Effects of cumulative COVID-19 cases on mental health: Evidence from multi-country survey.

BACKGROUND: Depression and anxiety were both ranked among the top 25 leading causes of global burden of diseases in 2019 prior to the coronavirus disease 2019 (COVID-19) pandemic. The pandemic affected, and in many cases threatened, the health and lives of millions of people across the globe and within the first year, global prevalence of anxiety and depression increased by 25% with the greatest influx in places highly affected by COVID-19. AIM: To explore the psychological impact of the pandemic and resultant restrictions in different countries using an opportunistic sample and online questionnaire in different phases of the pandemic. METHODS: A repeated, cross-sectional online international survey of adults, 16 years and above, was carried out in 10 countries (United Kingdom, India, Canada, Bangladesh, Ukraine, Hong Kong, Pakistan, Egypt, Bahrain, Saudi Arabia). The online questionnaire was based on published approaches to understand the psychological impact of COVID-19 and the resultant restrictions. Five standardised measures were included to explore levels of depression [patient health questionnaire (PHQ-9)], anxiety [generalized anxiety disorder (GAD) assessment], impact of trauma [the impact of events scale-revised (IES-R)], loneliness (a brief loneliness scale), and social support (The Multi-dimensional Scale of Perceived Social support). RESULTS: There were two rounds of the online survey in 10 countries with 42866 participants in Round 1 and 92260 in Round 2. The largest number of participants recruited from the United Kingdom (112985 overall). The majority of participants reported receiving no support from mental health services throughout the pandemic. This study found that the daily cumulative COVID-19 cases had a statistically significant effect on PHQ-9, GAD-7, and IES-R scores. These scores significantly increased in the second round of surveys with the ordinary least squares regression results with regression discontinuity design specification (to control lockdown effects) confirming these results. The study findings imply that participants' mental health worsened with high cumulative COVID-19 cases. CONCLUSION: Whist we are still living through the impact of COVID-19, this paper focuses on its impact on mental health, discusses the possible consequences and future implications. This study revealed that daily cumulative COVID-19 cases have a significant impact on depression, anxiety, and trauma. Increasing cumulative cases influenced and impacted education, employment, socialization and finances, to name but a few. Building a database of global evidence will allow for future planning of pandemics, particularly the impact on mental health of populations considering the cultural differences.

Impact of lockdown relaxation and implementation of the face-covering policy on mental health: A United Kingdom COVID-19 study.

BACKGROUND: Pandemic mitigation policies, such as lockdown, are known to impact on mental health of individuals. Compulsory face covering under relaxed lockdown restrictions gives assurance of less transmission of airborne infection and has the potential to improve mental health of individuals affected by restrictions. AIM: To examine the association of the lockdown relaxation and the implementation of the face covering policy on the mental health of the general population and sub-groups in the United Kingdom using interrupted time series model. METHODS: Using a web-based cross-sectional survey of 28890 United Kingdom adults carried out during May 1, 2020 to July 31, 2020, changes in mental health status using generalised anxiety disorder (GAD-7), and impact of events scale-revised (IES-R) scales are examined, at the dates of the first lockdown relaxation (July 4, 2020) and the subsequent introduction of face covering (July 24, 2020) in United Kingdom. A sharp regression discontinuity design is used to check discontinuities in mental health outcomes at policy-change dates. RESULTS: Average GAD-7 scores of participants were 5.6, 5.6 and 4.3 during the lockdown period, the lockdown relaxation phase and the phase of compulsory face covering, respectively, with lower scores indicating lower anxiety levels. Corresponding scores for IES-R were 17.3, 16.8 and 13.4, with lower scores indicating less distress. Easing lockdown measures and subsequent introduction of face covering, on average, reduced GAD-7 by 0.513 (95%CI: 0.913-0.112) and 1.148 (95%CI: 1.800-0.496), respectively. Corresponding reductions in IES-R were 2.620 (95%CI: 4.279-0.961) and 3.449 (95%CI: 5.725-1.172). These imply that both lockdown relaxation and compulsory face-covering have a positive association with mental health scores (GAD-7 and IES-R). CONCLUSION: The differential impact of lockdown and relaxation on the mental health of population sub-groups is evident in this study with future implications for policy. Introduction of face covering in public places had a stronger positive association with mental health than lockdown relaxation.

Psychological impact of COVID-19 pandemic: Protocol and results of first three weeks from an international cross-section survey - focus on health professionals.

BACKGROUND: The psychological impact of COVID-19, resultant measures and future consequences to life will be unveiled in time. AIM: To investigate the psychological impact of COVID-19, resultant restrictions, impact on behaviours and mental wellbeing globally. This early analysis, explores positive and adverse factors and behaviours with focus on healthcare professionals. METHODS: This is a cross-sectional survey, using a questionnaire based on published approaches to understand the psychological impact of COVID-19. The survey will be repeated at 6 months because of rapidly changing situation. RESULTS: We have presented results from first 3 weeks of the survey. Conclusions may change as more individuals take part over time. 7,917 participants completed the survey in the first 3 weeks; 7,271 are from the United Kingdom. 49.7% of the participants are healthcare professionals. There is high representation of female participants. Participants reporting suicidal thoughts is 32%. Healthcare professionals have reported mild depression and anxiety in higher proportions. Increasing age and female gender report higher compliance with government advice on COVID 19 whereas higher education, homeowners, key worker status, high alcohol, drug use and participants with pre-existing suicidal thoughts reported low compliance with government advice. Participants who reported suicidal thoughts pre-COVID are less likely to communicate with friends and family, or engage in coping strategies. CONCLUSIONS: Evidence has shown an adverse psychological impact of previous pandemics on the population, especially wellbeing of healthcare professionals. Research should focus on identifying the need, preparing services and determining the factors that enhance and build resilience. FUNDING: This survey is linked to a MRC global health research program of the Portsmouth-Brawijaya center for Global Health, Population, and Policy, (MR/N006267/1), University of Portsmouth.

Mental Health Service Provision in Low- and Middle-Income Countries.

This article discusses the provision of mental health services in low- and middle-income countries (LMICs) with a view to understanding the cultural dynamics-how the challenges they pose can be addressed and the opportunities harnessed in specific cultural contexts. The article highlights the need for prioritisation of mental health services by incorporating local population and cultural needs. This can be achieved only through political will and strengthened legislation, improved resource allocation and strategic organisation, integrated packages of care underpinned by professional communication and training, and involvement of patients, informal carers, and the wider community in a therapeutic capacity.