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

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.

SciScore for 10.1101/2021.02.02.21250897: (What is this?)

Please note, not all rigor criteria are appropriate for all manuscripts.

Table 1: Rigor

Institutional Review Board Statement	IRB: Ethics statement: The survey was approved by the institutional research ethics committees at the University of Oxford (UK), the University of Addis Ababa (Ethiopia), the Centre for Economic and Social Studies in Hyderabad (India), the Instituto de Investigación Nutricional (Peru) and the Hanoi University of Public Health (Vietnam). Consent: Participants were asked for their verbal informed consent before the study commenced and were assured of confidentiality.
Randomization	not detected.
Blinding	not detected.
Power Analysis	not detected.
Sex as a biological variable	Changes in responsibilities, the labour market and education environment may affect males and females differently.

Table 2: Resources

No key resources detected.

Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

Strengths and limitations: Other studies have used longitudinal data to document the impact of the pandemic on mental health.5, 12 This study’s strength combines survey data about experiences of COVID-19 with long term information from two cohorts of participants of a population-based cohort study in four LMICs. The study was able to cover the poorest, those without internet (or mobile phone), and examine a broad range of pandemic-related stressors as well as controlling for longer-term risk and protective factors. Our study has a number of limitations. We do not have a directly comparable pre-COVID baseline for depression/anxiety. However, we use proxy variables for baseline and our explanatory variables capture dynamics during the pandemic. Finally, as for other studies, there may be underreporting because of stigma associated with mental health, despite piloting and validation; however, note that our analysis identifies high risk groups within each country. Also self-reported variables may be biased due to feelings of anxiety or depression. The findings are not fully generalizable to the whole population of LMICs due to the pro poor design and age group, however they broadly represent poor young people in the study countries.

Results from TrialIdentifier: No clinical trial numbers were referenced.

Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

Results from JetFighter: We did not find any issues relating to colormaps.

Results from rtransparent:

Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
No protocol registration statement was detected.

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