A narrative review of the available evidence on the effect of mask use on cognitive performance and psychological outcomes
| Author, year of publication | Participants (study design) | Outcome | Risk of bias | Certainty of evidence |
| Cognitive performance | ||||
| Braun-Trocchio et al,37 2022 | 54 (non-randomised study) | Wearing masks was associated with an increase in the internal focus score during the stepping exercise task compared with no mask. | High | ⊕◯◯◯* Very low |
| Deng et al,35 2022 | 20 (RCT) | Wearing a mask was associated with reduced mental workload compared with no mask; however, mask use was associated with worse performance scores and fewer correct numbers or rates. | Moderate | ⊕⊕◯◯† Low |
| Grimm et al,36 2022 | 23 (RCT) | Mask use was associated with little to no significant difference in cognitive performance, self-perceived arousal or ability to concentrate ratings during rest or exercise. | Moderate | ⊕⊕◯◯* Low |
| Ipek et al,17 2021 | 34 (cross-sectional study) | Wearing N95 masks was associated with higher attention deficit rates and difficulty in concentrating compared with the face mask group. | High | ⊕◯◯◯* Very low |
| Jahangiri et al,39 2023 | 40 (quasiexperimental study) | No significant difference was noted between face mask and N95 respirator groups in cognitive performance, number of correct responses or response time. | High | ⊕◯◯◯* Very low |
| Slimani et al,41 2021 | 17 (cross-sectional study) | Wearing face masks was associated with improved cognitive function, resulting in fewer errors compared with no mask group. | High | ⊕◯◯◯* Very low |
| Tornero-Aguilera and Clemente-Suarez,43 2021 | 50 (cross-sectional study) | Wearing a face mask was associated with little to no difference in mental fatigue perception or reaction time compared with no mask. | High | ⊕◯◯◯* Very low |
| Psychological outcomes | ||||
| Chong et al,38 2022 | 93 (cross-sectional study) | Claustrophobia was noted in 3% of the participants while wearing face masks. Comparable results were noted while wearing an N95 respirator or surgical mask. | High | ⊕◯◯◯* Very low |
| Khalid et al,40 2021 | 12 (cross-sectional study) | Higher rate of claustrophobia among the N95 respirator group when compared with the face mask group. | High | ⊕◯◯◯* Very low |
| Su et al,42 2021 | 68 (cross-sectional study) | No significant difference was noted in depression or anxiety rate among the surgical mask or N95 respiratory group. | High | ⊕◯◯◯* Very low |
*Low quality of evidence is due to unexplained inconsistency and imprecise results due to small magnitude of change and wide CI and some concern with risk of bias.
†Low quality of evidence is due to imprecise results due to small magnitude of change and wide CI.
RCT, randomised controlled trial.