The Impact of Social Support on Anxiety and Depression under the Context of COVID-19 Pandemic: A Systematic Review and Meta-analysis

Introduction: The COVID-19 pandemic has been associated with a sharp increase in anxiety and depression worldwide. Social support is widely recognized as a protective factor against psychological distress, yet findings across populations and regions remain inconsistent. The pandemic offers a unique natural experiment to examine how social support functions under sustained, global-level stressors.
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, meta-regression, sensitivity, and publication bias analyses conducted.
Results: Sixty studies comprising 64,693 participants met inclusion criteria. Social support was significantly associated with lower anxiety (r = -0.26, 95% CI [-0.33, -0.26]) and lower depression (r = -0.27, 95% CI [-0.37, -0.28]). 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 meta-regression analyses indicated that examined moderators—including age, gender, region, and occupation—did not significantly explain this variability, suggesting that unmeasured contextual factors are likely driving the observed differences. Publication bias was detected, though trim-and-fill analyses did not alter overall results.
Conclusion: Social support was consistently associated with lower anxiety and depression during the COVID-19 pandemic. These findings, interpreted within the main-effect model of social support, highlight the importance of strengthening social networks, particularly for vulnerable groups. The substantial heterogeneity underscores that social support effects are highly context-dependent, favoring tailored rather than universal intervention approaches. Future crisis preparedness efforts should prioritize the maintenance and facilitation of social support systems during prolonged public health emergencies. However, because the pooled effect sizes reflected bivariate associations, the results should not be interpreted as direct evidence that social support buffered the mental health impact of specific COVID-19-related stressors.