Lockdown, pandemic effects: Soweto study re-emphasises need for better access to mental healthcare

  • Mental health experts are finding increasing numbers of mental health issues in people during the pandemic.
  • In a local study, the psychological impact of the pandemic was found to be higher among people with childhood trauma.
  • The authors argue that mental health resources in resource-limited communities need to be urgently prioritised.

Mental health experts have warned that the Covid-19 pandemic and national lockdown are having a negative impact on people's mental health, and new research looking into the impact this has on people in Soweto, has found a significant link between symptoms of depression and how likely people feel they could be infected.

"South Africa's national lockdown introduced serious threats to public mental health in a society where one in three individuals develops a psychiatric disorder during their life," wrote Dr Andrew Wooyoung Kim (and colleagues) of Northwestern University, who co-directed the study for the Developmental Pathways for the Health Research Unit at the University of the Witwatersrand (Wits). 

The team also found that the perceived risk of infection and the likelihood of depression and anxiety were also higher among people who had suffered childhood trauma, as well as among those already suffering the effects of poverty and deprivation.

Their findings were published in the journal Psychological Medicine.

Childhood trauma, higher perceived risk of Covid-19 

Although previous studies looked at the link between depression and issues such as hunger, violence, poor healthcare, and high rates of poverty, the researchers wrote that theirs was the first to look at the mental health effects of the pandemic and national lockdown in South Africa under those conditions.

For their study, the researchers spoke to more than 200 adults who were already part of a long-term health study in Soweto, surveying 957 people in the months prior to the pandemic.

The earlier study aimed to measure their risk of mental ill-health, including depression, by asking them to score their mood, feelings, and behaviour. 

Participants were also asked about their day-to-day adversities, including family strife, poverty, deprivation, and violence; and about their ways of coping, such as support from friends, family, and church; and about adverse experiences in childhood like abuse, neglect, and household dysfunction.

For the follow-up survey carried out over the phone after the first six weeks of lockdown, participants were asked to do the following:

  • Score themselves against major symptoms of depression during the previous month;
  • Assess their knowledge of Covid-19 and how to protect against it; and
  • Indicate if they thought they were at less risk, the same risk or a greater risk than others.

According to the results, the higher participants' perceived risk from Covid-19, the greater their depressive symptoms.

Those with a history of childhood trauma were also found to be more likely to have a higher perceived risk of contracting the virus.

Overall, 14.5% of participants surveyed were found to be at risk of depression, with 20% indicating that the pandemic caused them deep worry, anxiety, or led to them to "thinking too much" about the virus and its impact.

Overall, the large majority did not think Covid-19 affected their mental health, but both the data and what people said about its impact on their lives suggested otherwise.

Critical need for prioritising mental health resources

"This discrepancy may be due to different ideas of mental health, including mental health stigma," the authors said. "While participants believed that the pandemic did not affect their mental health or their 'mind', the strong relationship between perceived risk and depressive symptoms raises the concern that they may not be aware of the potential threats to their mental health during Covid-19."

Other pre-existing adversities also increased these threats, added Kim and his colleagues. These included: hunger and violence, an overburdened healthcare system, a high prevalence of chronic and infectious disease, and alarming rates of poverty and unemployment.

A concerning argument they made, was that the pressures of the pandemic and lockdown risk, added to the already high levels of mental illness among people in the country, where one in three people experienced some kind of mental disorder in their lifetimes, and where only 27% of patients with a severe mental illness received treatment.

"Our study re-emphasises the importance of prioritising and provisioning accessible mental health resources for resource-limited communities in Soweto and across South Africa," Kim said.

Earlier study, similar results

In a separate study by Adeola Oyenubi (PhD), a senior lecturer at the School of Economics and Finance, Wits, and Uma Kollamparambil, head of the School of Economics & Finance at Wits, the prevalence of depressive symptoms was found to have doubled between 2017 and June 2020.

In this study, 12% of South Africans screened positive for possible depressive symptoms in 2017. However, when those same individuals were resurveyed in June and July 2020, it had increased to 24%.

The authors of this study also suggested that the negative impact of the pandemic was found to disproportionately affect vulnerable groups in terms of income and health.

"Policymakers need to pay attention to the impact of the pandemic on emotional wellbeing and mental health and make adequate provision for what may be an upsurge in acute mental health issues that could, if not addressed, become chronic and prolonged," Oyenubi and Kollamparambil said.

READ | OPINION: Equality in mental health hampered by lack of access, lack of investment

READ | Mental health effects of Covid-19 pandemic, lockdown - and concern over suicide risk 

READ | SA involved in massive global study on effects of Covid-19 pandemic - and you can play your part

Image: Getty/jayk7

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