**Question 3: what are the prevalence of the mental health consequences of COVID-19 containment measures, socio-demographic forces, and other health conditions for vulnerable groups?**

The mental health impact of disasters usually outlasts their physical impact, thus indicating that the elevated mental health impacts of COVID-19 will continue well beyond the outbreak of the pandemic. The vicarious trauma of the pandemic on clinicians and other health care providers during outbreaks may last up to three years after an outbreak. According to Carfì, Bernabei, and Landi [20], reports from viral outbreaks in earlier centuries, including the deadly "Spanish Flu" pandemic of 1918–1920, describe an increased incidence of neuropsychiatric symptoms such as insomnia, anxiety, depression, mania, psychosis, and suicidality. They also claimed that the full impact of COVID-19 on mental health may be known for several years, but it is likely to be significant—and potentially chronic in some patients globally.

However, Panchal et al. [21] noted that about four in 10 adults had symptoms of anxiety or depressive disorder prior to the onset of the pandemic between January

to June 2019 in the U.S. The Mental Health America (MHA) [22] reported surging rates of depression, anxiety, and other mental health problems because of COVID-19 among the people accessing their online mental health screening services. MHA observed a slight increase in the demand for mental health care between January and April 2020, a sharp spike around May and June of the same year. The MHA report also noted that screenings for anxiety (406%) and depression (457%) in June 2020 were greater than those in January. There was also a spike in the percentage of people diagnosed as "at-risk" for psychosis during the onset of the lockdown and self-isolation in May 2020. This continued to rise in June to more than four times the number in January. A six-fold increase was noted for those considering suicide or self-harm. The MHA [22] observation was confirmed by A KFF Health Tracking Poll in the US around July 2020 to 2021 on the mental health impacts of COVID-19 among adults that showed difficulty sleeping (36%), eating (32%), increases in alcohol consumption or substance use (12%), and worsening chronic conditions (12%), due to worry and stress over the coronavirus.

These have been worsened by the enforcement of the containment measures, including restriction of movements and self-isolation procedures, which led to increasingly negative and poor mental health outcomes. For many, this has been compounded by job loss and loss of income. In the US, more than half of young adults (ages 18–24) captured by the KFF study reported symptoms of anxiety and/or depressive disorder (56%). While the majority of these had suicidal thoughts (26% vs. 11%) during the pandemic, there were further concerns around poor mental health and well-being for children and their parents, particularly mothers, as many experienced challenges with school closures and lack of childcare. Panchal, Kamal, Orgera, Cox, Garfield, Hamel, and Chidambaram [21] claimed that women with children are more likely to report symptoms of anxiety and/or depressive disorder than men with children (49% vs. 40%).

Panchal et al. [21] further reported that Non-Hispanic Black adults (48%) and Hispanic or Latino adults (46%) are more likely to report symptoms of anxiety and/ or depressive disorder than Non-Hispanic White adults (41%) resulting from the pandemic in the US. They also reported that some of the mental health-related challenges experienced by many essential workers include a greater risk of contracting the coronavirus, symptoms of anxiety or depressive disorder (42% vs. 30%), starting or increasing substance use (25% vs. 11%), and suicidal thoughts (22% vs. 8%) than other workers during the pandemic compared to nonessential workers.

MHA [22] posited that the social consequences of the pandemic, rather than the threats of sickness or death, are the major causes of stress among persons using the screening tools. Factors identified as the major cause of depression and anxiety (73%), past trauma (46%), or relationship problems (44%) were loneliness and isolation among girls/women between 11 to 25 years of age.

In the UK, a British Medical Association survey conducted during the pandemic showed that 45% of UK doctors suffered depression, anxiety, stress, burnout, or other mental health conditions relating to, or made worse by, the COVID-19 crisis [23].

In India, the socio-economic and mental health of marginalized communities were disproportionately impacted by the pandemic [24]. Balaji and Patel [25] observed mental health difficulties among women, children, young people, sexual minorities, and people with pre-existing mental health conditions and substance use disorders. In spite of this information, Duggal et al. [26] claimed that there exists a lack of empirical data on the mental health impact of the pandemic on marginalized communities and their needs in India. In a meta-analysis of 31 studies conducted in China,

#### *A Scoping Analysis of the Psychosocial and Health Implications of COVID-19… DOI: http://dx.doi.org/10.5772/intechopen.104546*

Deng et al. [27] reported that the prevalence of depression among persons diagnosed with COVID-19 was 45%, anxiety was 47%, and sleep disturbances were 34%. Also, the Chinese, Singaporean and Australian governments have identified the psychological side effects of COVID-19 and the long-term impacts of isolation which could cause more harm than the pandemic itself [28–30].

Zeroing in on the African States, the experience of the disease, breakdown of social support, loss of loved ones, and stigmatization could trigger short-term mental health problems among affected persons and their families, while factors such as economic losses (job and income losses) can potentially trigger long-term mental health problems. Some of the COVID-19-related fears, worries, and anxieties may be borne out of lack of knowledge, rumors, and misinformation, while its associated mental health care has become one of the most neglected areas of health. Frissa and Dessalegn [31] predicted that the impact on mental health will be immense in sub-Saharan Africa due to their weak health care systems. They also hinted that patients with COVID-19 and other illnesses along with significant persons around them consistently experienced post-traumatic stress disorders, anxiety, depression, and insomnia. They further reported that the uptake of mental health care services is generally low in the region while individuals in some communities rely solely on social resources. This was further compounded by poor digital literacy, low smartphone penetration, limited internet connection, and weak expertise in online mental health service delivery even among clinicians and psychotherapists. While the majority of those who need mental health care do not have access to services, receive little or no treatment at all.

The COVID-19-related mental health treatment gap is thus higher in African nations. Consequently, the need to protect individual socio-cultural coping and resilience mechanisms is very critical in the continent, most especially the sub-Saharan African region.

The MTL status of some of the African states shows that:


Although numerous factors contribute to elevated stress among people, such as heavy workloads, lack of physical or psychological safety, moral conflicts, and workplace-related bullying or lack of social support [2]. These were exacerbated during the pandemic with a wide range of emotions, including uncomfortable feelings such as shame, sadness, anger, frustration, or any other emotional painful feelings. These were worsened during the pandemic (around 2019, 2020, and 2021) and also worsened the existing insecurity, herdsmen attacks, and Boko-Haram violent insurgencies across the nation. High incidence of job loss, domestic violence, rape, battering, sexual assaults, and brutal killings of innocent girls during the lockdown further stressed the mental health stability of individual Nigerians beyond the limit.

Consequently, the pandemic has heightened individual vulnerability to financial insecurity, unemployment, and fear, which have been identified as risk factors for poor mental health among Nigerians [2]. The pandemic amplified existing vulnerabilities, inequalities, societal divides, fragility, instability, and threats to social cohesion and peace processes [38]. Currently, a lot of Nigerians are facing psychological distress that can lead to burnout, depression, anxiety disorders, sleep disorders, and other illnesses due to the absence of protective factors, such as employment, educational engagement, physical exercise, and access to health services during the lockdown [38].

In spite of the fact that mental health challenges are huge across the nation, Nigeria has no clearly defined mental health-related allocated budget. The allocation for health in the entire 2016 National Budget was only 3.65% out of which about 3.3% was barely earmarked for mental health and more than 90% of this amount went to institution-based services provided through eight stand-alone mental hospitals [39].

Another major challenge is the lack of a social welfare package for addressing the mental health needs of the socially marginalized and neglected groups in Nigeria, most especially women, children, the elderly, the homeless, and the very poor. These groups of people are vulnerable to different risk factors associated with mental disorders and also exhibit poor health help-seeking behavior [39]. More than 70% of these categories of patients with mental health problems/disorders in Nigeria seek unorthodox interventions before orthodox care [39].


*A Scoping Analysis of the Psychosocial and Health Implications of COVID-19… DOI: http://dx.doi.org/10.5772/intechopen.104546*

Lukwata [46] reported increased psychological distress and onset of common mental disorders (CMD), such as major depressive disorders (MDD), generalized anxiety disorders (GAD), post-traumatic stress disorders (PTSD) and substance misuse disorders (SUD), among Ugandaians living with HIV, older adults (aged 60+) and health workers during the COVID-19 pandemics. Lemuel (2021) specifically observed a high incidence of anxiety among respondents with a primary and secondary level of education compared with those with no formal education and a tertiary level of education after the onset of the pandemic.
