Study finds negative impact of COVID-19 pandemic on mental health status in low- and middle-income countries

Scientists from around the world recently conducted a large-scale study to examine the impact of the coronavirus disease 2019 (COVID-19) pandemic on mental health problems in low- to middle-income countries.

Study: The effect of the COVID-19 pandemic on mental health in low- and middle-income countries. Image credit: eamesBot/Shutterstock

During the pandemic, there were significant seasonal fluctuations in mental health conditions. A detailed study report is currently available at medRxiv* prepress server.


The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has severely affected the global health system and economy, with the greatest impact in low- and middle-income countries. The pandemic has caused more than 572 million infections and over 6.3 million deaths worldwide.

Substantial economic deprivation, along with fear of the morbidity and mortality associated with COVID-19, increased mental health problems, including anxiety, stress, depression, and grief, among the general population worldwide during the pandemic. In addition, pandemic-related movement restrictions and lockdowns have added an additional burden to mental illness.

In the current study, researchers conducted several rounds of surveys before and during the pandemic in eight low- to middle-income countries to understand the impact of the COVID-19 pandemic on mental illness.

I study design

The studies were conducted on 21,162 individuals from eight low- to middle-income countries, including Asian, African, and South American countries (Bangladesh, Nepal, Colombia, Democratic Republic of Congo, Kenya, Nigeria, Rwanda, and Sierra Leone). Many rounds of surveys were done in pre-pandemic and pandemic periods.

The results of the studies are related to the timing of the lean season and the onset of the pandemic. In agricultural regions of low- to middle-income countries, the lean season refers to the period between planting and harvest when income and food insecurity increase due to lack of work opportunities and crop shortages.

Seasonal changes in mental health

Seasonal variations in depression were assessed by specifically focusing on two countries, namely Nepal and Kenya. The results of the study in both countries showed a positive change in the state of mental health before the start of the COVID-19 pandemic.

In Nepal, the state of mental health in the initial phase of the pandemic (April 2020) is significantly lower than the pre-pandemic average. However, it improved as the pandemic progressed. No significant difference in food security was observed between the period before and after the lean season (between April and October of the typical year).

A contrasting trend was seen in Kenya, which demonstrated a significant improvement in food security in October for a typical year compared to April. Given the seasonal trend in food security, the study’s analysis revealed that the improvement in mental health status seen as the pandemic progressed was not solely due to the diminishing effects of the pandemic. Seasonal food security also contributes significantly to this improvement.

Mental health outcomes

Two time periods were included in the study’s analysis to understand the impact of the COVID-19 pandemic on mental health. While a time period of 0 to 4 months after the start of the pandemic was considered to assess the short-term impact of the pandemic, the more sustained impact was determined by considering a period of more than four months after the start of the pandemic.

During the initial phase of the pandemic (within four months), there was a significant deterioration in the state of mental health in the countries studied. However, there was a trend towards improvement in mental health as the pandemic progressed (after four months).

After adjusting for seasonal changes in mental health status, the findings revealed a significant long-term negative impact of the pandemic on mental health.

Significance of the study

The present large-scale study, conducted in multiple low- to middle-income countries, highlights the significant negative impact of the COVID-19 pandemic on mental health problems, especially depression. This observation holds even after adjusting for seasonal fluctuations in mental health status and the time of pandemic onset.

In particular, the study demonstrated a clear link between food insecurity and poor mental health. Based on this observation, the scientists point out that the actual impact of the pandemic on the state of mental health in agricultural societies can only be determined by accounting for seasonal fluctuations.

The researchers also highlight the need to increase the availability and accessibility of mental health support services in low- to middle-income countries to reduce the risk of long-term mental health consequences during the COVID-19 pandemic.

*Important message

medRxiv publishes preliminary scientific reports that are not peer-reviewed and therefore should not be considered conclusive, guiding clinical practice/health-related behavior or treated as established information.

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