Evaluating the mental health impacts of the COVID-19 pandemic: perceived risk of COVID-19 infection and childhood trauma predict adult depressive symptoms in urban South Africa

Background 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. We aimed to evaluate the mental health impacts of the COVID-19 pandemic using a mixed-methods design. Methods This longitudinal study drew from a preexisting sample of 957 adults living in Soweto, a major township near Johannesburg. Psychological assessments were administered across two waves between August 2019 and March 2020 and during the first 6 weeks of the lockdown (late March-early May 2020). Interviews on COVID-19 experiences were administered in the second wave. Multiple regression models examined relationships between perceived COVID-19 risk and depression. Results Full data on perceived COVID-19 risk, depression, and covariates were available in 221 adults. In total, 14.5% of adults were at risk for depression. Higher perceived COVID-19 risk predicted greater depressive symptoms (p < 0.001), particularly among adults with histories of childhood trauma, though this effect was marginally significant (p = 0.063). Adults were about two times more likely to experience significant depressive symptoms for every one unit increase in perceived COVID-19 risk (p = 0.021; 95% CI 1.10-3.39). Qualitative data identified potent experiences of anxiety, financial insecurity, fear of infection, and rumination. Conclusions Higher perceived risk of COVID-19 infection is associated with greater depressive symptoms during the first 6 weeks of quarantine. High rates of severe mental illness and low availability of mental healthcare amidst COVID-19 emphasize the need for immediate and accessible psychological resources.

Automated summary

The national lockdown in South Africa has posed serious threats to the public mental health, with higher perceived risk of COVID-19 infection being associated with greater depressive symptoms. During the pandemic, individuals experienced anxiety, financial insecurity, fear of infection, and rumination. Immediate and accessible psychological resources are needed to address the high rates of severe mental illness and low availability of mental healthcare.