Changes in mental health outcomes of middle-aged and older adults during the COVID-19 pandemic: A scoping review

The COVID-19 pandemic negatively impacted mental health, particularly among middle-aged and older adults, who have emerged as especially vulnerable. This scoping review synthesizes findings from 44 population-based studies retrieved from six databases, aiming to map changes in mental health outcomes during the pandemic and identify associated factors. During the global spread and response phase of the pandemic (May 2020-December 2021), a notable rise in depressive symptoms, anxiety symptoms, stress, distress, loneliness, and poor well-being was documented, highlighting a decrease in overall mental health of middle-aged and older adults. Whereas some studies from the transition period toward the endemic phase of the pandemic (2022-2023), began reporting signs of stabilization or improvement, particularly in depressive symptoms, anxiety symptoms and stress. Factors influencing these negative mental health outcomes were multidimensional (demographic, socioeconomic, health-related, behavioral, and COVID-19-related factors). Female sex, old age, being married, unemployment, lower education status, higher income, poor physical health, limited physical activity, perceived threat of COVID-19, social isolation, and lack of support were mainly associated with worsening mental health changes during the pandemic among middle-aged and older adults. However, there is little research highlighting population-level factors (COVID-19 cases, deaths, vaccination status, etc.) associated with these changes. Also, the evidence remains limited regarding mental health changes during the transition to the endemic phase, possibly due to shifts in research priorities, but it is essential to continue monitoring mental health outcomes to track long-term changes and to prepare for future public health emergencies.