Copyright
©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Effects of cumulative COVID-19 cases on mental health: Evidence from multi-country survey
Shanaya Rathod, Saseendran Pallikadavath, Elizabeth Graves, Mohammad M Rahman, Ashlea Brooks, Pranay Rathod, Rachna Bhargava, Muhammad Irfan, Reham Aly, Haifa Mohammad Saleh Al Gahtani, Zahwa Salam, Steven Wai Ho Chau, Theone S E Paterson, Brianna Turner, Viktoria Gorbunova, Vitaly Klymchuk, Peter Phiri
Shanaya Rathod, Elizabeth Graves, Ashlea Brooks, Department of Research and Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
Saseendran Pallikadavath, Portsmouth-Brawijaya Centre for Global Health, University of Portsmouth, Portsmouth PO1 2UP, United Kingdom
Mohammad M Rahman, Salford Business School, University of Salford, Salford M5 4WT, United Kingdom
Pranay Rathod, Patient and Public Involvement, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
Rachna Bhargava, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India
Muhammad Irfan, Department of Mental Health, Psychiatry and Behavioral Sciences, Peshawar Medical College, Riphah International University, Islamabad 46000, Pakistan
Reham Aly, Department of Clinical Services, Ministry of Health, Cairo 4262114, Egypt
Haifa Mohammad Saleh Al Gahtani, College of Medicine and Medical Sciences, Arabian Gulf University, Bahrain 329, Bahrain
Zahwa Salam, Peshawar Dental College, Ripah International University, Islamabad 46000, Pakistan
Steven Wai Ho Chau, Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
Theone S E Paterson, Brianna Turner, Department of Psychology, University of Victoria, Victoria BC V8P 5C2, Canada
Viktoria Gorbunova, Department of Social Psychology, Zhytomyr State University, Zhytomyr 10002, Ukraine
Vitaly Klymchuk, National Psychological Association, Mental Health for Ukraine Project, European Federation of Psychologists' Association, GFA, Kyiv 04071, Ukraine
Peter Phiri, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
Author contributions: Rathod S, Rathod P and Phiri P developed the study protocol and questionnaire; Rathod S, Phiri P, and Rahman MM contributed to the manuscript development; All authors reviewed and approved the final manuscript.
Supported by MRC Global Health Research Program, No. MR.N006267/1.
Institutional review board statement: The study received ethics and HRA approval. IRAS project ID: 282858; REC reference: 20/HRA/1934 from London-Westminster Research Ethics Committee on 27 April 2020. Each country followed their own ethics procedure.
Informed consent statement: All participants gave informed consent.
Conflict-of-interest statement: Professor Shanaya Rathod declares in the past 5 years to have received sponsorship for educational events and honoraria for lecture from Lundbeck, Janssen, Boehringer and Otsuka. She has been on advisory group for Boehringer. To have been CI for Otsuka Hummingbird study and CI and PI for Janssen TRD studies. No shareholdings in pharmaceutical companies. Dr. Phiri declares grants from NovoNordisk, paid lectures Queen Mary University of London, other from John Wiley & Sons, outside the submitted work. Visiting Academic University of Southampton. Professor Saseendran Pallikadavath, Dr Elizabeth Graves, Miss Ashlea Brooks, Mr Pranay Rathod, Rachna Bhargava, Muhammad Irfan, Reham Aly, Haifa Mohammed Saleh Al Gahtan, Zahwa Salam, Steven Wai Ho Chau, Theone S E Paterson, Brianna Turner, Viktoria Gorbunova, Vitaly Klymchuk declare no conflicts of interest or financial declarations.
Data sharing statement: The Correspondence author and first author will consider sharing anonymised datasets upon reasonable request after approval by the ethics committee.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Peter Phiri, BSc, PhD, Senior Research Fellow, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southampton SO17 1BJ, United Kingdom. p.phiri@soton.ac.uk
Received: January 20, 2023
Peer-review started: January 20, 2023
First decision: February 21, 2023
Revised: February 27, 2023
Accepted: April 24, 2023
Article in press: April 24, 2023
Published online: July 19, 2023
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.
Core Tip: This study explores the effect of cumulative coronavirus disease 2019 cases on mental health, more specifically on anxiety, depression, and trauma. Negative impact on mental health was found internationally, with individuals struggling to receive support from mental health services. Results also show that as the pandemic continued, mental health scores got worse.
