Accumulating evidence suggests a sharp growth in antidepressant use worldwide. Up to 8% to 10% of adults in the United States take at least 1 antidepressant drug, which is ranked third among prescribed and fourth among sold medications.^1,2 Antidepressants are indicated and used for depressive disorders, anxiety disorders, posttraumatic stress disorder, premenstrual dysphoric disorder, obsessive-compulsive disorder, bulimia nervosa, and binge-eating disorder, among others.^3-5

Hospital staff is at high risk of developing mental health issues during the coronavirus (COVID-19) pandemic. However, the literature lacks an overall and inclusive picture of mental health problems with comprehensive analysis among hospital staff during the COVID-19 pandemic. To ascertain the prevalence of anxiety, depression and other mental health outcomes as reported in original articles among hospital staff during the COVID-19 pandemic. A PRISMA 2020 and MOOSE 2000 compliant umbrella review of published meta-analyses of observational studies evaluating the prevalence of mental health problems in hospital staff during the pandemic. Systematic searches were conducted in PubMed/Medline, CINAHL, EMBASE, and PsycINFO from December 1st, 2019, until August 13th 2021. The random effects model was used for the meta-analysis, and the I² index was employed to assess between-study heterogeneity. Publication bias using Egger test and LFK index was examined. Data was analyzed using STATA 17.0 software. AMSTAR-2 was applied for the quality assessment of systematic reviews, while we used GRADE to rate the quality of evidence. Forty-four meta-analyses from 1298 individual studies were included in the final analysis, encompassing the prevalence of 16 mental health symptoms. One-third of hospital workers reported anxiety (Prevalence: 29.9%, 95% CI:27.1% to 32.7%) and depression (Prevalence: 28.4%, 95% CI:25.5% to 31.3%) symptomatology, while about 40% (95% CI: 36.9% to 42.0%) suffered from sleeping disorders. Fear-related symptoms, reduced well-being, poor quality of life, and acute stress symptoms had the highest prevalence among hospital staff. However, the quality of evidence in these areas varied from low to very low. Nurses suffered more often from sleep problems and symptoms of anxiety and depression than doctors, whereas doctors reported a higher prevalence of acute stress and post-traumatic disorders. The burden of anxiety, depression, and sleep disorders was higher among female employees than their male counterparts. Remarkably, acute stress and insomnia affected more than half of first-line medical staff. The prevalence of mental health problems among hospital staff during the COVID-19 pandemic is generally high, with anxiety, depression and insomnia symptoms representing the most robust evidence based on a large dataset of prevalence meta-analyses. However, there is no strong confidence in the body of evidence for each outcome assessed. Not registered. The COVID-19 pandemic is having a major impact on the mental health of hospital staff. The need for support must be different for nurses and doctors @eldi12345.

Objective: Bipolar disorder (BD) is associated with premature mortality. All-cause and specific mortality risks in this population remain unclear, and more studies are still needed to further understand this issue and guide individual and public strategies to prevent mortality in bipolar disorder Thus, a systematic review and meta‐analysis of studies assessing mortality risk in people with BD versus the general population was conducted. The primary outcome was all‐cause mortality, whilst secondary outcomes were mortality due to suicide, natural, unnatural, and specific‐causes mortality. Results: Fifty-seven studies were included (BD; n = 678,353). All‐cause mortality was increased in people with BD (RR = 2.02, 95% CI: 1.89–2.16, k = 39). Specific‐cause mortality was highest for suicide (RR = 11.69, 95% CI: 9.22–14.81, k = 25). Risk of death due to unnatural causes (RR = 7.29, 95% CI: 6.41–8.28, k = 17) and natural causes (RR = 1.90, 95% CI: 1.75–2.06, k = 17) were also increased. Among specific natural causes analyzed, infectious causes had the higher RR (RR = 4,38, 95%CI: 1.5–12.69, k = 3), but the analysis was limited by the inclusion of few studies. Mortality risk due to respiratory (RR = 3.18, 95% CI: 2.55–3.96, k = 6), cardiovascular (RR = 1.76, 95% CI: 1.53–2.01, k = 27), and cerebrovascular (RR = 1.57, 95% CI: 1.34–1.84, k = 13) causes were increased as well. No difference was identified in mortality by cancer (RR = 0.99, 95% CI: 0.88–1.11, k = 16). Subgroup analyses and meta-regression did not affect the findings. Conclusion: Results presented in this meta-analysis show that risk of premature death in BD is not only due to suicide and unnatural causes, but somatic comorbidities are also implicated. Not only the prevention of suicide, but also the promotion of physical health and the prevention of physical conditions in individuals with BD may mitigate the premature mortality in this population. Notwithstanding this is to our knowledge the largest synthesis of evidence on BD-related mortality, further well-designed studies are still warranted to inform this field.