Prevalence and correlates of depression during the COVID-19 pandemic and the major role of stigmatization in low- and middle-income countries: A multinational cross-sectional study.

OBJECTIVES: Currently, there is little data on the mental health consequences of the COVID-19 pandemic in low- and middle-income countries (LMICs). This study aims to examine the pooled and separate prevalence and determinants of depression during the pandemic in samples from four LMICs. METHODS: Participants (N= 1267, 40.9% women) were recruited from the Democratic Republic of the Congo (DRC), Haiti, Rwanda, and Togo. They completed an online cross-sectional survey on sociodemographics, exposure and stigmatization related to COVID-19, the Hopkins Symptom Checklist depression subscale, and the Connor-Davidson Resilience Scale-2. RESULTS: The pooled prevalence for depression symptoms was 24.3% (95% CI: 22.08-26.79%), with significant differences across countries. Younger age, gender (women), and high levels of exposure and stigmatization related to COVIID-19, and resilience were associated with depression in the pooled data. There were significant variations at the country level. Stigmatization (but not exposure to COVID-19 and resilience) was a strong predictor among the four countries. CONCLUSIONS: The prevalence of depression symptoms in the LMICs are similar to those reported in China and in most high-income countries during the pandemic. The findings emphasize the need for implementing non-fear-based education programs during epidemics to reduce stigmatization.

Frequency and correlates of anxiety symptoms during the COVID-19 pandemic in low- and middle-income countries: A multinational study.

OBJECTIVE: Studies have documented the significant direct and indirect psychological, social, and economic consequences of the Coronavirus disease 2019 (COVID-19) in many countries but little is known on its impact in low- and middle-income countries (LMICs) already facing difficult living conditions and having vulnerable health systems that create anxiety among the affected populations. Using a multinational convenience sample from four LMICs (DR Congo, Haiti, Rwanda, and Togo), this study aims to explore the prevalence of anxiety symptoms and associated risk and protective factors during the COVID-19 pandemic. METHODS: A total of 1267 individuals (40.8% of women) completed a questionnaire assessing exposure and stigmatization related to COVID-19, anxiety, and resilience. Analyses were performed to examine the prevalence and predictors of anxiety. RESULTS: Findings showed a pooled prevalence of 24.3% (9.4%, 29.2%, 28.5%, and 16.5% respectively for Togo, Haiti, RDC, and Rwanda, x2 = 32.6, p < .0001). For the pooled data, exposure to COVID-19 (ß = 0.06, p = .005), stigmatization related to COVID-19 (ß = 0.03, p < .001), and resilience (ß = -0.06, p < .001) contributed to the prediction of anxiety scores. Stigmatization related to COVID-19 was significantly associated to anxiety symptoms in all countries (ß = 0.02, p < .00; ß = 0.05, p = .013; ß = 0.03, p = .021; ß = 0.04, p < .001, respectively for the RDC, Rwanda, Haiti, and Togo). CONCLUSIONS: The findings highlight the need for health education programs in LMICs to decrease stigmatization and the related fears and anxieties, and increase observance of health instructions. Strength-based mental health programs based on cultural and contextual factors need to be developed to reinforce both individual and community resilience and to address the complexities of local eco-systems.