Higher perceived risk for COVID-19 infection linked to greater depressive symptoms

People from a socioeconomically disadvantaged area had a higher perceived COVID-19 infection risk linked to greater depressive symptoms during the first 6 weeks of quarantine, according to study results published in Psychological Medicine.

“The South African response to coronavirus was swift and assertive in testing, tracing and quarantining those infected with COVID-19,” Andrew Wooyoung Kim, a PhD candidate in the department of anthropology at Northwestern University, and colleagues wrote. “Despite the rapid and effective public health response at the onset of the pandemic, early evidence shows that the economic and social ramifications of the pandemic have disproportionately afflicted those already socioeconomically disadvantaged in a society defined by its racial and economic inequity. Furthermore, recent research shows that the harsh government sanctions to adhere to COVID-19 mitigation policies, including militarization, demolitions of informal settlements and widespread police brutality, have impacted already vulnerable communities who are unable to properly quarantine.”

According to the researchers, these measures highlight existing disproportionate inequalities in common mental disorders, which the dramatic and rapid societal changes related to the pandemic and countrywide lockdown may exacerbate.

In the current longitudinal study, Kim and colleagues sought to assess the mental health effects of the COVID-19 pandemic among 221 adults living in a major township near Johannesburg. They administered psychological assessments across two waves between August 2019 and March 2020, as well as between late March and early May 2020. Further, they conducted interviews regarding COVID-19 experiences for the second wave and examined relationships between depression and perceived COVID-19 risk using multiple regression models.

Results showed 14.5% of participants were at risk for depression. The researchers noted an association between higher perceived COVID-19 risk and greater depressive symptoms (P < 0.001). This association was present particularly among adults with histories of childhood trauma, although it was marginally significant. For every one unit perceived COVID-19 risk increase, participants were twice as likely to exhibit significant depressive symptoms. Kim and colleagues also observed potent experiences of anxiety, financial insecurity, fear of infection and rumination, according to qualitative data.

Threats to mental health among this population were amplified by pre-existing adversities, such as hunger and violence, an overburdened health care system, a high prevalence of chronic and infectious disease and significant rates of poverty and unemployment.

“Greater knowledge of COVID-19 prevention and transmission was associated with lower perceived risk [for] depression but higher depressive symptoms,” Kim and colleagues wrote. “While a large majority of participants reported that experiences of the COVID-19 pandemic did not affect their mental health (or ‘mind’), 10% to 20% of participants reported potent experiences of anxiety, fear and ‘thinking too much’ as a result of the pandemic. Our results highlight the compounding effects of past traumatic histories and recent stress exposures on exacerbating the severity of depressive symptoms among adults living in an urban South African context.”