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 young people who grew up in poverty in low/middle-income countries (LMICs).

Design: A phone survey administered between August and October 2020 to participants of a population-based longitudinal cohort study established in 2002 comprising two cohorts born in 1994-1995 and 2001-2002 in Ethiopia, India (Andhra Pradesh and Telangana), Peru and Vietnam. We use logistic regressions to examine associations between mental health and pandemic-related stressors, structural factors (gender, age), and lifelong protective/risk factors (parent and peer relationship, wealth, long-term health problems, past emotional problems, subjective well-being) measured at younger ages.

Setting: A geographically diverse, poverty-focused sample, also reaching those without mobile phones or internet access.

Participants: 10 496 individuals were approached; 9730 participated. Overall, 8988 individuals were included in this study; 4610 (51%) men and 4378 (49%) women. Non-inclusion was due to non-location or missing data.

Main outcome measures: Symptoms consistent with at least mild anxiety or depression were measured by Generalized Anxiety Disorder-7 (≥5) or Patient Health Questionnaire-8 (≥5).

Results: Rates of symptoms of at least mild anxiety (depression) were highest in Peru at 41% (32%) (95% CI 38.63% to 43.12%; (29.49-33.74)), and lowest in Vietnam at 9% (9%) (95% CI 8.16% to 10.58%; (8.33-10.77)), mirroring COVID-19 mortality rates. Women were most affected in all countries except Ethiopia. Pandemic-related stressors such as health risks/expenses, economic adversity, food insecurity, and educational or employment disruption were risk factors for anxiety and depression, though showed varying levels of importance across countries. Prior parent/peer relationships were protective factors, while long-term health or emotional problems were risk factors.

Conclusion: Pandemic-related health, economic and social stress present significant risks to the mental health of young people in LMICs where mental health support is limited, but urgently needed to prevent long-term consequences.

Keywords: COVID-19; anxiety disorders; depression & mood disorders.

Figure 1

Cumulative confirmed COVID-19 cases per million people in the four Young Lives countries. Source: Johns Hopkins University CSSE COVID-19 Data, accessed via our world in data. Last updated 15 December 2020. Testing and challenges in the attribution of the cause of death mean that the number of confirmed deaths may not be an accurate count of the true number of deaths from COVID-19. CSSE, Center for Systems Science and Engineering

Figure 2

Theoretical framework of the hypothesised impact of COVID-19 stressors, background characteristics and the country-level environment on mental health. (1), (2) and (3) are the channels as discussed in the framework. Red font colour indicates hypothesised risk factors, blue font colour hypothesised protective factors. In case of gender, women are the hypothesised vulnerable group. Urban participants are hypothesised to be more vulnerable than rural residents (location). Black font colour indicates a potential effect in either direction. White font colour refers to outcome variables. (Solid) lines indicate that the variable was measured in previous in-person rounds. Filled subcircles are categorical/composite variables. Boxes with no fill colour indicate robustness checks to the main framework. Dotted arrows indicate that the variable was only considered implicitly for descriptive statistics. Solid arrows indicate use in logistic regressions. Changes in employment status and changes in the educational status (=educational disruption) are used interchangeably for the younger cohort. Mental health was measured using the GAD-7 and PHQ-8 and a cut-off of five reflecting at least mild symptoms of anxiety/depression was chosen. GAD-7, Generalized Anxiety Disorder-7; PHQ-8, Patient Health Questionnaire-8.