The impact of social support on anxiety and depression under the context of COVID-19 pandemic: a systematic review and meta-analysis

Abstract

Introduction The COVID-19 pandemic created an extreme and prolonged context of collective stress while simultaneously disrupting ordinary sources of interpersonal support. Although social support is widely associated with better mental health, it remains unclear how consistently this association was observed across populations and contexts during the pandemic and what the findings may imply for future crisis preparedness. Methods This systematic review and meta-analysis followed PRISMA 2020 guidelines. Six databases (PubMed, Web of Science, PsycINFO, Taylor & Francis Online, ScienceDirect, and ERIC) were searched for studies published between February 2020 and June 2022. Eligible studies quantitatively examined the association between social support and anxiety and/or depression using validated measures. Study quality was assessed with the Newcastle-Ottawa Scale. Random-effects models were applied to calculate pooled correlations, with subgroup, sensitivity, and publication bias analyses conducted. Results Sixty studies comprising 64,693 participants met inclusion criteria. Social support was significantly associated with lower anxiety (ρ = −0.30, 95% CI [−0.33, −0.26]) and lower depression (ρ = −0.33, 95% CI [−0.37, −0.27]). Subgroup analyses showed consistent protective effects across age groups and occupations, particularly among college students and medical workers. Family support demonstrated the strongest associations. Heterogeneity was high (I2 > 90%), and publication bias was detected, though trim-and-fill analyses did not alter overall results. Conclusion Higher social support was consistently associated with lower anxiety and depression during the COVID-19 pandemic. Viewed as evidence from an extreme and prolonged context of collective stress, these findings may inform mental health preparedness for future public health emergencies and other large-scale crises. However, substantial heterogeneity indicates that the magnitude of the association varies across populations and contexts. Because the pooled estimates were based on bivariate correlations, the findings should not be interpreted as evidence that social support causally was associated with lower symptoms of specific pandemic-related stressors.