52%).
In IG7 and from a global perspective, there was a strong link (77%) between including information for parents (Q19) and including information on how to explain the coronavirus to children (Q20). However, in clusters 2 and 3, Q19 alone was also relevant. All the documents without Q19 and Q20 were concentrated in cluster 5.