Frequency and correlates of anxiety symptoms during the COVID-19 pandemic in low- and middle-income countries: A multinational study

Objective: Studies have documented the significant direct and indirect psychological, social, and economic consequences of the Coronavirus disease 2019 (COVID-19) in many countries but little is known on its impact in low- and middle-income countries (LMICs) already facing difficult living conditions and having vulnerable health systems that create anxiety among the affected populations. Using a multinational convenience sample from four LMICs (DR Congo, Haiti, Rwanda, and Togo), this study aims to explore the prevalence of anxiety symptoms and associated risk and protective factors during the COVID-19 pandemic. Methods: A total of 1267 individuals (40.8% of women) completed a questionnaire assessing exposure and stigmatization related to COVID-19, anxiety, and resilience. Analyses were performed to examine the prevalence and predictors of anxiety. Results: Findings showed a pooled prevalence of 24.3% (9.4%, 29.2%, 28.5%, and 16.5% respectively for Togo, Haiti, RDC, and Rwanda, x(2) = 32.6, p < .0001). For the pooled data, exposure to COVID-19 (beta = 0.06, p = .005), stigmatization related to COVID-19 (beta = 0.03, p < .001), and resilience (beta = -0.06, p < .001) contributed to the prediction of anxiety scores. Stigmatization related to COVID-19 was significantly associated to anxiety symptoms in all countries (beta = 0.02, p < .00; beta = 0.05, p = .013; beta = 0.03, p = .021; beta = 0.04, p < .001, respectively for the RDC, Rwanda, Haiti, and Togo). Conclusions: The findings highlight the need for health education programs in LMICs to decrease stigmatization and the related fears and anxieties, and increase observance of health instructions. Strength-based mental health programs based on cultural and contextual factors need to be developed to reinforce both individual and community resilience and to address the complexities of local eco-systems.