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TYPE Systematic Review
PUBLISHED 06 December 2022
DOI 10.3389/fpubh.2022.1061486
OPEN ACCESS
EDITED BY
Mohammadreza Shalbafan,
Iran University of Medical
Sciences, Iran
REVIEWED BY
Tsz Kit Ng,
The University of Hong Kong, Hong
Kong SAR, China
Xue Lan,
China Medical University, China
Carlo Lazzari,
South West Yorkshire Partnership NHS
Foundation Trust, United Kingdom
Qian Zhang,
Xiangya Hospital, Central South
University, China
*CORRESPONDENCE
Jianzhen Zhang
jianzhenzhangedu@foxmail.com
†These authors have contributed
equally to this work and share first
authorship
SPECIALTY SECTION
This article was submitted to
Public Mental Health,
a section of the journal
Frontiers in Public Health
RECEIVED 04 October 2022
ACCEPTED 21 November 2022
PUBLISHED 06 December 2022
CITATION
Fu Q, Ge J, Xu Y, Liang X, Yu Y, Shen S,
Ma Y and Zhang J (2022) The evolution
of research on depression during
COVID-19: A visual analysis using
Co-Occurrence and VOSviewer.
Front. Public Health 10:1061486.
doi: 10.3389/fpubh.2022.1061486
COPYRIGHT
©2022 Fu, Ge, Xu, Liang, Yu, Shen, Ma
and Zhang. This is an open-access
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permitted, provided the original
author(s) and the copyright owner(s)
are credited and that the original
publication in this journal is cited, in
accordance with accepted academic
practice. No use, distribution or
reproduction is permitted which does
not comply with these terms.
The evolution of research on
depression during COVID-19: A
visual analysis using
Co-Occurrence and VOSviewer
Qiannan Fu1†, Jiahao Ge2†, Yanhua Xu3†, Xiaoyu Liang1,
Yuyao Yu1, Suqin Shen1, Yanfang Ma1and Jianzhen Zhang1*
1College of Geography and Environmental Sciences, Zhejiang Normal University, Jinhua, China,
2College of Teacher Education, Zhejiang Normal University, Jinhua, China, 3School of Geography
and Environment, Jiangxi Normal University, Nanchang, China
Background: The COVID-19 pandemic has led to public health problems,
including depression. There has been a significant increase in research on
depression during the COVID-19 pandemic. However, little attention has been
paid to the overall trend in this field based on bibliometric analyses.
Methods: Co-Occurrence (COOC) and VOSviewer bibliometric methods were
utilized to analyze depression in COVID-19 literature in the core collection of
the Web of Science (WOS). The overall characteristics of depression during
COVID-19 were summarized by analyzing the number of published studies,
keywords, institutions, and countries.
Results: A total of 9,694 English original research articles and reviews on
depression during COVID-19 were included in this study. The United States,
China, and the United Kingdom were the countries with the largest number of
publications and had close cooperation with each other. Research institutions
in each country were dominated by universities, with the University of Toronto
being the most productive institution in the world. The most frequently
published author was Ligang Zhang. Visualization analysis showed that
influencing factors, adverse eects, and coping strategies were hotspots
for research.
Conclusion: The results shed light on the burgeoning research on depression
during COVID-19, particularly the relationship between depression and public
health. In addition, future research on depression during COVID-19 should
focus more on special groups and those at potential risk of depression in the
general population, use more quantitative and qualitative studies combined
with more attention to scale updates, and conduct longitudinal follow-ups of
the outcomes of interventions. In conclusion, this study contributes to a more
comprehensive view of the development of depression during COVID-19 and
suggests a theoretical basis for future research on public health.
KEYWORDS
COOC analysis, VOSviewer, depression during COVID-19, bibliometric analysis,
visualization analysis
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Fu et al. 10.3389/fpubh.2022.1061486
Introduction
The COVID-19 pandemic had a tremendous impact on
humans, crippling daily life activities and posing a serious threat
to human health, particularly regarding public mental health.
The outbreak of the COVID-19 pandemic caused widespread
mass panic. Meanwhile, the lockdown brought about by
the COVID-19 outbreak has further triggered psychological
stress among the public, including symptoms of depression,
anxiety, and posttraumatic stress. For example, Wu et al.
found that depression and anxiety rates were significantly
higher among college students during the pandemic than
before, due to factors such as being isolated at home, online
learning stress, and conflict between parents and children (1).
Socioeconomic instability, increased burden of living, social
isolation, and unemployment were suicidal behavior triggers
during the pandemic (2–4). Furthermore, fear of infection,
unpredictability, and uncertainty of the COVID-19 pandemic
were major stressors that triggered various mental health
problems (5,6). Thus, studying the public’s mental state under
the impact of a pandemic has become necessary.
The study of depression was an important area of research,
even before the pandemic, focusing on depression measurement
tools, influencing factors, and treatments. First, in its assessment,
many researchers have developed appropriate scales, such as the
Beck Depression Inventory and Montgomery Depression Test
Scale. Second, regarding factors influencing the development
of depression, psychosocial stress (7), patient status (8,9),
physical health status (10,11), obesity (12), cross-cultural factors
(13), and others play a role. Third, many scholars are still
exploring treatments for depression, which can be divided into
psychotherapy, pharmacotherapy, and other treatments (14,15).
The relationship between depression and COVID-19 has
received considerable attention in the face of sudden outbreaks.
There are many theoretical and practical studies on depression
during COVID-19, focusing on four aspects: the causes of
depression during COVID-19, influencing factors, effects on
people, and methods of alleviation. First, regarding its causes,
several studies have concluded that the public’s social activities
were restricted due to pandemic prevention and control
measures and that the masses were faced with a lack of exercise
and unstable economic resources, in addition to the fear of
infection (16,17). For example, an online survey of 1,258 Italian
residents revealed that social isolation during the pandemic had
a significant psychosocial impact on people, especially those in
vulnerable groups within the population (18). Second, various
factors influenced depression during the COVID-19 pandemic.
These factors can be divided into several categories: sex, age,
occupation, and environmental factors, such as daily exercise.
In a study involving 2,992 adults in China, depression rates
were higher among men than women and higher among young
adults than older adults (19). In addition to sex and age,
several other factors contribute to depression. Some researchers
have linked the emergence of psychological problems, such as
depression, to professions (20–22). Third, depression during
COVID-19 also affects public behaviors, such as insomnia (23,
24), alcohol abuse (25,26) and irregular eating behaviors (27).
Fourth, many scholars are currently seeking better ways to cope
with the current trend of a high prevalence of psychological
disorders, allowing for alleviation. Healthcare workers, for
example, face heavy work pressure during the pandemic and
usually have higher psychological stress and a higher prevalence
of depression than the general population. In response, the
mental burden on healthcare workers can be reduced by
providing high-quality and transparent communication and
accurate information updates to all staff, complete and high-
quality personal protective equipment, and supplies to prevent
infection (28).
This study applies an innovative approach to conducting
literature reviews through systematic reviews with the
support of COOC (29) and VOSviewer software, commonly
used for bibliometric analysis. COOC is the most powerful
bibliometrics and knowledge mapping software available,
which eliminates duplication, clears multiple databases, and
constructs multidimensional relationship matrices simply and
efficiently (29–31). Similarly, VOSviewer is a scientific tool for
creating web-based maps, visualizing and navigating them, and
presenting large amounts of data in the form of knowledge
maps (32). As a powerful tool for quantitatively assessing
various parameters related to scientific literature published
in a specific field, bibliometric analysis provides insights
into popular research topics, trends, key researchers, and
scientific institutions (33,34). Several studies using bibliometric
methods have been conducted in areas related to the COVID-19
pandemic. For example, Fan et al. (35) compared English and
Chinese COVID-19 literature using bibliometric methods to
summarize their differences and characteristics. Another study
used a bibliometric approach to analyze literature related to
the pediatric field during COVID-19 (36). During the last
3 years of the COVID-19 pandemic, while research in the
depression-related field has evolved, the use of bibliometric
methods to study this field remains incomplete (37–39).
This study provides a broad understanding of depression
during COVID-19 and highlights key research topics to provide
ideas for future research. It focuses on a systematic review of
depression during COVID-19 using the bibliometric software
COOC and VOSviewer, while considering and addressing
the following questions: What are the research trends and
evolutionary paths of depression during COVID-19? Which
countries, authors, and institutions contributed the most
to this research area? What are the research hotspots?
What are the implications and limitations of this research?
Considering the above, this study not only provides a deeper
analysis of the literature in the field of depression during
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TABLE 1 Summary of data source and selection.
Search
settings
Contents
Databases Science citation index expanded, social sciences citation index
Search term TS =“depression” and “COVID-19”
TS =“depression” and “SARS-CoV-2”
TS =“depression” and “Novel Coronavirus 2019”
TS =“depression” and “coronavirus-2”
TS=“depression” and “Coronavirus disease 2019”
TS =“depression” and “2019-nCOV”
Language English
Literature type Articles, early access, review articles
Date of search August 31, 2022
Number of
records
9,464
COVID-19 but also broadens the ideas for future research
and provides a basis and reference for innovation in this field
of research.
Data sources and research methods
Data sources
In this study, WOS was used as the literature information
acquisition platform, and SSCI and SCIE in the core collection
of WOS were used as data sources. A general search was selected,
and the search conditions are shown in Table 1, with Articles,
Early Access, and Review Articles selected as the literature types,
and the search time range started in 2020 and ended on August
31, 2022, yielding 12,331 records. In addition, to ensure the
integrity of literature retrieval, we extracted the corresponding
terms from Medical Subject Headings (http://www.ncbi.nlm.
nih.gov/mesh/). After merging the retrieved data with synonyms
and removing duplicate and missing keyword documents, 9,464
valid records were obtained.
Research methods
Through the quantitative data analysis, bibliometrics
summarizes and presents the developmental history and
research hotspots of a given field. Correspondingly, based
on bibliometrics, the analysis of scientific knowledge maps
transforms complex knowledge from data mining and
information processing into a visual knowledge map that
assists scholars in scientifically obtaining the laws of dynamic
development in relevant fields. Available software includes
COOC, VOSviewer, CiteSpace, Bibexcel, and Bicomb. In this
study, COOC and VOSviewer were mainly used, which were
jointly developed by Academic Drip and the bibliometric team
and are the most complete and relatively simple to operate in
the bibliometric field. In addition, COOC can quickly construct
relationship matrices and instantly derive matrix results such
as word-part and dissimilarity matrices. More importantly, it
can also pre-process data, such as batch merging synonyms and
removing unnecessary words.
COOC does not currently allow for citation analysis;
therefore, this study combined it with VOSviewer, developed
in collaboration with Nees Jan van Eck and Ludo Waltman
at Leiden University in the Netherlands, as a bibliometric
analysis, and visualization tool based on a Java environment
to further analyze the field of research on depression during
COVID-19 (40). This is a powerful tool for “co-occurrence”
network clustering and density analysis. In addition, while
VOSviewer lacks data pre-processing and fast matrix generation
functions compared to the COOC software, its powerful
graphical presentation capabilities allow for better visualization
of bibliographic relationships and provide an excellent operating
environment for this study (40,41).
This study was based on the retrieved literature and
utilized tools including COOC and VOSviewer for statistical
analysis, information processing, and visual knowledge mapping
to comprehensively grasp the research hotspots and dynamic
change patterns of “depression during COVID-19.” COOC was
used to create a cumulative time-zone map, while VOSviewer
was used to create a co-occurrence map, as shown in Figure 1.
Results
Background information
The statistics of the temporal distribution of the literature
partially reflect the level of research and development in the field,
as shown in Figure 2. Overall, the relevant research literature
in this field started late; however, the number of publications
is increasing. The COVID-19 pandemic started to spread at the
end of 2019, and the number of related publications was 1,214 at
the end of 2020. The cumulative number of publications reached
5,525 by 2021, with a rapid upward trend in annual publications.
As of August 31, 2022, 9,464 articles had been published.
Importing the processed literature data in the COOC
software yielded the top 10 countries with the highest number
of publications from 2020 to 2022, as shown in Figure 3.
Since 2020, there has been a gradual increase in research on
depression during the COVID-19 pandemic. Articles published
in 2020 were mainly from countries such as the United States,
China, and Italy. As the COVID-19 epidemic continued to
spread and worsen, the year 2021 witnessed a steady spurt of
relevant literature, with 4,311 publications. Articles published
in 2021 were mainly from the United States, China, the
United Kingdom, Italy, Canada, and Spain. As of August 31,
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Fu et al. 10.3389/fpubh.2022.1061486
FIGURE 1
Flow chart of the research process.
FIGURE 2
Number of cumulative publications on depression during
COVID-19.
there were 3,939 articles published for 2022, mainly from the
United States, China, and the United Kingdom.
Core journal analysis
According to statistics, 1,727 journals are involved in
depression during COVID-19 research publications at WOS,
and the top 10 journals in terms of the number of articles
published are shown in Table 2, accounting for 29.17% of
the total literature volume. Journals with citations ≥2,924 are
considered among the top 10 journals in terms of citations,
while in Table 2, the International Journal of Environmental
Research and Public Health, Frontiers in Psychiatry, Frontiers
in Psychology, PLOS One, Journal of Affective Disorders, and
Psychiatry Research are among the top 10 cited journals. These
six journals can shed light specifically on research hotspots
and evolutionary trends in the field of research on depression
during COVID-19, which can provide direction and ideas for
future research.
Statistics show that journals in the field of depression
research during the COVID-19 pandemic focus on psychology,
clinical practice, psychiatry, and others.
Core institution analysis
To further understand the cooperation relationship between
institutions, the data were imported into VOSviewer by setting
the frequency to be ≥40, and the remaining parameters to
default, resulting in 83 institutional cooperation networks, as
shown in Figure 4. As can be seen from the inter-institutional
cooperation network diagram, cooperation between institutions
is relatively close. Kings College London, University of Toronto,
and Harvard Med School are at the center of the network.
Table 3 shows the top 10 institutions by number of
publications, and the top 10 institutions had ≥3,880 citations.
Statistics show that Kings College London, University of
Toronto, Wuhan University, and University College London
(UCL) are among the top 10 institutions regarding the number
of published articles and citations. This shows that these
four institutions are in a highly significant position in the
field of depression during COVID-19 research and can lead
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FIGURE 3
Top 10 countries with the highest number of publications from 2020 to 2022.
TABLE 2 Top 10 journals ranked by number of publications.
Rank Journal Publication Citation Subjects covered
1 International Journal of Environmental
Research and Public Health
769 15,170 Environmental Sciences; Public, Environmental &
Occupational Health
2 Frontiers in Psychiatry 492 5,943 Psychiatry
3 Frontiers in Psychology 420 6,137 Psychology, Multidisciplinary
4 PLOS One 222 6,749 Multidisciplinary Science
5 Journal of Affective Disorders 206 7,515 Clinical Neurology; Psychiatry
6 Frontiers in Public Health 179 1,200 Public, Environmental & Occupational Health
7 BMJ Open 140 1,198 Medicine, General & Internal
8 Psychiatry Research 116 7,790 Psychiatry
9 Current Psychology 110 552 Psychology, Multidisciplinary
10 Healthcare 106 580 Health Care Sciences & Services; Health Policy &
Services
future trends and hotspots in the field. From the institutional
cooperation chart and the top 10 institutions ranking table,
clearly the main force in research on depression during
COVID-19 is major universities. Most of these universities
are from the United States, China, and the United Kingdom,
where universities are more active in the research field and
the connections between universities from different countries
are stronger.
Core country analysis
The number of publications in a country reflects the
level of research and impact of the country in the relevant
field. Table 4 lists the top 10 countries in terms of the
number of publications on depression during COVID-19. As
can be seen from Table 4, the United States had the highest
number of publications (2,557 times), followed by China (1,535
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FIGURE 4
Map of institution network. The nodes represent institutions. The lines represent cooperation relationships.
TABLE 3 Top 10 institutions ranked by number of publications.
Rank Institution Publication Citation
1 Univ Toronto 177 7,504
2 Harvard Med Sch 162 2,771
3 Kings Coll London 149 8,727
4 UCL 139 5,050
5 Columbia Univ 121 2,494
6 Huazhong Univ Sci & Technol 118 2,973
7 Univ Melbourne 118 1,337
8 Sapienza Univ Rome 100 3,153
9 Wuhan Univ 95 6,502
10 Univ Oxford 93 2,624
times), the United Kingdom (1,289 times), Italy (806 times),
Canada (636 times), Spain (588 times), Australia (523 times),
Germany (480 times), Turkey (412 times), and Brazil (325
times). The United States, China, and the United Kingdom
have accounted for more than 50% of the publications in
this field and have made major contributions to research in
this area.
The retrieved literature from 144 countries was imported
into VOSviewer with the frequency set to 40, and the remaining
parameters defaulted to obtain the cooperation network graph
TABLE 4 Top 10 countries ranked by number of publications.
Rank Country Publication Citation
1 United States 2,557 43,143
2 China 1,535 36,123
3 United Kingdom 1,289 17,990
4 Italy 806 13,006
5 Canada 636 10,383
6 Spain 588 10,602
7 Australia 523 8,849
8 Germany 480 8,103
9 Turkey 412 5,892
10 Brazil 325 6,384
from 52 countries, as shown in Figure 5. The major research
forces in this field are concentrated in the United States,
China, the United Kingdom, Canada, Australia, Italy, and
Spain. There are cooperative relationships among various
countries, particularly the United States, with China and the
United Kingdom having strong ties. Analyzing cooperative
exchange relations between countries is conducive to further in-
depth research on depression during the COVID-19 pandemic,
which is an inevitable trend in research and development in
this field.
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FIGURE 5
Map of countries network. The nodes represent countries. The lines represent cooperation relationships.
Core reference analysis
Citation analysis can reflect the structure of research
and important literature in the field. To further understand
the citation structure of the depression research field during
COVID-19, this study analyzed the cited literature with
critical reading and obtained three clusters. The required
data were imported into VOSviewer, and the frequency was
set to 300 to obtain the top 30 cited studies, as shown in
Table 5. The most frequently cited references were Spitzer
R. L. (published in 2006; cited 1391 times), Brooks S. K.
(published in 2020; cited 1351 times), Kroenke K. (published
in 2001; cited 1156 times), Wang C. Y. (published in
2020; cited 1053 times), Lai J.B. (published in 2020; cited
1040 times), and Holmes E.A. (published in 2020; cited
834 times).
In Figure 6, the 30 references were grouped into three
categories, with each color representing a category. The
references with high strength values in Table 5 represent
important milestones in the field of depression research
during COVID-19. The first milestone was to summarize
the broad psychological impact of isolation measures and
to consider how to reduce this impact (42). The second
milestone was to study the mental health status of healthcare
workers and its associated factors during COVID-19 (43).
The third milestone was to develop a validated tool
to screen for generalized anxiety disorder and assess its
severity (44).
Core author analysis
The number of publications by an author reflects the author’s
degree of influence in the relevant field. Table 6 lists the top
10 authors who published articles on depression during the
COVID-19 pandemic. The statistical analysis of the authors
who published articles in the field of research on depression
during COVID-19 was performed using VOSviewer, with the
frequency set to 10 and other parameters defaulted, to generate
an author collaboration network graph, as shown in Figure 7.
The nodes in the graph represent the authors, the number of
articles published by the author determines the size of the nodes
and fonts, and the connecting lines between the nodes represent
the existence of cooperative relationships between the nodes.
Overall, author collaborations in this field show a cluster-like
distribution. The largest number of authors was the author
collaboration network formed by Jing Li, Ying Wang, and 55
other individuals.
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TABLE 5 Top 30 references with the strongest citation bursts.
Clusters References Strength Citations
Mental health status, influencing factors, and
coping strategies of the public during
COVID-19
Ahorsu D.K., 2022, int j ment health ad, v20, p1537, doi 1,137 410
Brooks S.K., 2020, lancet, v395, p912, doi 3,493 1,531
Ettman C.K., 2020, jama netw open, v3, doi 875 365
Holmes E.A., 2020, lancet psychiat, v7, p547, doi 2,453 834
Lovibond P.F., 1995, behav res ther, v33, p335, doi 1,027 481
Pfefferbaum B., 2020, new engl j med, v383, p510, doi 1,637 571
Rajkumar R.P., 2020, asian j psychiatr, v52, doi 1,697 508
Salari N., 2020, globalization health, v16, doi 1,351 449
Torales J., 2020, int j soc psychiatr, v66, p317, doi 1,050 342
Vindegaard N., 2020, brain behav immun, v89, p531, doi 1,502 491
Wang C.Y., 2020, int j env res pub he, v17, doi 10.3390/ijerph17051729 3,135 1,053
Xiong J.Q., 2020, j affect disorders, v277, p55, doi 1,931 650
Cao W.J., 2020, psychiat res, v287, doi 2,153 663
Hawryluck L., 2004, emerg infect dis, v10, p1206, doi 1,276 409
Huang Y.E., 2020, psychiat res, v288, doi 2,295 658
Mazza C., 2020, int j env res pub he, v17, doi 1,575 399
Qiu J.Y., 2020, gen psychiat, v33, doi 2,414 687
Wang C.Y., 2020, brain behav immun, v87, p40, doi 2,109 589
Wang C.Y., 2020, int j env res pub he, v17, doi 10.3390/ijerph17072459 979 311
Mental health status, influencing factors and
coping strategies of healthcare workers
during COVID-19
Chew N.W.S., 2020, brain behav immun, v88, p559, doi 1,140 306
Lai J.B., 2020, jama netw open, v3, doi 3,005 1,040
Luo M., 2020, psychiat res, v291, doi 1,123 305
Pappa S., 2020, brain behav immun, v88, p901, doi 1,927 591
Wu P., 2009, can j psychiat, v54, p302, doi 1,011 301
Xiang Y.T., 2020, lancet psychiat, v7, p228, doi 1,602 498
Zhang W.R., 2020, psychother psychosom, v89, p242, doi 1,173 312
Zigmond A.S., 1983, acta psychiat scand, v67, p361, doi 818 442
Measures of mental health status Cohen S., 1983, j health soc behav, v24, p385, doi 942 422
Kroenke K., 2001, j gen intern med, v16, p606, doi 2,864 1,156
Spitzer R.L., 2006, arch intern med, v166, p1092, doi 3,508 1,391
Research hotspots
Keywords are the essence and distillation of the article’s
content, which can effectively reflect the research content,
purpose, method, object, and results of the article and
link them together to reveal the general lineage of the
article. If a keyword appears frequently and repeatedly in
a research field during a certain period, the research topic
characterized by that keyword is considered the research
hotspot of that research field. Table 7 lists the top 30
keywords related to the depression research field during the
COVID-19 period, and the co-occurrence graph of keywords
was obtained by importing the data into VOSviewer, as
shown in Figure 8, the larger the corresponding font and
node, the greater the weight of its keywords. The keywords
“mental health,” “anxiety,” “lockdown,” and “adolescents”
are important hotspots in depression-related fields during
COVID-19. Through the analysis, the following three main
categories of research hotspots on depression during COVID-19
were obtained.
Factors influencing depression during
COVID-19
High-frequency keywords included in the study’s hotspots
were lockdown (338 times), healthcare workers (297 times),
physical Activity (187 times), burnout (182 times), older adults
(132 times), gender (119 times), and unemployment (25 times).
During the COVID-19 pandemic, the prevalence of mental
illness was significantly higher than before the pandemic.
Studies on the prevalence of depression during the pandemic
have focused on factors that influence mental illness. Various
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FIGURE 6
Map of references network. The nodes represent cited literature. The lines represent co-citation relationships. The green and red represent
“Mental health status, influencing factors, and coping strategies of the public during COVID-19.” The blue represents “Mental health status,
influencing factors and coping strategies of health care workers during COVID-19.” The yellow represents “Measures of mental health status.”
TABLE 6 Top 10 most productive authors ranked by number of
publications.
Rank Author Publication
1 Ligang Zhang 47
2 Ying Wang 46
3 Yaya Liu 40
4 Yutao Xiang 38
5 Teris Cheung 36
6 Mark D. Griffiths 35
7 Yan Zhang 32
8 Jing Li 31
9 Xiangyang Zhang 27
10 Jianwei Wang 27
analytical methods have been used to investigate this issue, and
the following factors have been identified:
1. Quarantine policies enacted by governments during the
COVID-19 pandemic reduced exercise time and social
activities for the population in each country, and the lack
of both activities was a significant factor in the elevated
prevalence of mental illness in the population (45).
2. During the COVID-19 pandemic, most productive social
activities were halted, and the country’s population was left
with unemployment and job insecurity (46,47).
3. The sex, age, occupation, and social media use of residents
influenced the development of mental illness (47–49).
Problems caused by depression during
COVID-19
High-frequency keywords included in this research hotspot
were PTSD (310 times), quality of life (240 times), insomnia
(177 times), sleep (160 times), suicide (98 times), and alcohol
(47 times). During the pandemic, mental illness has also
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FIGURE 7
Map of co-authors network. The nodes represent authors. Node size indicates the number of articles produced. The lines represent cooperation
relationships.
caused problems such as insomnia, alcoholism, suicide, and
smartphone addiction (50–52). These seriously affect the quality
of life of people, especially adolescents (53); teenagers, college
students, older adults (54); health care workers (55–57); and
pregnant women (58,59).
How to deal with depression during COVID-19
The high-frequency keywords included in this research
hotspot were resilience (356 times), well-being (282 times),
and social support (205 times). The increase in the prevalence
of mental health problems, particularly depression, during the
COVID-19 pandemic, cannot be ignored; therefore, how should
this phenomenon be faced and what measures should be taken
to prevent or alleviate it? Some scholars suggest that the
phenomenon of “social isolation” caused by home isolation can
be alleviated through digital media (60). Additionally, frontline
healthcare workers should improve their subjective wellbeing
and pay attention to their mental health status (61). For those
who are already depressed, interventions to promote resilience
should be provided whenever possible (62–64). In addition,
authorities should provide adequate supplies to the population
during the quarantine period and promote the benefits of public
isolation to society.
Emerging trends
The cumulative time zones of the keywords were mapped
using COOC, and Figure 9 shows the top 15 high-frequency
keywords for 2020–2022. The graph provides an overall picture
of changes in the study path (65–68). The size of the circles next
to the keywords represents the number of keyword occurrences.
The 2020 study concluded that the outbreak and prolonged
isolation caused by the COVID-19 pandemic would affect public
mental health, particularly the wellbeing of adolescents and
healthcare workers, and emphasized that negative emotions
should be alleviated through social support and improving
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TABLE 7 Top 30 highest frequency keywords related to depression
during COVID-19.
Keywords Frequency Keywords Frequency
COVID-19 8,651 Physical activity 187
Depression 3,708 Depressive symptoms 187
Anxiety 2,864 Burnout 182
Mental Health 2,204 Insomnia 177
Stress 933 Quarantine 175
Loneliness 499 Public health 171
Resilience 356 Pregnancy 168
Students 345 Sleep 160
Lockdown 338 Nurse 160
PTSD 310 Older adults 132
Healthcare workers 297 Risk factors 129
Wellbeing 282 Gender 119
Adolescents 274 Children 113
Quality of life 240 Psychological impact 102
Social support 205 Suicide 98
psychological resilience. The 2021 study concluded that the
duration of the COVID-19 pandemic was long. The 2022 study
focused on the harm caused by depression during COVID-
19, such as economic collapse, loss of fixed housing, brain
fog, neuropsychiatric disorders, and collective trauma, as well
as on coping strategies, including social interaction, social
engagement, and good mood regulation strategies.
Discussion
Discussion of the results
In this study, WOS was selected as a search platform for
bibliometric analysis of publications, countries, institutions, and
keyword counts in the field of depression during COVID-
19 and for the presentation of scientific knowledge maps.
Statistics show that the literature in this field peaked in 2021.
In total, 144 countries, 48,103 authors, and 10,853 research
institutions worldwide participated in this study. Of these,
the United States, China, and the United Kingdom had the
highest total number of publications and strong collaborative
relationships, and the main research institutions in each country
are universities. In addition, this study specifically focused on
exploring the evolution of knowledge structures and research
themes. Regarding the development of this study and its hotspot
tracking, the important findings are as follows:
First, a general upward trend in research on depression
during COVID-19 is evident in terms of research progress.
Although this area has been studied for <3 years, it has
received widespread attention worldwide due to its specificity.
The number of publications in the field of depression during
COVID-19 peaked in 2021, and related research in this field
entered a period of rapid development. This may be because
several studies have found significant changes in the frequency
of public psychological problems arising at two time points,
before the pandemic and during the embargo. In particular,
the prevalence of depression was greatly increased during the
embargo (1,69–74). Moreover, according to the World Health
Organization, the pandemic has led to a significant increase
in the global prevalence of depression and anxiety disorders
by 28 and 26%, respectively (75). COVID-19 has significantly
impacted global healthcare, and new research hotspots are
gradually shifting from COVID-19 and related clinical studies to
studies on its psychological and social impact on humanity (36).
Therefore, the shift in research hotspots and the societal impact
of COVID-19 have been influenced by COVID-19’s significant
impact on global healthcare. As a result, an increasing number of
scholars have started to conduct research on depression during
the COVID-19 pandemic, influenced by the shift in research
hotspots and social concerns.
Second, the hotspots of depression research during COVID-
19 were significantly concentrated in regions such as the
Americas, Western Europe, and South Asia. This may be related
to the severity of the COVID-19 pandemic in each region. For
example, India, which is in South Asia and had the second-
highest total number of people diagnosed with COVID-19
worldwide, had a high prevalence of psychological problems
among the population during the COVID-19 pandemic (76). In
addition, a study on adults from several countries showed that
participants living in Brazil had the most severe symptoms of
anxiety and depression (77). This may be related to the severe
COVID-19 pandemic experienced in Brazil. Furthermore,
several Western European countries have paid considerable
attention to the impact of the COVID-19 pandemic on public
mental health and have conducted corresponding studies. For
example, Bäuerle et al. found that the public mental health
burden in Germany significantly increased during the COVID-
19 pandemic (78). Notably, panic after infection, social isolation
during treatment, and implicit discrimination after recovery
were important causes of depression during COVID-19 in
confirmed individuals (79,80).
Finally, the hotspots of depression research during the
pandemic could be summarized into three areas: factors
influencing depression during COVID-19, consequences of
depression during COVID-19, and coping strategies for
depression during COVID-19.
Factors influencing depression during
COVID-19
To better explain the relationship between depression and
COVID-19, the factors influencing the formation of depression
during COVID-19 were examined. Regarding social factors,
the pressure from rising house prices (81), negative news
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Fu et al. 10.3389/fpubh.2022.1061486
FIGURE 8
Map of keywords. The nodes represent keywords. The lines represent co-occurrence relationships. Green represents “Factors influencing
depression during COVID-19.” Light blue, purple, and red represent “Problems caused by depression during COVID-19.” Dark blue and yellow
represent “How to deal with depression during COVID-19.”
spread on social media (82), the anxiety caused by social
isolation (83,84), and others are contributing factors to the
poor mental health of residents during the pandemic. First, the
ecosystem theory proposed by Bronfenbrenner mainly studies
the interrelationship between human behavior and the social
environment, which treats the social environment in which
humans grow up as a kind of social ecosystem, emphasizes the
importance of the ecosystem for analyzing and understanding
human behavior, and focuses on the interaction between
humans and environmental systems and their influence on
individual development. Social factors that lead to depression
during COVID-19, such as rising housing prices, negative news,
and social isolation, change the social environment on which
human growth depends. Changes in the social environment
inevitably affect individual development and, consequently, have
an impact on public mental health.
Regarding characteristic factors, gender, age, and occupation
of the residents are conditions for the occurrence of depression
during COVID-19 (85). For example, several meta-analytic
studies on the prevalence of depression during COVID-19
among frontline healthcare workers have shown that they
exhibit higher levels of depression than the general population
(86,87). During the pandemic, healthcare workers not only
face a heavy workload but also the risk of contracting COVID-
19, and their negative emotions need to be attended to.
Additionally, a meta-analytic study by Li et al. found that the
prevalence of depression and anxiety disorders among college
students has greatly increased (88). According to Erikson’s
theory of psychological development, college students are still
in the sameness-to-role confusion stage, and their psychological
development is still in a transitional stage, immature, and
vulnerable to disturbance by negative external events. Moreover,
during the pandemic, college students are forced to be isolated at
home, which interrupts their social activities. They have to also
manage their online studies, and all of these contribute to their
depressive symptoms.
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Fu et al. 10.3389/fpubh.2022.1061486
FIGURE 9
Emerging trends of research on depression during COVID-19. The nodes represent keywords. The node size indicates the number of keyword
occurrences. The year corresponding to the node is the year in which the keyword first appeared.
Problems caused by depression during
COVID-19
Brailovskaia et al. found a significant increase in suicidal
ideation and suicide rates among the public during the COVID-
19 pandemic (89). The American clinical psychologist Beck
(90) proposed a cognitive model of depression that argues
that the underlying cognitive schema and cognitive theoretical
assumptions of depressed individuals are at the root of patients’
negative attitudes. Some individuals with depression may be less
depressed; however, sudden negative events in their lives give
them a heavy blow, leading to further despair and helplessness.
Despair and helplessness are important factors influencing
suicide. Therefore, the COVID-19 pandemic, as a sudden
negative life event, may be the root cause of helplessness and
negative attitudes in depressed patients. Furthermore, several
studies have pointed out that the probability of abnormal
behaviors, such as insomnia and irregular diet, has increased
significantly during the pandemic (91,92). These studies are
consistent with the Theory of Planned Behavior, which suggests
that people’s intentions or behaviors can be manipulated by
attitudes, subjective norms, and perceived behavioral control
to target behaviors (93). The negative, desperate, and helpless
attitude of depressed individuals can lead to changes in their
behavior, which may include loss of appetite, overeating,
insomnia, and other abnormal behaviors. The rise in the
probability of alcoholism and Internet addictive behavior is also
a prevalent feature of COVID-19 (94,95). Learned helplessness
theory suggests that uncontrollable negative events are an
important cause of depression. If such negative events are
frequent and prolonged, they can lead to an uncontrollable
perception that, no matter what one does, one cannot change
the outcome. Because of the prolonged preventive and control
measures and socioeconomic impacts during the COVID-19
pandemic, people’s normal social activities are restricted, and
their physical and mental health are damaged, making them
prone to psychological burdens and causing them to develop
learned helplessness. Alcoholism and Internet addiction are
among the behaviors that make patients give up on their efforts
and paralyze them.
How to deal with depression during COVID-19
To mitigate the increased prevalence of depression during
COVID-19, treatment interventions should be improved
(96,97). Previous studies found that digital socialization, social
support, and welfare measures are important in alleviating
depression during the COVID-19 pandemic (98). Rose and
Rudolph reconstructed the interpersonal context theory
based on the interpersonal theory (99), arguing that negative
early family experiences can cause individuals to develop
negative interpersonal relationship evaluation tendencies and
social behavior disorders, which adversely affect subsequent
interpersonal skills and thus deepen public depression.
Therefore, residents can reduce the incidence of depression
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Fu et al. 10.3389/fpubh.2022.1061486
during COVID-19 by constructing good interpersonal
relationships. House (100) considers social support as an
interpersonal transaction involving emotional care (liking,
love, empathy), instrumental assistance (goods or services),
information (environment), and assessment (information
related to self-assessment). In sociological theory, Virginia (101)
states that social support is a reciprocal relationship between
individuals and networks that provide psychological, social,
and substantive help through social networks. Therefore, to
some extent, social support can alleviate the development of
depression during COVID-19.
In addition, residents can prevent depression by exercising
regularly and actively adjusting their mindset (102,103). The
embodied cognition theory emphasizes the interaction between
cognitive processes and the anatomical structure of the body,
body movements, and the external environment of the body
(104). It is believed that cognition is not only related to the
brain, but also to the body, which is the carrier of cognition
and cognitive functions. The body can also directly participate in
mental processes such as emotion and thinking. Lack of physical
exercise, as mentioned earlier, is one of the factors contributing
to depression during COVID-19. However, regular exercise
can influence the mental health of the public by improving
their mood.
Implications
The significance of this study is reflected in the following two
aspects: First, this study used COOC (29) and VOSviewer (40)
software as tools to conduct a literature econometric analysis
and scientific knowledge mapping in the field of depression
research during COVID-19, aiming to systematically summarize
the trends and research hotspots in this field. Second, as an
emerging topic, depression during COVID-19 has not been
developed for a long time; however, it has been widely noticed
worldwide owing to its specificity (43,105). In addition, this
study adopted a visualization method to quickly locate the key
research results in this field. A review of the literature in this area
will assist future researchers in further analyzing the causes of
depression and finding measures to alleviate depression during
COVID-19. It also assists the government in improving the
current trend of frequent public psychological problems and
provides ideas and references for solving public psychological
problems caused by global issues in the future (106,107).
Limitations and directions for future
research
This study has some limitations. First, as an emerging hot
topic, the earliest literature on depression during COVID-19
was published in 2020, which was <3 years ago, and scholars’
research in this field is limited to the initial stage, which does not
perfectly reflect the development and evolutionary trends of this
field. Future research should continue to track the literature in
this field over the next few years to enrich the research trends and
hotspots. Second, the search platform of this study was limited
by the WOS platform, the type of literature is specified, and
the amount of literature obtained is incomplete. Future research
should attempt to join other search platforms, such as PubMed,
and compare and analyze the literature retrieved by WOS and
PubMed to summarize the patterns.
Through bibliometric analysis and scientific knowledge
mapping of the field of depression research during COVID-19,
the following aspects may also be of interest in the future. First,
most articles in the field of depression research during COVID-
19 have been studied using quantitative research methods,
and few have been studied using a mixture of qualitative and
quantitative research methods (108,109). Second, by reading
the articles, it was established that most of the scales used to
assess depression in the field articles were developed before the
pandemic. Future research could thus update the depression
assessment scales (110). Third, there is a lack of research on
the differences in depression during COVID-19 caused by
the cross-cultural context (13). Fourth, regarding factors that
shape depression during COVID-19, future research should
consider multi-layer linear modeling. Feinberg et al. (111) used
HLM methods to study effects of public health interventions
on families and individuals; in terms of causing problems,
there could be a sustained focus on the specific impact of
depression on special groups during COVID-19 (112); in terms
of coping strategies, longitudinal studies of interventions (113)
are warranted, while government (114) and society should also
pay sustained attention to those with low levels of depression but
are potentially at risk.
Conclusion
This study used COOC and VOSviewer tools for a
comprehensive follow-up and visual analysis of the literature
in the field of depression during COVID-19. The goal of this
study was to systematically review the literature in this area
and draw the following conclusions. First, regarding research
progress, the field of depression during COVID-19 has been
studied for <3 years but has entered a rapid development
period. Second, the number of regional publications in the area
is related to the severity and importance of the pandemic in
each region. Among these, the strongest collaboration is between
the United States, China, and the United Kingdom. Finally,
regarding research hotspots, the field of depression during
COVID-19 is particularly concerned with “factors influencing
depression during COVID-19,” “consequences of depression
during COVID-19,” and “coping strategies for depression
during COVID-19.” The three areas of “depression during
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Fu et al. 10.3389/fpubh.2022.1061486
COVID-19” are discussed. Finally, this series of studies on
COVID-19 provides a reference for future exploration of public
mental health in the context of a global pandemic, as well
as helps to forge new pathways for addressing the legacy of
human psychological problems after the end of the COVID-19
pandemic and setting a research agenda for future investigations.
Data availability statement
The original contributions presented in the study are
included in the article/supplementary material, further inquiries
can be directed to the corresponding author.
Author contributions
JZ, QF, JG, and YX designed the study. QF, JG, and YX
performed the analysis and interpreted the data. JZ, XL, YY,
YM, and SS reviewed the article and provided comments or
suggestions. JZ had primary responsibility for final content.
All authors contributed to manuscript and approved the
submitted version.
Funding
This study was supported by National Office for Education
Sciences Planning, Grant Number BAA180017.
Conflict of interest
The authors declare that the research was conducted in the
absence of any commercial or financial relationships that could
be construed as a potential conflict of interest.
Publisher’s note
All claims expressed in this article are solely those of the
authors and do not necessarily represent those of their affiliated
organizations, or those of the publisher, the editors and the
reviewers. Any product that may be evaluated in this article, or
claim that may be made by its manufacturer, is not guaranteed
or endorsed by the publisher.
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