Yang Youqi, Zimmermann Lauren, Pramanik Santanu, Wahl Brian, Mukherjee Bhramar
Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States of America.
Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America.
PLOS Glob Public Health. 2025 Aug 8;5(8):e0004704. doi: 10.1371/journal.pgph.0004704. eCollection 2025.
The COVID-19 pandemic has substantially impacted mental health worldwide, yet little attention has been given to its acute and long-term effects on mental health in low- and middle-income countries (LMICs). This study investigates how a triad of pandemic-related worries-financial stress, food insecurity, and COVID-19-related illness concerns-are associated with depression and anxiety across five South Asian LMICs: Bangladesh, India, Nepal, Pakistan, and Sri Lanka. Using data from the COVID-19 Trends and Impact Survey (CTIS), we analyzed responses from over 3.6 million participants collected between June 27, 2020 and June 25, 2022. We employed survey-weighted logistic regression models based on the complete cases (N = 1,062,786), adjusting for demographics and calendar time. Due to a substantial change in the survey design on May 20, 2021, our analysis was divided into two distinct periods: Period 1 (pre-change) and Period 2 (post-change). Our main findings reveal that all three types of pandemic-related worries were significantly associated with increased levels of depression and anxiety across the studied countries. In Period 1, a random-effects meta-analysis showed financial stress had the highest pooled adjusted odds ratio (OR) for depression at 2.41 (95% confidence interval, CI: [2.26, 2.58]), followed by COVID-19-related illness concerns at 1.58 (95% CI: [1.43, 1.75]), and food insecurity at 1.52 (95% CI: [1.40, 1.67]). In Period 2, the pooled adjusted OR for depression increased to 2.74 (95% CI: [2.38, 3.12]) for financial stress, while food insecurity showed a notable rise to 2.42 (95% CI: [2.23, 2.62]). Heterogeneity across countries was substantial ([Formula: see text] ranged from 60.33% to 86.68%), except for the association between food insecurity and depression in Period 2. Country-specific analyses further confirmed these results. Additionally, calendar time, vaccination status, gender, education, and rural-urban residential status modified these associations. These results underscore the need for targeted interventions to address socioeconomic stressors and improve mental health resilience in LMICs.
新冠疫情对全球心理健康产生了重大影响，但低收入和中等收入国家（LMICs）的心理健康受到的急性和长期影响却很少受到关注。本研究调查了与疫情相关的三重担忧——经济压力、粮食不安全以及对新冠相关疾病的担忧——如何与五个南亚低收入和中等收入国家（孟加拉国、印度、尼泊尔、巴基斯坦和斯里兰卡）的抑郁和焦虑相关联。我们使用了新冠疫情趋势与影响调查（CTIS）的数据，分析了2020年6月27日至2022年6月25日期间收集的360多万参与者的回复。我们基于完整案例（N = 1,062,786）采用了调查加权逻辑回归模型，并对人口统计学和日历时间进行了调整。由于2021年5月20日调查设计发生了重大变化，我们的分析分为两个不同时期：时期1（变化前）和时期2（变化后）。我们的主要研究结果表明，在所研究的国家中，所有三种与疫情相关的担忧都与抑郁和焦虑水平的增加显著相关。在时期1，随机效应荟萃分析显示，经济压力对抑郁的合并调整优势比（OR）最高，为2.41（95%置信区间，CI：[2.26, 2.58]），其次是对新冠相关疾病的担忧，为1.58（95% CI：[1.43, 1.75]），粮食不安全为1.52（95% CI：[1.40, 1.67]）。在时期2，经济压力对抑郁的合并调整OR增加到2.74（95% CI：[2.38, 3.12]），而粮食不安全显著上升至2.42（95% CI：[2.23, 2.62]）。除了时期2中粮食不安全与抑郁之间的关联外，各国之间的异质性很大（I²范围从60.33%到86.68%）。各国具体分析进一步证实了这些结果。此外，日历时间、疫苗接种状况、性别、教育程度和城乡居住状况改变了这些关联。这些结果强调了在低收入和中等收入国家开展有针对性干预措施以应对社会经济压力源并提高心理健康恢复力的必要性。
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