Article Text

Original research
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
  1. Catherine Porter1,
  2. Marta Favara2,
  3. Annina Hittmeyer2,
  4. Douglas Scott2,
  5. Alan Sánchez Jiménez3,
  6. Revathi Ellanki4,
  7. Tassew Woldehanna5,
  8. Le Thuc Duc6,
  9. Michelle G Craske7,
  10. Alan Stein8,9
  1. 1Management School, Lancaster University, Lancaster, UK
  2. 2Oxford Department of International Development, University of Oxford, Oxford, UK
  3. 3Niños del Milenio, Grupo de Análisis para el Desarrollo (GRADE), Lima, Peru
  4. 4Director, Centre for Economic and Social Studies, Begumpet, India
  5. 5Department of Economics, Addis Ababa University, Addis Ababa, Ethiopia
  6. 6Centre for Analysis and Forecasting, Vietnam Academy of Social Sciences, Hanoi, Vietnam
  7. 7Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
  8. 8Department of Psychiatry, University of Oxford, Oxford, UK
  9. 9School of Public Health, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
  1. Correspondence to Dr Catherine Porter; catherine.porter{at}lancaster.ac.uk

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.

  • COVID-19
  • anxiety disorders
  • depression & mood disorders

Data availability statement

Data are available in a public, open access repository. The entire individual participant data collected during the phone survey and previous in-person rounds, after de-identification, are available including data dictionaries. Furthermore, the questionnaire, attrition reports and the fieldwork manual are available at https://www.younglives.org.uk/. The data are available from January 2021, with no end date to anyone who wishes to access the data for any purpose, via the UK Data Archive (study number 8678, DOI: 10.5255/UKDA-SN-8678-1).

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Data availability statement

Data are available in a public, open access repository. The entire individual participant data collected during the phone survey and previous in-person rounds, after de-identification, are available including data dictionaries. Furthermore, the questionnaire, attrition reports and the fieldwork manual are available at https://www.younglives.org.uk/. The data are available from January 2021, with no end date to anyone who wishes to access the data for any purpose, via the UK Data Archive (study number 8678, DOI: 10.5255/UKDA-SN-8678-1).

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Footnotes

  • Twitter @EconCath

  • Contributors CP and MF conceived the study. CP, MF, DS and ASJ designed the study. MF, ASJ, RE, TW and LTD led data collection. CP and AH did the statistical analyses. CP, AH and MF wrote the first draft of the article. AS and MC provided comments and input to the several drafts of the article. MF, DS and ASJ verified the underlying data. AS, MF, CP and AH assessed scale validation and methodology. AH prepared the supplemental files. All authors critically reviewed multiple versions of the manuscript and approved the final version.

  • Funding Young Lives at Work is funded by a UK aid from the Foreign, Commonwealth and Development Office (FCDO), under the Department for International Development, UK Government (grant number 200 425).

  • Disclaimer The funders of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. The views expressed are those of the authors. They are not necessarily those of, or endorsed by, the University of Oxford, Young Lives, FCDO. All authors had full access to the anonymised data in the study and had final responsibility for the decision to submit for publication.

  • Competing interests CP, MF, AH, DS, ASJ, RE, TW and LTD report grants from the FCDO, during the conduct of the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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