Mental Health in Europe After COVID-19: A Systematic Review of Depression, Anxiety, and Stress Among Adult Primary Health Care Users

The COVID-19 pandemic has had a profound impact on mental health globally, especially among users of primary health care (PHC) services. This systematic review aims to synthesize the current evidence on the prevalence and associated factors of depression, anxiety, and stress among adult PHC users in Europe during the post-pandemic period. The review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420251033455). We searched Web of Science, PubMed, b-on, and Scopus up to April 2025. Eligible studies included peer-reviewed, quantitative observational studies conducted in Europe from 2022 onward, provided they addressed the post-pandemic context and assessed depression, anxiety, and/or stress using validated tools. Two reviewers independently screened the studies and performed data extraction. The risk of bias was assessed using the ROBINS-I tool. A narrative synthesis of the findings was subsequently conducted. A total of 11 studies involving 8958 participants were included in this analysis. Most studies were cross-sectional and employed tools such as the DASS-21, PHQ-9, and HADS. The prevalence of depressive symptoms reached up to 63%, and anxiety affected over 40% of participants in several studies. Vulnerable groups included women, individuals with chronic illnesses, those unemployed, and persons living alone or facing financial hardship. The risk of bias was moderate to serious in most studies. The evidence highlights significant post-pandemic psychological distress, conceptualized as symptoms of depression, anxiety, and stress measured through validated psychometric instruments, in PHC settings, with underdiagnosis remaining a key issue. Limitations include heterogeneity in assessment tools and designs, as well as reliance on self-report measures. Results underscore the need for routine mental health screening and integrated care in PHC. This review received no specific funding.