Intersections between COVID-19 and socio-economic mental health stressors in the lives of South African adolescent girls and young women

'Life became harder with COVID-19': exploring the experiences of the COVID-19 pandemic among youth living in eThekwini district, South Africa

BACKGROUND

In South Africa, pervasive age and gender inequities have been exacerbated by the COVID-19 pandemic and public health response. We aimed to explore experiences of the COVID-19 pandemic among youth in eThekwini district, South Africa.

METHODS

Between December 2021-May 2022 we explored experiences of the COVID-19 pandemic on youth aged 16-24 residing in eThekwini, South Africa. We collated responses to the open-ended question "Has the COVID-19 pandemic affected you in any other way you want to tell us about?" in an online survey focused on understanding the pandemic's multi-levelled health and social effects. We used a thematic analysis to summarise the responses.

RESULTS

Of 2,068 respondents, 256 (12.4%, median age = 22, 60.9% women) completed the open-ended survey question (11% in isiZulu). Results were organized into three main themes encompassing (1) COVID-19-related loss, fear, grief, and exacerbated mental and physical health concerns; (2) COVID-19-related intensified hardships, which contributed to financial, employment, food, education, and relationship insecurities for individuals and households; and (3) positive effects of the pandemic response, including the benefits of government policies and silver linings to government restrictions.

CONCLUSIONS

We found that South African youth experienced significant grief and multiple losses (e.g., death, income, job, and educational) during the COVID-19 pandemic. Trauma-aware interventions that provide economic and educational opportunities must be included in post-COVID recovery efforts.

Relationship impacts of the COVID-19 pandemic and lockdown restrictions on young women and men in Durban and Soweto, South Africa

To deepen our understanding of the impact of the COVID-19 pandemic on intimate and/or sexual relationships, we conducted a qualitative study among 26 South African women and men aged 21-30 years in Durban and Soweto between September 2020 and March 2021. Overall, 13 women and 12 men who had been in an intimate and/or sexual relationship since the start of the COVID-19 pandemic were asked about the impact of COVID-19 on their relationships with their current or most recent primary partners. Data were analysed using reflexive thematic analysis. The three most common impacts of the COVID-19 pandemic on relationships were on (i) communication and connection; (ii) strained relationships; and (iii) job and economic loss. Both women and men discussed how COVID-19-related lockdowns provided opportunities to foster better communication, connection and support to one another. However, too little or too much time together strained relationships. Finally, income loss among young men meant that some young women became the primary income earner, changing relationship power dynamics. Findings highlight the importance of young people's relationships and the need for action to support young people in building positive relationships in challenging times.

Economic vulnerabilities, mental health, and coping strategies among Tanzanian youth during COVID-19

BACKGROUND

The COVID-19 pandemic has exacerbated struggles for youth living in poor households. Youth in rural Tanzania are particularly vulnerable given widespread poverty, lack of formal sector employment opportunities, and health risks. We examine influences of the pandemic on economic insecurity and mental health and explore the coping strategies employed by youth and their households.

METHODS

We conducted mixed-method data collection with youth (N = 760 quantitative and N = 44 qualitative interviews) and households (n = 542) via mobile phone among a sub-set of a cohort from an on-going longitudinal sample in two rural regions in Tanzania. In addition to phone interviews, we collected data bi-weekly via SMS messaging. We present mixed-methods, descriptive analysis of the outcomes and longitudinally compare quantitative outcomes pre- and post-COVID-19, within the same individuals.

RESULTS

Adverse economic impacts were most salient, and to cope, youth engaged in more labor and domestic chores. Compared to prior the COVID-19 pandemic, youth reported spending more time caring for elderly or sick household members and gathering firewood or nuts.

CONCLUSIONS

These findings underscore the potential opportunity to promote policies and programs which address risks youth face. Recommended measures include expansion and adaptation of social protection policies, strengthened food and nutrition surveillance and referral systems, and scaling up community-based mental health programming.

Pregnancy and STI/HIV prevention intervention preferences of South African adolescent girls: findings from a cultural consensus modelling qualitative study

South African adolescent girls experience high rates of unintended pregnancy and sexually transmitted infections including HIV. To inform culturally-tailored dual protection interventions to prevent both unintended pregnancy and STIs/HIV, this study qualitatively examined girls' sexual health intervention preferences. Participants were aged 14-17 years old and Sesotho-speaking (N = 25). To elucidate shared cultural beliefs, individual interviews examined participants' perceptions about other adolescent girls' pregnancy and STI/HIV prevention intervention preferences. Interviews were conducted in Sesotho and translated into English. Two independent coders identified key themes in the data using a conventional content analysis approach with discrepancies resolved by a third coder. Participants indicated that intervention content should include efficacious pregnancy and STI/HIV prevention methods and ways to navigate peer pressure. Interventions should be accessible, avoid criticism and provide high-quality information. Preferred intervention formats included online, SMS/text, or delivery by social workers or older, knowledgeable peers, with mixed acceptability for delivery by parents or same-age peers. Schools, youth centres and sexual health clinics were preferred intervention settings. Results highlight the importance of cultural context in tailoring dual protection interventions to address the reproductive health disparities among adolescent girls in South Africa.

Network analysis of mental health problems among adults in Addis Ababa, Ethiopia: a community-based study during the COVID-19 pandemic

OBJECTIVE

COVID-19 has negatively impacted mental health of adults globally with increased rates of psychiatric comorbidities. However, network analysis studies to examine comorbidities and correlations between symptoms of different mental disorders are uncommon in low-income countries. This study aimed to investigate the network structure of depression, anxiety and perceived stress among adults in Addis Ababa and identify the most central and bridge symptoms within the depressive-anxiety-perceived symptoms network model.

DESIGN

Community-based cross-sectional study.

SETTING

This study was carried out on a sample of the general population in Addis Ababa during the first year of the COVID-19 pandemic. A total of 1127 participants were included in this study, of which 747 (66.3%) were females, and the mean age was 36 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

Symptoms of depression, anxiety and stress were measured using the Patient Health Questionnaire, Generalized Anxiety Disorder Scale and the Perceived Stress Scale, respectively.Network analysis was conducted to investigate the network structure. The centrality index expected influence (EI) and bridge EI (1-step) were applied to determine the central and bridge symptoms. Case-dropping procedure was used to examine the network stability.

RESULT

The sad mood (EI=1.52) was the most central and bridge symptom in the depression, anxiety and perceived stress network model. Irritability (bridge EI=1.12) and nervousness and stressed (bridge EI=1.33) also served as bridge symptoms. The strongest edge in the network was between nervousness and uncontrollable worry (weight=0.36) in the anxiety community. The network had good stability and accuracy. The network structure was invariant by gender and age based on the network structure invariance test.

CONCLUSIONS

In this study, the sad mood was the core and bridge symptom. This and the other central and bridge symptoms identified in the study should be targeted to prevent mental health disorders and comorbidities among adults.

Factors Associated with COVID-19 Vaccine Uptake among Schoolgoing Adolescent Girls and Young Women in South Africa

(1) Background: By October 2022, vaccination rates with at least one dose of a COVID-19 vaccine were low among adolescent girls aged 12-17 (38%) and young women aged 18-34 (45%) in South Africa. This study aimed to measure and identify barriers to and facilitators of motivation to take up, access to, and uptake of COVID-19 vaccines among schoolgoing adolescent girls and young women in two districts in South Africa. (2) Methods: Using the theory of the HIV prevention cascade, we conceptualised the relationship between motivation, access, and uptake of COVID-19 vaccines, and associated barriers. Potential barriers and facilitators were identified using bivariate and multivariable Poisson regression. (3) Results: Among all 2375 participants, access was high (69%), but motivation (49%) and vaccination with at least one COVID-19 vaccine (45%) were lower. Fear of injections was a barrier to vaccine uptake (aRR 0.85 95% CI 0.82-0.88), while being tested for COVID-19 (aRR 2.10 95% CI 1.85-2.38) and believing that the COVID-19 vaccine was safe (aRR 1.31 95% CI 1.18-1.44) and would prevent you from getting very sick (aRR 1.11 95% CI 1.04-1.19) were facilitators. (4) Conclusions: The controversy about the value of vaccinating adolescents and the delay in vaccine rollout for adolescents and young adults may have contributed to fears about the safety and efficacy of COVID-19 vaccines, as well as a lack of motivation to get vaccinated.

Young People and the Future: School Students' Concerns and Hopes for the Future after One Year of COVID-19 in Austria-Findings of a Mixed-Methods Pilot Study

The COVID-19 pandemic resulted in enormous changes in everyday life and numerous burdens for adolescents. This pilot study focused on how young people look to the future in the face of these burdens. Responses to two open-ended questions on concerns and hopes for the future that were part of a larger online survey on the mental health of school students in Austria were analyzed using qualitative content analysis. Subsequently, differences in the experiences of boys and girls, young people with and without a migration background and psychologically stressed and non-stressed young people were examined by applying a mixed-methods approach. Data collection took place from 3 February to 28 February 2021. From a total survey sample of 3052 adolescents aged 14-20, a representative sample according to gender and migration background (N = 500) was drawn. Qualitative content analysis revealed several areas of concern about the future, including school-related concerns, concerns about the further development of the pandemic and the associated restrictions, concerns related to a lack of locus of control, health-related concerns and concerns about social relationships. The analysis also indicated young people's greatest hopes for the future, such as hopes related to further pandemic development, hopes regarding major life goals, school, social relationships and health. Young people's experiences differ according to gender, migration background and the extent of psychological distress. This study contributes to research on the psychological well-being of adolescents during the pandemic and provides important insights into the subjective experience of young people. It aims to gain a more comprehensive understanding of the concerns and hopes for the future of young people in a time marked by various challenges. The results of the study should be used to develop ideas for measures, such as the expansion of school psychological services and low-threshold support services for students, such as school social work and counseling.

Food Insecurity and Transmission Risks Among People with HIV Who Use Substances

Food insecurity (FI) impacts people with HIV (PWH) and those who use substances (i.e. drugs and alcohol). We evaluated the longitudinal association between FI and HIV transmission risks (unprotected sexual contacts and shared needles/syringes). Among 351 PWH who use substances in Russia, 51.6% reported FI and 37.0% past month injection drug use. The mean number of unprotected sexual contacts in the past 90 days was 13.4 (SD 30.1); 9.7% reported sharing needles/syringes in the past month. We did not find a significant association between mild/moderate FI (adjusted IRR = 0.87, 95% CI 0.47, 1.61) or severe FI (aIRR = 0.84, 95% CI 0.46, 1.54; global p = 0.85) and unprotected sexual contacts. We observed a significant association between severe FI and sharing needles/syringes in the past month (adjusted OR = 3.27, 95% CI 1.45, 7.39; p = 0.004), but not between mild/moderate FI and sharing needles/syringes in the past month (aOR = 1.40,95% CI 0.58, 3.38; p = 0.45). These findings suggest that severe FI could be a potential target for interventions to lower HIV transmission.

School closures and well-being-related topic searches on Google during the COVID-19 pandemic in Sub-Saharan Africa

BACKGROUND

Following the outbreak of the 2020 coronavirus, governments adopted non-pharmaceutical interventions (NPIs) to save lives. The NPIs have been deemed to have unintended consequences on mental health and well-being. This study aimed to estimate the impact of the COVID-19 pandemic-induced school closures on the relative search volumes (RSVs) of well-being-relevant topics in 30 low and lower- middle income countries in Sub-Saharan Africa.

METHODS

Google Trends search data, difference-in-differences and event study methods were used to evaluate the impact on the related search volume (RSV) of well-being related topic queries in Sub-Saharan Africa.

RESULTS

The results suggest positive and significant increases in the search intensity for anger, boredom, fear, sleep, exercise, and prayer. Contrary to other studies, we find no discernible effects on the relative search volumes (RSVs) on loneliness, sadness, and suicide.

CONCLUSION

Our findings suggest that the pandemic and the associated restrictions had a mixed effect on well-being-related searches. We recommend increased vigilance and proactive communication from the government and policy makers with the general population in times of emergencies when social policies that restrict lives and liberties need to be adopted.

Integrating Adolescent Mental Health into HIV Prevention and Treatment Programs: Can Implementation Science Pave the Path Forward?

Adolescent mental health (AMH) is a critical driver of HIV outcomes, but is often overlooked in HIV research and programming. The implementation science Exploration, Preparation, Implementation, Sustainment (EPIS) framework informed development of a questionnaire that was sent to a global alliance of adolescent HIV researchers, providers, and implementors working in sub-Saharan Africa with the aim to (1) describe current AMH outcomes incorporated into HIV research within the alliance; (2) identify determinants (barriers/gaps) of integrating AMH into HIV research and care; and (3) describe current AMH screening and referral systems in adolescent HIV programs in sub-Saharan Africa. Respondents reported on fourteen named studies that included AMH outcomes in HIV research. Barriers to AMH integration in HIV research and care programs were explored with suggested implementation science strategies to achieve the goal of integrated and sustained mental health services within adolescent HIV programs.

Trends in health behaviors and mental health among Korean adolescents in Korea over 5 years, 2017-2021: focusing on the comparisons before and during the COVID-19 pandemic

Objectives

We investigated recent trends in health behaviors and mental health conditions among Korean adolescents from 2017 to 2021 and compared the changes before and during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

Data analysis was conducted on 289,415 adolescents participating in the Korea Youth Risk Behavior Web-Based Survey, an annual cross-sectional study from 2017 to 2021. All analysis was conducted using sex stratification, and the annual percentage change (APC) was calculated.

Results

Alcohol consumption and smoking decreased in the first year of the COVID-19 pandemic compared with before, except for girls from the low-income level. The prevalence of inadequate physical activity for both boys and girls increased in 2020 compared with the pre-COVID-19 period and decreased again by 2021. The prevalence of obesity in both sexes increased regardless of the period (boys, APC = 8.2%, 95% confidence intervals (CI), 6.4-10.1; girls, APC = 3.3%, 95% CI, 1.8-4.8). The prevalence of stress, depression, and suicidal ideation, plans, and attempts for both sexes decreased in 2020 compared to the pre-COVID-19 period. By 2021, this prevalence had returned to a level similar to before the pandemic. No significant APC changes were observed in the prevalence of mental health.

Conclusions

These findings demonstrate the trends and APCs in health behaviors and mental health conditions among Korean adolescents over the last 5 years. We must pay attention to the heterogeneous and multifaceted features of the COVID-19 pandemic.

COVID-19 on Pregnancy Outcomes, Mental Health and Placenta: Focus in Latin America

The COVID-19 pandemic has impacted many aspects of health and society worldwide. One vulnerable group that faced SARS-CoV-2 infection is pregnant women, who were considered to have potentiated risk factors. In physiological pregnancy, maternal systems have several changes and adaptations to support fetal development. These changes involve regulations of cardiovascular, respiratory, and immunologic systems, among others, which SARS-CoV-2 could severely alter. Furthermore, the systemic effects of viral infection could be associated with placental dysfunction and adverse pregnancy outcomes, which have been studied from the start of the pandemic to date. Additionally, pregnancy is a condition of more significant mental health vulnerability, especially when faced with highly stressful situations. In this chapter, we have collected information on the effect of COVID-19 on maternal mortality, the SARS-CoV-2 infection rate in pregnancy, and the impact on pregnancy outcomes, maternal mental health, and placental function, with a particular focus on studies that consider the Latin American population.

The sex-dependent response to psychosocial stress and ischaemic heart disease

Stress is an important risk factor for modern chronic diseases, with distinct influences in males and females. The sex specificity of the mammalian stress response contributes to the sex-dependent development and impacts of coronary artery disease (CAD). Compared to men, women appear to have greater susceptibility to chronic forms of psychosocial stress, extending beyond an increased incidence of mood disorders to include a 2- to 4-fold higher risk of stress-dependent myocardial infarction in women, and up to 10-fold higher risk of Takotsubo syndrome-a stress-dependent coronary-myocardial disorder most prevalent in post-menopausal women. Sex differences arise at all levels of the stress response: from initial perception of stress to behavioural, cognitive, and affective responses and longer-term disease outcomes. These fundamental differences involve interactions between chromosomal and gonadal determinants, (mal)adaptive epigenetic modulation across the lifespan (particularly in early life), and the extrinsic influences of socio-cultural, economic, and environmental factors. Pre-clinical investigations of biological mechanisms support distinct early life programming and a heightened corticolimbic-noradrenaline-neuroinflammatory reactivity in females vs. males, among implicated determinants of the chronic stress response. Unravelling the intrinsic molecular, cellular and systems biological basis of these differences, and their interactions with external lifestyle/socio-cultural determinants, can guide preventative and therapeutic strategies to better target coronary heart disease in a tailored sex-specific manner.

Using Arts-Based Methodologies to Understand Adolescent and Youth Manifestations, Representations, and Potential Causes of Depression and Anxiety in Low-Income Urban Settings in Peru

BACKGROUND

Arts-based methodologies can be beneficial to identify different representations of stigmatized topics such as mental health conditions. This study used a theater-based workshop to describe manifestations, representations, and potential causes of depression and anxiety as perceived by adolescents and young adults.

METHODS

The theater company Teatro La Plaza conducted three online sessions with a group of adolescents and another with a group of young adults from Lima, Peru. The artistic outputs, which included images, similes, monologues, and narrations, were used to describe the experiences of depression and anxiety symptoms following a content analysis using posteriori categories.

RESULTS

Seventeen participants joined the sessions. The artistic outputs showed: physical, behavioral, cognitive, and emotional manifestations of depression and anxiety; a perception that both disorders have a cyclical nature; and an awareness that it is often difficult to notice symptom triggers. The mandatory social isolation due to the COVID-19 pandemic was highlighted as an important symptom trigger, mostly linked to anxiety.

CONCLUSIONS

The findings are consistent with the literature, especially with regard to the manifestations, representations, and potential causes that trigger depression and anxiety. Using arts-based methods allowed adolescents and young adults to expand the articulation of their representations of mental disorders.

Are COVID-19's restrictive measures associated with people's quality of life and the prevalence of anxiety and depression in Kinshasa in the Democratic Republic of Congo?

BACKGROUND

The spread of COVID-19 and the economic repercussions of several restrictive measures have worsened the lives of the Congolese and caused panic, fear, and anxiety. No study has yet examined the effect COVID-19's restrictive measures had on the quality of life in the Congo.

AIMS

The purpose of this study is to determine if the restrictive measures of COVID-19 are associated with the quality of life and the prevalence of anxiety and depression in Kinshasa.

METHODS

A cross-sectional survey was conducted in seventeen Kinshasa municipalities. N=100 adults over the age of 18 were recruited (41 females, 58 males and 1 prefer not). Social Contacts Assessment (SCA), Time Use Survey (TUS), Manchester Short Assessment of quality of life (MANSA), Health status EQ-5D-3L, UCLA Loneliness Scale; Patient Health Questionnaire (PHQ-9); General Anxiety Disorder (GAD-7) and COVID-19 related questions were utilized. We conducted descriptive statistics and multiple regression analyses.

RESULTS

suggest that depression and anxiety are more prevalent (PHQ-9 and GAD-7 scores were 9.1 (SD=6.8) and 8.5 (SD=6.1) respectively). Negative associations were found between the quality of life and living alone (B=-0.35, p=0.05) and mental health decline due to COVID- 19 (B=-0.30, p=0.04). Those who described themselves as less lonely reported a higher quality of life (B=0.34, p=0.03).

CONCLUSIONS

Living alone is associated with a lower quality of life. This study fills a gap in the literature on public health in the DRC and low- and middle-income countries.

Child, adolescent, and caregiver mental health difficulties and associated risk factors early in the COVID-19 pandemic in South Africa

At the onset of the COVID-19 pandemic in early 2020 in South Africa, many safety measures were implemented to protect the lives of the population. Ironically, these same safety measures have negatively impacted on the lives of children and their caregivers resulting in increased mental health problems. This study forms part of the multicountry Co-SPACE (COVID-19: Supporting Parents, Adolescents and Children during Epidemics) study that explores how families are coping during the COVID-19 pandemic, and what caregivers can do to help support their children's mental health. This paper aims to gain a better understanding of the mental health status of families specifically in South Africa in the early onset of the pandemic during restrictive lockdown measures, and identify certain risk factors that might contribute towards deteriorating mental health. Two hundred and fifty-four South African parents and carers of children and adolescents completed an online survey about their child's mental health as well as their own mental health during and post- hard lockdown in South Africa. Data collection took place over the period of the first and second waves of the COVID-19 pandemic in South Africa. Results showed that children experienced significantly higher mental health problems than adolescents (p = 0.016). Younger children were particularly negatively affected by lockdown and had more mental health problems than adolescents (p = 0.023); including emotional problems (p = 0.017), misconduct (p = 0.030), and hyperactivity (p = 0.001). Additionally, the presence of special educational needs/neurodevelopmental disorders (SEN/ND) was associated with more mental health problems (p = 0.001). Surprisingly, single parent households, which is another well-known risk factor showed no differences in mental health problems compared to nuclear families. There was also a reciprocal relationship between parental/carer mental health and child/adolescent mental health, with higher level of endorsement of mental health problems in children by parents/caregivers who themselves associated with higher levels of depression, anxiety and stress (all p's < 0.001). These results highlight the dramatic impact that COVID-19 had on children, adolescents and parents in South Africa early in the pandemic, and emphasises the need for specific support structures to be implemented within the SEN/ND community, as well as for younger children and single parent households.

HIV and SRH healthcare delivery experiences of South African healthcare workers and adolescents and young people during COVID-19

While substantial research has emerged from the frontlines of the COVID-19 pandemic, as well as from studies with adolescent populations, there has been a dearth of research focused in South Africa on the context-specific experiences of healthcare workers (HCWs) and the adolescents and young people (AYP) to whom they provide services. This article documents the experiences of provision and receipt of HIV and sexual and reproductive health (SRH) services during the COVID-19 pandemic from the perspective of South African HCWs (n = 13) and AYP (n = 41, ages 17-29). Findings highlight several barriers to accessing comprehensive HIV and SRH services during the pandemic including lockdown-related mobility restrictions (reported by HCWs), prioritisation of COVID-19 above other healthcare needs, longer health facility waiting times, poor treatment by HCWs (reported by AYP), discomfort and perceived stigma from having to queue outside health facilities, and fear of contracting COVID-19 (reported by both groups). While HCWs reported that HIV and SRH services continued to be available during the pandemic, AYP described seeking these services - such as long-acting reversible contraception, check-ups for their babies and medical refills - and being told that because they were not considered emergency cases, they should return on a different date. By capturing diverse experiences and perspectives from both groups, our findings reiterate the growing call for health system investments to strengthen the delivery of adolescent services, including investing in appropriate channels of communication between young people and their healthcare providers (for example, through adolescent peer supporters or community healthcare workers) and differentiated models of service delivery (for example, multi-month ART refills and community pick-ups). Closing the gap between the experiences and needs of adolescents and the healthcare workers who serve them may support young people and HCWs in buffering against changes brought about by the COVID-19 pandemic.