Lay Summary

We assessed the extent of mental health challenges and how factors related to the COVID-19 outbreak and lockdown were associated with mental health during the first COVID-19 lockdown in Lebanon, which occurred amid an ongoing severe economic crisis and sociopolitical turmoil. We found a high prevalence of depression and anxiety symptoms – despite the low infection rates at the time – and that all assessed factors related to the COVID-19 outbreak and lockdown (e.g., more worries about the outbreak and having more emotional, financial, food, and medical difficulties) were related to elevated depression and anxiety symptoms. Lower trust and satisfaction with the government and health agencies’ response were consistently related to higher depression and anxiety symptoms, highlighting the importance of responses to health emergencies, particularly in times of significant crises.

Background

Several investigations report important impact of the COVID-19 pandemic and related lockdowns on mental health, with notable population- and group-specific particularities. We investigated the extent and correlates of mental health challenges during the first country-wide lockdown in Lebanon, which happened amid an ongoing severe economic crisis and sociopolitical turmoil.

Methods

Using a cross-sectional internet-based survey, we assessed depression (Patient Health Questionnaire (PHQ-9)) and anxiety (Generalized Anxiety Disorder (GAD-7)) symptoms, and their associations with several outbreak- and lockdown-related psychosocial factors among adults (age≥18) residing in Lebanon in April-May 2020.

Results

Among the 510 participants with complete data on the measures of interest (mean age 36.1 (SD=11.3; 69.4% women), 32.3% had elevated depression and 27.3% had elevated anxiety symptoms, although infection rates were still low at the time (0.6% had contracted the virus in the sample and average national case count was ~0.1/100,000). Younger age, lower educational attainment, unemployment and recent loss of job due to the pandemic and the crisis were related to more mental health symptoms. Elevated depression and anxiety symptoms were associated with more worries regarding the outbreak (including worries about spreading the virus and contracting it, financial and health consequences of infection, and stigma). Elevated mental health symptoms were also related to higher reported levels of difficulties in all emotional and functional aspects related to the lockdown and pandemic (including fear from circumstances, financial and food insecurity, and medical worries). Social media outlets (p=0.04) and having an outdoor space (p=0.024) provided positive support for participants with elevated depression and anxiety symptoms during the lockdown. Participants with higher depressive symptoms reported having more conflicting information regarding the pandemic; both higher anxiety and depression symptoms were associated with significantly lower rates of trust in and satisfaction with the pandemic management by the Lebanese government and health institutions.

Conclusion

Results show a considerable impact on Lebanese residents' mental health during the first lockdown, even when the magnitude of the outbreak was still small. Results also highlight additional financial and emotional burdens and the importance of trust in the institutions handling the pandemic for the well-being of the population facing multiple challenges.