The Effect of the COVID-19 Pandemic on Mental Health in Low and Middle Income Countries

We track the effects of the COVID-19 pandemic on mental health in eight Low and Middle Income Countries (LMICs) in Asia, Africa, and South America utilizing repeated surveys of 21,162 individuals. Many respondents were interviewed over multiple rounds pre- and post-pandemic, allowing us to control for time trends and within-year seasonal variation in mental health. We demonstrate how mental health fluctuates with agricultural crop cycles, deteriorating during pre-harvest “lean” periods. Ignoring this seasonal variation leads to unreliable inferences about the effects of the pandemic. Controlling for seasonality, we document a large, significant, negative impact of the pandemic on mental health, especially during the early months of lockdown. In a random effects aggregation across samples, depression symptoms increased by around 0.3 standard deviations in the four months following the onset of the pandemic. The pandemic could leave a lasting legacy of depression. Absent policy interventions, this could have adverse long-term consequences, particularly in settings with limited mental health support services, which is characteristic of many LMICs. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The authors did not receive specific funding from any source to write this paper. To construct this paper, we had to assemble different datasets. There are some funding sources attached to the data collection for each individual dataset. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. A.Moya received grants from Saving Brains–Grand Challenges Canada (grant number SB-POC-1809-19901, https://www.grandchallenges.ca/programs/saving-brains/) United Way Colombia (https://unitedwaycolombia.org/), Fundación Éxito (https://www.fundacionexito.org/), Fundación FEMSA (https://fundacionfemsa.org/), Genesis Foundation, Fundación Coca-Cola (https://www.fundacioncocacola.com/), Primero lo Primero (https://primeroloprimero.co/es/), Universidad de los Andes (https://uniandes.edu.co/) for COL sample. M.V. received grant from Dutch Research Council (grant number VI.Vidi.191.154, https://www.nwo.nl/) for SLE sample. M.V. received grant from NORC at the University of Chicago (https://www.norc.org/Pages/default.aspx) for DRC sample. W.J., N.A. and A.A. received grant from Joep Lange Institute (16801.03, www.joeplangeinstitute.org), for KEN3 sample. Y.v.D. received grant from Sint Antonius Stichting (1913112,https://www.aham.nl/sintantoniusstichtingprojecten/) for RWA sample. BGD received grants from BRAC (http://www.brac.net/) and LEGO Foundation (https://learningthroughplay.com/). B.B., A.S., P. M. received grant from IPA Peace and Recovery Initiative for NGA sample. KEN1 sample (M.W.) is supported by grants from PA's Peace and Recovery Initiative, IZA's G2LMLIC, Berkeley Population Center, NIH and GiveWell. KEN2 sample (D.E. and M.W.) is supported by International Growth Centre, PEDL, NSF and Weiss Family Fund. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The studies BGD, COL, DRC, KEN1, KEN2, KEN3, NPL, NGA, RWA, and SLE received Institutional Review Board (IRB) approval from BRAC University (ref no. 2019-028-ER) the Ethics Committee of the Universidad de los Andes, Colombia (protocol 786, 2017) the NORC Institutional Review Board (IRB00000967) UC Berkeley, Maseno University AM- REF Ethics and Scientific Review Committee Kenya (P679/2019) Yale University (IRB Protocol 2000025621) IPA (IRB Protocol 15057) Vrije University Amsterdam (20210413.1) and Sierra Leone Ethics and Scientific Review Committee (SLERC 2904202) and Wageningen University (24062020), respectively. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Not Applicable The data underlying the results presented in the study are available upon request for researchers who meet the criteria for access to confidential data.