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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

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  • C. Porter
  • M. Favara
  • A. Hittmeyer
  • D. Scott
  • A. Sánchez Jiménez
  • R. Ellanki
  • T. Woldehanna
  • L.T. Duc
  • M.G. Craske
  • A. Stein
Article numbere049653
<mark>Journal publication date</mark>30/04/2021
<mark>Journal</mark>BMJ Open
Issue number4
Number of pages14
Publication StatusPublished
Early online date15/04/21
<mark>Original language</mark>English


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.