Stigma associated with mental health problems among young people in India: a systematic review of magnitude, manifestations and recommendations

Effectiveness of a mental health literacy module on stigma related mental health knowledge and behaviour among youth in two educational settings in Chennai, South India: A quasi-experimental study

BACKGROUND

Improving mental health literacy (MHL) can reduce stigma towards mental illness, decreasing delays in help-seeking for mental disorders such as psychosis. We aimed to develop and assess the impact of an interactive MHL intervention on stigma related mental health knowledge and behaviour (SRMHKB) among youth in two urban colleges in South India.

METHODS

Incorporating input from stakeholders (students, teachers, and mental health professionals), we developed a mental health literacy module to address SRMHKB. The module was delivered as an interactive session lasting 90 min. We recruited 600 (300 males; 300 females; mean age 19.6) participants from two city colleges in Chennai from Jan-Dec 2019 to test the MHL module. We assessed SRMHKB before the delivery of the MHL intervention, immediately after, and at 3 and 6 months after the intervention using the Mental Health Knowledge Schedule (MAKS) and Reported and Intended Behaviour Scale (RIBS). We used generalised estimating equations (GEE) to assess the impact of the intervention over time.

RESULTS

Compared to baseline, there was a statistically significant increase in stigma related knowledge and behaviour immediately after the intervention (coefficient=3.8; 95% CI: 3.5,4.1) and during the 3-month (coefficient=3.4; 95% CI: 3.0,3.7) and 6-month (coefficient=2.4; 95% CI: 2.0,2.7) follow-up.

CONCLUSION

Preliminary findings suggest that a single 90-minute MHL interactive session could lead to improvements in SRMHKB among youth in India. Future research might utilise randomised controlled trials to corroborate findings, and explore how improvements can be sustained over the longer-term.

The prevalence of depression, anxiety, and sleep disorder among dental students: A systematic review and meta-analysis

BACKGROUND

Despite the increasing concern, the literature lacks a comprehensive synthesis of the prevalence of depression, anxiety, and sleep disturbances among dental students.

METHODS

We conducted a systematic review following Cochrane Manual for Systematic Reviews of Interventions and PRISMA guidelines. Our search, spanning databases like Medline, Web of Science, and Scopus, covered data until June 5, 2023. A random effect model was utilized for the meta-analysis.

RESULTS

From 508 initially identified articles, 45 studies met eligibility criteria. The pooled prevalence of depression, anxiety, and sleep disorders among dental students was estimated as follows: depression [38%, 95% confidence interval (CI): 32%-44%; I2  = 98%], anxiety [48%, 95% CI: 41%-55%; I2  = 97.7%], and sleep disorders [31%, 95% CI: 24%-38%; I2  = 85.7%]. Subgroup analyses based on geographical regions and assessment scales revealed significant between-subgroup differences. Meta-regression identified associations between the prevalence of depression and the year of publication and between the prevalence of anxiety and total sample size, participant age, and year of publication. Publication bias assessments demonstrated a lack of significant bias, strengthening the validity of the findings.

CONCLUSIONS

The prevalence of depression, anxiety, and sleep disturbances in dental students is significant. This study highlighted the need for targeted interventions and support systems within dental education to alleviate the mental health challenges students face, ultimately ensuring their well-being and competence as future healthcare providers. Further research should explore the effectiveness of interventions in this population.

Role of detailed psychological evaluation and treatment in pulmonary rehabilitation programs for patients with chronic obstructive pulmonary disease

Psychological co-morbidities are common in chronic obstructive pulmonary disease (COPD) but remain overlooked. Psychosocial interventions are deemed to promote mental health and optimize management. This study aimed to determine the role of detailed psychological evaluation and treatment in the comprehensive management of COPD. COPD patients after screening with the general health questionnaire-12 (GHQ-12) for psychological co-morbidity were divided into three groups (26 patients each): i) group A [GHQ-12 score<3, received pulmonary rehabilitation (PR) and standard medical management]; ii and iii) group B and C (GHQ-12 score>3, in addition, received management by a psychiatrist and counseling by a pulmonologist, respectively). At baseline and 8 weeks of follow-up, all participants were evaluated for respiratory [forced expiratory volume in the first second (FEV1), six-minute walk distance (6-MWD), St. George's respiratory questionnaire (SGRQ), modified medical research council (mMRC) dyspnea scale], and psychological [GHQ-12, patient distress thermometer (PDT), coping strategy checklist (CSCL), World Health Organization-quality of life-brief (WHOQOL-Bref-26), and depression anxiety stress scales (DASS)] parameters. Psychological distress (GHQ-12>3) decreased significantly at follow-up, with 11.5% and 53.8% of patients having psychological distress in groups B and C, respectively, versus baseline (p<0.001). mMRC score, SGRQ score, FEV1 and 6-MWD significantly improved in all three groups. Improvement in mMRC and SGRQ was maximal in group B when compared with the other groups. PDT, CSCL, and WHO-QOL-Bref-26 scores improved significantly at follow-up in all three groups, with maximum improvement in group B, followed by group C, and then group A. The DASS score also improved maximally in group B. Patients should be screened for psychological co-morbidities using simple screening tools. PR plays an important role in improving the psychology of COPD patients. However, results are better with directed psycho-educative sessions by non-experts and best with definitive treatment by psychiatrists.

What Women Want: Mental Health in the Context of Violence Against Women in Sri Lanka-A Qualitative Study of Priorities and Capacities for Care

Insufficient evidence guides mental health service development for survivors of violence against women in Sri Lanka. Provider and survivor perspectives on (1) what constitutes mental health, (2) quality of care, and (3) priority areas and stakeholders for intervention were identified through framework analysis of 53 in-depth interviews. Desired care is chiefly psychosocial-not psychological-prioritizing socioeconomic, parenting, and safe environment needs in non-clinical community settings. Our evidence points strongly to the need to strengthen non-mental health community-based providers as "first contacts" and reassessment of health system-centric interventions which neglect preferred community responses and more holistic approaches accounting for women's full circumstances.

Personal academic tutors (PATs): A student perspective

INTRODUCTION

Personal academic tutors (PATs) have an important role in providing academic and non-academic support for university students. This study sought to assess the effectiveness of a PAT system developed for pharmacy students.

METHODS

A student-led survey was developed using a mix of single answer, Likert-style scale, and free text responses. The questionnaire was peer reviewed by students and other researchers and was piloted before being made available online to pharmacy students.

RESULTS

One hundred fifty-nine responses were received from students across all stages of the programme. In general, students expressed high levels of satisfaction with their PATs. Despite high levels of recognition of positive attributes of the PAT system, students had low levels of willingness to discuss personal issues with their PAT. Male students were more comfortable than female students in discussing personal issues. The level of comfort expressed by female participants was not significantly different with male or female PATs. Often students turn to friends and family who may provide advice that is unhelpful or outdated, particularly for issues such as poor mental health. Reasons for not speaking to PATs included concerns about being judged and academic records being affected. Worryingly, 18% of respondents (n = 28) had personal issues that had not been disclosed to anyone.

CONCLUSIONS

Satisfaction with more traditional academic tutoring was high but the reluctance to discuss wellbeing issues was concerning. Further work involving the student body is planned to co-create strategies to overcome reluctance to discuss personal issues.

Exploring Body Image Dissatisfaction and Psychiatric Co-morbidities in Rural India: A Comprehensive Review

This comprehensive review examines the intricate landscape of body image dissatisfaction (BID) in rural India, shedding light on the multifaceted factors influencing individual perceptions and societal expectations. Delving into cultural nuances, economic disparities, and gender-specific experiences, the study highlights the pervasive nature of BID across diverse age groups. Unveiling the complex interplay between BID and psychiatric co-morbidities, such as depression and anxiety, underscores the urgency of integrated mental health interventions. The review concludes with a resounding call to action for policymakers, healthcare professionals, and communities. It advocates for culturally sensitive mental health policies, targeted healthcare training, and community-driven initiatives to foster environments conducive to positive body image and mental well-being. By acknowledging these challenges and committing to collaborative solutions, this review aims to contribute to developing comprehensive strategies that address BID in rural India and pave the way for healthier and more resilient communities.

Knowledge, attitudes, and behaviours towards schizophrenia, bipolar disorder, and autism: a pilot study

OBJECTIVES

Lack of knowledge and discriminatory attitudes and behaviours towards individuals with mental disorders is a worldwide problem but may be particularly damaging for young people. This pilot study examined knowledge, attitudes and behaviours towards schizophrenia, bipolar disorder and autism within a large sample of adults in Ireland, a country with the youngest population in Europe, in order to better understand public views on these groups.

METHODS

In a correlational, cross-sectional design, 307 adults in Ireland over the age of 18 completed a questionnaire over Google Forms examining knowledge, attitudes and behaviours towards schizophrenia, bipolar disorder and autism. Responses to questions specifically relating to each diagnosis were compared using trimmed mean ANOVA to examine whether responses to questions differed depending on diagnosis.

RESULTS

Results indicate varied knowledge, attitudes and behaviours towards these groups, but a majority believe it should be a research priority. ANOVA and post hoc tests revealed significant differences in knowledge, attitudes and behaviours towards each of schizophrenia, bipolar disorder, and autism (p < 0.005), and reported attitudes and behaviours towards schizophrenia were more negative than either bipolar disorder or autism. A majority of participants (54.8%) felt not informed enough about mental health by the media.

CONCLUSIONS

In our Irish sample, type and level of stigma varies according to mental health diagnosis. Our sample also report feeling inadequately informed about mental health by the media. Thus future policy and campaigns could consider targeting individual mental health diagnoses, with a focus on increasing familiarity and knowledge.

Buffering against exposure to mental health misinformation in online communities on Facebook: the interplay of depression literacy and expert moderation

BACKGROUND

The proliferation of health misinformation on social media is a growing public health concern. Online communities for mental health (OCMHs) are also considered an outlet for exposure to misinformation. This study explored the impact of the self-reported volume of exposure to mental health misinformation in misinformation agreement and the moderating effects of depression literacy and type of OCMHs participation (expert vs. peer-led).

METHODS

Participants (n = 403) were recruited in Italian-speaking OCMHs on Facebook. We conducted regression analyses using PROCESS macro (moderated moderation, Model 3). Measures included: the Depression Literacy Questionnaire (Griffiths et al., 2004), the self-reported misinformation exposure in the OCMHs (3 items), and misinformation agreement with the exposure items (3 items). Whether participants were members of expert or peer-led OCMHs was also investigated.

RESULTS

The final model explained the 12% variance in the agreement. There was a positive and significant relationship between misinformation exposure and misinformation agreement (β = 0.3221, p < .001), a significant two-way interaction between misinformation exposure and depression literacy (β = - 0.2179, p = .0014 ), and between self-reported misinformation exposure and type of OCMH (β = - 0.2322, p = .0254), such that at higher levels of depression literacy and in case of participation to expert-led OCMHs, the relationship misinformation exposure-misinformation agreement was weaker. Finally, a three-way interaction was found (β = 0.2497, p = .0144) that showed that depression literacy moderated the positive relationship between misinformation exposure and misinformation agreement such that the more misinformation participants were exposed to, the more they agreed with it unless they had higher levels of depression literacy; this, however, occurred only if they participated in peer-led groups.

CONCLUSIONS

Results provide evidence that the more members reported being exposed to mental health misinformation, the more they tended to agree with it, however this was only visible when participants had lower depression literacy and were participating in peer-led OCMHs. Results of this study suggest that both internal factors (i.e., high depression literacy) and external factors (the type of online community individuals were participating in) can buffer the negative effects of misinformation exposure. It also suggests that increasing depression literacy and expert community moderation could curb the negative consequences of misinformation exposure related to mental health. Results will guide interventions to mitigate the effects of misinformation in OCMHs, including encouraging health professionals in their administration and implementing health education programs.

Perceived Wellbeing, Happiness, and Related Challenges among Indian College Students

The present study aimed to examine the conceptualisation and determinants of happiness among Indian college students and identify areas in which they require help. The sample consisted of 362 students in the age group of 18 to 30 years (M_age = 20.9, SD_age = 2.25) from two locations in North and South India. Online forms, including the Satisfaction with Life Scale (Diener et al., 1985), Positive and Negative Affect Schedule (Watson et al. in J Pers Soc Psychol 54:1063-1070, 1998) and a qualitative survey, were used to collect the data. Results indicated that participants from institutions that offered mental health initiatives reported higher well-being than those who did not. Findings from the qualitative survey suggest that most participants conceptualised happiness in terms of need for satisfaction and well-being. The responses also indicated that leisure activities and time spent with the family determined the participants' happiness. Concerns related to interpersonal relationships made the participants unhappy, and most of them were willing to seek help in this regard. Factors beyond immediate self and interpersonal networks had a limited role in participants' perceived happiness and unhappiness. Study findings could guide the development of customised mental health and well-being promotion initiatives to meet the needs of Indian college students.

Relationship between behavioral and mood responses to monetary rewards in a sample of Indian students with and without reported pain

Physical pain has become a major health problem with many university students affected by it worldwide each year. Several studies have examined the prevalence of pain-related impairments in reward processing in Western, Educated, Industrialized, Rich, and Democratic (WEIRD) countries but none of the studies have replicated these findings in a non-western cultural setting. Here, we aimed to investigate the prevalence of physical pain symptoms in a sample of university students in India and replicate our previous study conducted on university students in Switzerland, which showed reduced mood and behavioral responses to reward in students with significant pain symptoms. We grouped students into a sub-clinical (N = 40) and a control group (N = 48) to test the association between pain symptoms and reward processes. We used the Fribourg reward task and the pain sub-scale of the Symptom Checklist (SCL-27-plus) to assess physical symptoms of pain. We found that 45% of the students reported high levels of physical symptoms of pain and interestingly, our ANOVA results did not show any significant interaction between reward and the groups either for mood scores or for outcomes related to performance. These results might yield the first insights that pain-related impairment is not a universal phenomenon and can vary across cultures.

Investigation of the relationship between incidence of mental disorders and economic growth among the Visegrad countries

Prevention and care for mental disorders represent an important public health task in achieving global development goals. Proper access to adequate healthcare and social services is an important step related to care for mental disorders, which is presumably strongly related to economic growth. The main aim of the study was to investigate the relationship between the economic growth and the incidence of mental disorders in the V4 countries. An ecological correlation study was conducted regarding the four Visegrad countries. Indicators were derived from the World Health Organization (WHO) 'Health for All' (HFA) online database and Penn World Table version 10. The incidence of mental disorders increased in the V4 countries throughout the years between 2000-2018 except in Hungary, where a decreasing trend was observed. The prevalence of mental disorders increased in all countries as well, but it stagnated in Hungary. At the same time standardized death rate due to mental disorders increased in all Visegrad countries. According to the Hungarian data, while the prevalence of the disease did not change remarkably, the incidence decreased and the mortality increased as well as the prescription of drugs used in the treatment of mental disorders. This could indicate a serious hidden morbidity.

Finding the Rainbow in the Deluge: Community Mental Health Perspectives on Psychosocial Impacts of COVID-19 in India

The COVID-19 pandemic has caused significant disruptions in health care services, including mental health services. The impact of the pandemic has been especially severe in low- and middle-income countries, such as India. This Open Forum examines the challenges faced by primary care psychiatry in India and elaborates on how the pandemic has accentuated them. The "rainbow in the deluge" model is introduced as a simple model to train in usage of basic coping strategies for mental health issues that arise because of the pandemic and to provide a framework for finding meaning through the pandemic experience.

An exploratory study using the OMI scale to assess the opinion toward mental illness among young adults

Background: Public perception of mental illness is critical for successful treatment seeking behaviour as well as for early diagnosis and surveillance of disease. Two hundred eleven young patients were interviewed at Department of psychiatry, Sir Sunderlal Hospital, Varanasi with the help of consecutive sampling method. Objective: To assess the opinion towards mental illness among young adults by using the opinion on mental illness scale (OMI). Methods: Data was collected using the opinion about mental illness scale (OMI) which consists of 51 questions out of which, 15 questions directly related to the cause, care, and management of mental illness were randomly selected and analyzed. Analysis was done showing Percentage and chi-square tests to see the significance of scores between the respondents. Results: The finding shows that more than 70% of respondents believe that mental illness is a consequence of bad behavior, lack of willpower, or negative beliefs and gap in the treatment seeking behavior and understanding the cause of disease was found. Conclusions: Opinions on Mental health have received increasing attention as a useful strategy to promote early identification of mental illness, reduce stigma and enhance help-seeking behaviors. As part of the National Mental Health Programme, there is a need to raise awareness in order to enhance understanding of mental illness in facilitating early diagnosis and treatment of disease.

Adapting a School-Based Motivational Interviewing Mentoring Program for Use in India

We report on the process of planning, adapting, and implementing a brief, instrumental, school-based mentoring curriculum originally developed in the United States, in three cities in India. India has the world’s largest population of young adults aged 10-24 years, a developmental period associated with heightened psychosocial stressors and the onset of mental health issues, as well as a dire shortage of mental health professionals. Moving services that are typically provided by highly skilled professionals to individuals with fewer credentials or less formal training (e.g., from psychologists to mentors) can increase access to adolescent mental health services. Yet, transferring programs internationally is accompanied by unique barriers including cultural differences, and should be guided by an established framework. In this paper, we discuss the formation of a research-practice partnership designed to generate applied knowledge through emic cultural perspectives. We describe each stage of the program adaptation process within the Cultural Adaptation Framework ( Fendt-Newlin et al., 2020 ), including our decisions to strategically adjust, remove, or retain content from the original mentoring intervention. Although program delivery was prematurely discontinued due to the COVID-19 pandemic, we provide a brief synopsis of lessons learned through the international partnership.

Comprehending the potential of metallic, lipid, and polymer-based nanocarriers for treatment and management of depression

The World Health Organization (WHO) ranked depression as the third leading cause of global burden of disease in 2004, and it is predicted to overtake it and move to first place by 2030. It is a mental disorder that causes significant changes in the mood and day-to-day activity of an individual. Various approaches already exist for treating depression but, none of them are completely successful in treating depression. At present, discovering a new medication or delivery mechanism that can manage depression safely and efficiently is a huge challenge. Conventional formulations used in the management of depression have drawbacks like limited penetration, frequent dosing, toxicity, patient compliance concerns as well as brain barriers which are a big hurdle for antidepressant drugs to reach the brain through conventional formulations. Nano-based formulations are gaining popularity as one of the possibilities to overcome the limitations of conventional formulations by reducing the dose and dosing frequency, increasing the efficacy as well as proving it to be safe and effective means of treating depression. This review targets the neurochemistry and pathophysiological concerns of depression, strategies and problems of conventional therapies, and also recent advances in the metallic, lipid, and polymer-based nanoformulations for a variety of antidepressants. A detailed discussion of the expediency of various nanoformulations like liposomes, nanostructured lipid carriers, solid lipid nanoparticles, ethosomes, nanocapsules, dendrimer, gold and silver nanoparticles are addressed in the current review. In essence, nanoformulations hold great promises for the treatment of depression as they provide a platform with high penetration potential, targeted transmission, and improved protection and efficacy.

A Guided Internet-Based Problem-Solving Intervention Delivered Through Smartphones for Secondary School Pupils During the COVID-19 Pandemic in India: Protocol for a Pilot Randomized Controlled Trial

Background

“POD Adventures” is a gamified mental health intervention delivered via a smartphone app and supported by counsellors for a target population of secondary school students in India. This paper describes the protocol for a pilot randomized controlled trial of a remotely delivered version of the intervention in the context of COVID-19 restrictions.

Objective

Our objectives are to assess the feasibility of research procedures and intervention delivery and to generate preliminary estimates of the effectiveness of the intervention to inform the sample size calculation of a full-scale trial.

Methods

We will conduct a parallel, 2-arm, individually randomized pilot controlled trial in 11 secondary schools in Goa, India. This pilot trial aims to recruit 70 participants with a felt need for psychological support. Participants will receive either the POD Adventures intervention delivered over 4 weeks or usual care comprising information about local mental health services and national helplines. Outcomes will be assessed at two timepoints: baseline and 6 weeks post randomization.

Results

The first participant was enrolled on January 28, 2021, and 6-week assessment completed on April 4, 2021. Owing to a second wave of the COVID-19 pandemic in India, schools in Goa were closed on April 22, 2021. Trial participants are currently receiving the intervention or completing follow-up assessments.

Conclusions

This pilot trial will help understand the feasibility of implementing and evaluating a remotely delivered digital mental health intervention in a low-resource setting. Our findings will be used to design future trials that can address difficulties of accessing psychosocial support in-person and support wider efforts to scale up evidence-based mental health interventions for young people.

Trial Registration

ClinicalTrials.gov NCT04672486; https://clinicaltrials.gov/ct2/show/NCT04672486

International Registered Report Identifier (IRRID)

DERR1-10.2196/30339

Forecasting suicide rates in India: An empirical exposition

INTRODUCTION

Suicide is a major social and health issue in India. Yearly statistics show a concerning increasing pattern of suicidal deaths in India which is higher in comparison to the global trend. There is limited evidence regarding historical analysis of suicide or any forecasting for suicide in India towards predicting the possible risks of death due to suicide.

METHODS

This paper examines the trend of suicide rate and characteristics of suicide victims in India, based on the longitudinal time series data over the last 50 years-collected from the National Crime Record Bureau Reports (1969 to 2018) of the Government of India. In our analysis, we have used the time series model to forecast the suicide rates in India for the next decade. ARIMA (4,1,0) model is found to be the best fit model for forecasting the data.

FINDINGS

There has been an observable and rising trend of suicide rates in India over the last five decades. The forecast indicates a continuance of rising suicide cases for an upcoming couple of years in India with a limited decline in the following years. The prediction model indicates a future relatively consistent pattern of suicide in India which does not seem to be a very encouraging trend. As we have not included the period staring the year 2020 onwards affected by Covid-19 and which has several disruptions in personal and family spaces, the projected suicide trend during the period of next two to three years (2020-22) may rise far high and then it may show a declining path. Along with this, there is a shift in means of suicide in the last couple of decades. Constituting the second-highest number of cases, Illness associated suicide was visibly a serious concern.

CONCLUSION

The present analysis finds that there is no visible substantial relief for suicide deaths during the coming years in India. On the other hand, more extensive exploration of sample cases may provide important information for suicide prevention. Availability of detailed and more inclusive data will be highly useful for analysis and suicide preventive policies. Investment in public health care and other welfare activities like education and employment generation will yield visible positive results in suicide control.

Stigmatizing Attitudes Toward Depression Among Male and Female, Medical and Non-medical Major College Students

Background: Stigma is often reported to be a barrier to the treatment and rehabilitation of depression. However, little is known about stigma toward people with depression among college students in China.

Methods: Using a questionnaire with a case vignette describing depression, a total of 1,056 students from nine colleges/universities in Hunan Province of China were included in this study. The questionnaire addressed the attitudes toward depression and the desire for keeping a distance from depressed individuals. The current study explored the stigma attitudes of college students toward people with depression and the desire for social distancing, as well as the gender (male and female) and major (medical and non-medical) differences.

Results: Over half of the respondents agreed that people described in the vignette were “dangerous” (60.7%) and “could snap out of the problem” (58.7%). Compared with female students, males were more likely to agree that “If I had this problem, I would not tell anyone” (7.0 vs. 13.2%, p = 0.001); compared with non-medical students, medical students were more likely to agree that “The problem is a sign of personal weakness” (38.0 vs. 50.0%, p < 0.001). A lot of respondents would be unwilling to “marry into the family of people with depression” (71.1%) or “work closely with them” (45.1%). Compared with male students, females were more unwilling to “work closely with them” (40.3 vs. 47.5%, p = 0.026).

Conclusion: This study found that a high proportion of Chinese college students showed stigma toward and desire for social distancing from people with depression, male students and medical major students showed higher stigma in some subscale items toward people with depression. The present results suggest that more anti-stigma interventions should be applied for Chinese college students to help prevent or reduce stigma attitudes toward people with depression.

Impact of the COVID-19 pandemic on anxiety and depression symptoms of young people in the global south: evidence from a four-country cohort study

OBJECTIVE

To provide evidence on the effect of the COVID-19 pandemic on the mental health of young people who grew up in poverty in low/middle-income countries (LMICs).

DESIGN

A phone survey administered between August and October 2020 to participants of a population-based longitudinal cohort study established in 2002 comprising two cohorts born in 1994-1995 and 2001-2002 in Ethiopia, India (Andhra Pradesh and Telangana), Peru and Vietnam. We use logistic regressions to examine associations between mental health and pandemic-related stressors, structural factors (gender, age), and lifelong protective/risk factors (parent and peer relationship, wealth, long-term health problems, past emotional problems, subjective well-being) measured at younger ages.

SETTING

A geographically diverse, poverty-focused sample, also reaching those without mobile phones or internet access.

PARTICIPANTS

10 496 individuals were approached; 9730 participated. Overall, 8988 individuals were included in this study; 4610 (51%) men and 4378 (49%) women. Non-inclusion was due to non-location or missing data.

MAIN OUTCOME MEASURES

Symptoms consistent with at least mild anxiety or depression were measured by Generalized Anxiety Disorder-7 (≥5) or Patient Health Questionnaire-8 (≥5).

RESULTS

Rates of symptoms of at least mild anxiety (depression) were highest in Peru at 41% (32%) (95% CI 38.63% to 43.12%; (29.49-33.74)), and lowest in Vietnam at 9% (9%) (95% CI 8.16% to 10.58%; (8.33-10.77)), mirroring COVID-19 mortality rates. Women were most affected in all countries except Ethiopia. Pandemic-related stressors such as health risks/expenses, economic adversity, food insecurity, and educational or employment disruption were risk factors for anxiety and depression, though showed varying levels of importance across countries. Prior parent/peer relationships were protective factors, while long-term health or emotional problems were risk factors.

CONCLUSION

Pandemic-related health, economic and social stress present significant risks to the mental health of young people in LMICs where mental health support is limited, but urgently needed to prevent long-term consequences.