Martine Elbejjani, Sara Mansour, Rawan A. Hammoud, Catrina Ziade, Batoul Assi, Ahmad Assi, Samya El Sayed, Rita El Hachem, Hala Kerbage
Abstract
Research from around the world shows important differences in the impact of the COVID-19 pandemic and lockdowns on mental health. This study examined the extent of mental health challenges (depressive and anxiety symptoms and daily life difficulties) and their associations with pandemic- and response-related factors during the first lockdown in Lebanon, which happened amid a severe economic crisis and socio-political turmoil.
Introduction
Three years on and the coronavirus disease 2019 (COVID-19) pandemic continues to be a global health problem. In addition to its large toll on mortality and physical illness [1], the pandemic’s impact on mental health has been substantial [2]. The pandemic and related response measures, notably lockdowns, triggered significant disruptions in daily life and had far-reaching consequences, particularly on people’s well-being worldwide [3, 4]. Studies conducted early in the pandemic found a higher prevalence of depressive and anxiety symptoms compared to pre-pandemic trends, with varying estimates across populations [2], ranging from 14.7% to 42% for anxiety and 18.7% to 39% for depression [5–9]. This uneven impact on mental health is thought to be explained by the heterogeneity in the severity of the pandemic and stringency of response measures, in addition to differences in individual and contextual factors such as socio-economic conditions, existing social inequalities, and cultural attitudes.
Materials and method
The study consists of a cross-sectional internet-based survey conducted between May 2 and June 8, 2020, following the 3-month first nationwide lockdown in Lebanon, which was set on March 10, 2020, with lockdown measures gradually easing off in the first week of May 2020. Eligibility criteria were: i) being 18 years or older and ii) residing in Lebanon for the duration of this first government-mandated lockdown.
Results
The samples’ mean age was 36.1 ± 11.3 years; 69.4% were women, 44.1% were married/engaged, 91.8% had a university degree or higher educational attainment and 95.1% were employed (Table 1). At the time of our survey, 2.9% had lost their job and 42.5% reported a decrease or loss of income since the start of the lockdown. Among participants, 32.3% had elevated depressive (PHQ-9 score ≥ 10) and 27.3% had elevated anxiety (GAD-7 score ≥10) symptoms (Table 1).
Discussion
This study showed that the mental health burden was substantial during the first COVID-19 lockdown in Lebanon and that people faced high levels of emotional, financial, and daily life difficulties adapting to the lockdown circumstances, with difficulties being significantly exacerbated among those with depressive and anxiety symptoms. Mental health symptoms were associated with all key aspects of the pandemic and response measures. Having higher outbreak-related worries, lower knowledge about the pandemic, lower reliance, trust, and satisfaction with the information and response provided by governmental and health institutions were associated with higher depressive and anxiety symptoms. Results indicate that numerous sources of distress are at play during outbreaks and lockdowns and highlight key elements of the response measures that can simultaneously mitigate the pandemic and mental health burden, notably increasing the reach and trustworthiness of information dissminated and integrating emotional and financial support and protection of daily life functioning.
Conclusions
Our study shows that mental health burden among Lebanese adults during the first COVID-19 lockdown was among the highest reported worldwide, especially among university students and young adults. People with elevated depressive and anxiety symptoms had an important clustering of negative experiences, including individual emotional and functional challenges, more pandemic-related worries, poorer pandemic-related knowledge and means of information, and lower trust and satisfaction with the response measures implemented. Results also highlight a widespread toll of outbreak and lockdown measures and the need for prevention and intervention strategies that can alleviate both emotional and financial distress and improve access to health information and support. Results also strengthen the rationale for research and intervention efforts that can monitor and lessen the ramifications of this high mental health burden in the Lebanese population in these difficult times.
Acknowledgments
We would like to thank all participants for their time and contribution to this study.
Citation: Elbejjani M, Mansour S, Hammoud RA, Ziade C, Assi B, Assi A, et al. (2024) Mental health during the COVID-19 pandemic and first lockdown in Lebanon: Risk factors and daily life difficulties in a multiple-crises setting. PLoS ONE 19(2): e0297670. https://doi.org/10.1371/journal.pone.0297670
Editor: Guglielmo Campus, University of Bern: Universitat Bern, SWITZERLAND
Received: March 14, 2023; Accepted: January 11, 2024; Published: February 16, 2024
Copyright: © 2024 Elbejjani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files.
Funding: The work of C.Z. and R.E.H. was supported by the American University of Beirut Medical Practice Plan funding. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0297670#ack
