The Impact of Inequality on Mental Health Outcomes During the COVID-19 Pandemic: A Systematic Review

Previous research on pandemics and emergencies has shown that such events often widen health inequalities in society and have a greater impact on socially disadvantaged groups. No review has so far looked at the impact of inequality factors on mental health outcomes during the novel coronavirus outbreak (COVID-19). The aim of the current review was therefore to assess the impact of inequality factors on mental health outcomes during COVID-19. After registration on PROSPERO, a systematic review was conducted for papers published up to July 31, 2020, using the databases Google Scholar, PsycINFO, PubMed (MEDLINE), and Web of Science. The following inequality factors were considered: education, income, employment, occupation, material and social deprivation, age, immigrant status, sexual orientation, functional health, cultural/racial background, sex, gender, and place of residence. Out of 1,931 references, 117 studies (300,061 participants) were included. Female sex, being of a younger age, financial insecurity, lack of access to clear messaging/information about the pandemic, proximity to large infection sites, having existing physical and/or psychological health conditions, and being subjected to abuse/stigma because of one's identity as a member of an ethnic or sexual marginalized group predicted mental health inequalities. More research is required on how inequality affects mental health in less studied vulnerable populations, such as ethnic, sexual, and gender marginalized participants, as well as how inequality factors interact to affect mental health in the long term. Recommendations for researchers, mental health practitioners, and public health authorities for mitigating adverse mental health outcomes in vulnerable populations are outlined. Public Significance Statement The findings of this review suggest that several inequality factors, such as female sex, younger age, financial insecurity, having existing chronic health conditions, and being in an ethnic or sexual marginalized group predict worse mental health outcomes during the ongoing COVID-19 pandemic. There is an urgent need for mental health services to support vulnerable populations at this time, to reduce mental health inequalities and improve long-term psychological functioning. Des recherches antérieures sur les pandémies et les urgences ont montré que de tels événements augmentent souvent les inégalités en matière de santé dans la société et ont une incidence plus grave sur les groupes s