Impact of the COVID-19 Pandemic on anxiety and depression symptoms of young people in the Global South: evidence from a four-country cohort study

Abstract

Objective To provide evidence on the effect of the COVID-19 pandemic on the mental health of adolescents and young adults who grew up in poverty in Low and Middle Income Countries (LMICs). Design A phone survey implemented August-October 2020 to participants of a population-based cohort study since 2002 comprising two cohorts born in 1994-5 and 2001-2 in Ethiopia, India (Andhra Pradesh and Telangana), Peru and Vietnam. We examined associations between mental health and pandemic-related stressors, as well as structural factors (gender, location, wealth); and lifelong protective/risk factors (parent and peer relationship, past household wealth, long-term health problems, past emotional problems and subjective well-being) measured at younger ages. Setting A diverse, poverty focused sample, reaching those without mobile phones or internet access. Participants 10,496 individuals were approached, 9,730 participated. Overall, 8,988 individuals were included in this study, 4,610 (51%) male and 4,378 (49%) female. Non-inclusion was due to non-location or missing data. Main outcome measures At least mild anxiety and depression were measured by Generalized Anxiety Disorder-7 (GAD-7, ≥5) and Patient Health Questionnaire-8 (PHQ-8, ≥5). Results Rates of symptoms of at least mild anxiety (depression) were highest in Peru at 41% (32%) [95% CI, 38.63-43.12; (29.49-33.74)], and lowest in Vietnam at 9% (9%) [95% CI, 8.16- 10.58; (8.33- 10.77)], mirroring COVID-19 mortality rates. Females were most affected in all countries but Ethiopia. In all countries, pandemic-related stressors were associated with increased rates of anxiety and depression, though with varying levels of importance across countries. Prior parent and peer relationships were protective factors for mental health while having a long-term health problem or prior emotional problems were risk factors. Conclusion The COVID-19 pandemic presents significant risks to the mental health of young people. Mental health support is limited in LMICs and young people have to date been lower priority for COVID-19 interventions.

COVID-19 and gender differences in mental health in low- and middle-income countries: Young working women are more vulnerable

“…Economic hardship in terms of job and income loss during COVID-19 has reached a new global high. This has resulted in deteriorating mental health in both high- and low-income countries ( Porter, Favara, Hittmeyer, et al, 2021 ; Salameh et al, 2020 ; Witteveen & Velthorst, 2020 ). While a global issue, research from different platforms has warned that young women in vulnerable communities in the developing world are at a greater risk of suffering from anxiety and mental stress due to rising financial hardship ( Plan International, 2020 ; UN, 2020 ).…”

COVID-19 and Depression: Prevalence and Risk Factors in Youth from Maharashtra, India

“…Contrary to such findings, this study found no significant gender effects, though overall percentages of symptomatic women were slightly more than that of men across mild (M = 17%, F = 18%), moderate (M = 16%, F = 18%), and severe (M = 16%, F = 17%) categories. In their study comparing depression among the youth of Peru, Ethiopia, Vietnam, and India during the pandemic, Porter et al ( 2021 ) found similar results in Indian youth. One reason for variations observed in studies conducted during the pandemic could be the stress-inducing conditions imposed by the pandemic regardless of gender.…”

“…Fluctuations in perception of the pandemic over time as being less dangerous (data collection took place in November when the first wave was coming to an end) may contribute to lower emotional impact (Terry et al, 2020 ). Several external and intrinsic factors moderate COVID-related depression in young people and a clearer understanding of the experience of depression during the pandemic requires an inquiry into these factors (Porter et al, 2021 ; Rehman et al, 2021 ; Sundarasen et al, 2020 ; Wang et al, 2020 ).…”

“…Social isolation, increased screen time, falling academic confidence and performance, heightened future uncertainty, overwork, gaming addiction, poor sleep quality, parental anxiety, increased family violence, and home confinement were some of the reported effects of the pandemic on Indian youth (Jacob et al, 2020 ; John & John, 2021 ; Patra & Patro, 2020 ). The cascading effect of this sustained health crisis is expected to exacerbate problems like depression and anxiety, particularly among those in a developmentally sensitive period (Courtney et al, 2020 ; Porter et al, 2021 ).…”

The Evolution of Young People’s Mental Health during COVID-19: Evidence from four Low-and-Middle-Income-Countries

“…Building on pre-pandemic research, 20 we highlight the association between food shortages and continuing high rates of poor mental health. Young Lives research shows food insecurity increased during the pandemic, except in Vietnam 1 and that pandemic-related stressors worsened mental health in mid-2020 21 . A 149-country pre-pandemic study 20 found that food insecurity is associated with poorer mental health and identifies channels through which food insecurity affects mental health: i) feelings of powerlessness, sadness, frustration ii) uncertainty regarding acquiring sufficient food iii) feelings of guilt/shame from acquiring food in socially unacceptable ways.…”