Mental Health Burden and Vulnerability Among Long-Term Care Facility Residents During the COVID-19 Pandemic: A Systematic Review With Exploratory Prevalence Meta-Analysis

BackgroundOlder adults in long-term care facilities (LTCFs) faced social and care disruptions during COVID-19, but evidence on mental health burden and vulnerability remains fragmented.ObjectiveTo synthesise evidence on mental health outcomes among LTCF residents during the pandemic and identify resident- and facility-level vulnerability and protective conditions.MethodsMEDLINE, Embase and PsycINFO were searched for English-language peer-reviewed studies published from January 2020 to January 2025. Findings were narratively synthesised, and exploratory random-effects meta-analyses were conducted where at least three studies reported extractable resident-level prevalence.ResultsThirty-two studies were included as follows: 24 quantitative, six qualitative and two mixed-methods. Most reported high prevalence, deterioration, or qualitative evidence of depression, anxiety, loneliness, isolation, or related distress. Pooled prevalence was 55.6% for depression, 51.4% for anxiety and 54.5% for loneliness, with substantial heterogeneity. Vulnerability reflected clinical, social and facility-level factors; consistent staffing, social connection and family communication were potential protective conditions.