Association between recent COVID-19 diagnosis on depression and anxiety symptoms among slum residents in Kampala, Uganda

Background An increase in mental health problems has been reported since the beginning of the COVID-19 pandemic. However, little is known about the prevalence of depressive and anxiety disorders, and how recent COVID-19 diagnosis may influence risk of these conditions especially in low-income settings. In this study, we assessed the association between recent COVID-19 diagnosis and depressive and anxiety symptoms among residents in an urban slum setting in Uganda. Methods A cross-sectional study was conducted among 284 individuals in a slum settlement in Kampala, Uganda between April and May 2022. We assessed generalized anxiety and depression symptoms using two validated questionnaires. We collected data on sociodemographic characteristics, and self-reported recent COVID-19 diagnosis (in the previous 30 days). Using a modified Poisson regression, adjusted for age, sex, gender and household income, we separately provided prevalence ratios and 95% confidence intervals for the associations between recent COVID-19 diagnosis and depressive and anxiety symptoms. Results Overall, 33.8% and 13.4% of the participants met the depression and generalized anxiety screening criteria respectively. People with recent COVID-19 diagnosis were more likely to be depressed (53.1%) than those with no recent diagnosis (31.4%). Participants who were recently diagnosed with COVID-19 reported higher prevalence of anxiety (34.4%) compared to those with no recent diagnosis of COVID-19 (10.7%). After adjusting for confounding, recent diagnosis with COVID-19 was associated with depression (PR= 1.60, 95% CI 1.09 - 2.34) and anxiety (PR = 2.83, 95% CI 1.50 - 5.31) . Conclusion This study suggests an increased risk of depressive symptoms and GAD in adults following a COVID-19 diagnosis. We recommend additional mental health support for recently diagnosed persons. The long-term of COVID-19 on mental health effects also need to be investigated.


Introduction
38 In 2020, the World Health Organization (WHO) declared COVID-19 a pandemic and has since 39 had detrimental effects on population health and well-being worldwide [1]. The uncertainties and 40 unpredictable nature of the pandemic resulted in individuals experiencing various forms of mental 41 health problems such as depression, anxiety, psychosocial dysfunction, dissociation disorders, 42 substance abuse, and insomnia. It was projected that these effects would be most severe in low-43 resourced settings due to constraints related to weak health systems with limited access to mental 44 health services [2].  is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint    is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted December 30, 2022. ; https://doi.org/10.1101/2022.12.28.22284012 doi: medRxiv preprint 7 117 medians and interquartile range. Participant characteristics by depression and anxiety status were 118 compared using the Wilcoxon rank sum test for non-normally distributed continuous variables 119 and the Chi-squared test for dichotomous variables. We also performed two separate multivariable 120 modified Poisson regressions adjusting for age, sex, gender and household income [22] and 121 producing prevalence ratios (PRs) and corresponding 95% confidence interval (95% CI) for the 122 association between recent COVID-19 infection and depression and anxiety. All statistical tests 123 were two-tailed, and statistical significance was assumed when a p-value was ≤ 0.05.

Background characteristics of participants
127 In total, 284 participants participated in the study including responding to the PHQ-9 and GAD-128 7 questionnaires. Characteristics of all participants are described for depressive and anxiety 129 disorders determined by PHQ-9 and GAD-7 cutoffs ≥10. Most participants were females 85.2% 130 and had a median age of 29 years (IQR = 24,37). The median depression score based on PHQ-9 131 was 8 (6,10) while for anxiety, the median score was 6 (4,8) based on the GAD-7. The prevalence 132 of depression was 33.8% and anxiety was 13.4%, which differed significantly depending on income 133 (p<0.001) and recent positive COVID-19 diagnosis status (p<0.001) ( Table 1).
. CC-BY 4.0 International license It is made available under a perpetuity.
is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint 154 USD> 150 (PR = 0.30, 95%CI (0.11 -0.87)) were associated with lower risk of anxiety symptoms 155 compared to those who earned less than USD 50. The likelihood of meeting anxiety screening 156 criteria was 2.23 times higher among particular who reported regularly drinking alcohol compared 157 to those with no/limited alcohol consumption (PR = 2.23, 95CI 1.12 -4.42) ( Table 3). is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

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The copyright holder for this this version posted December 30, 2022. ; https://doi.org/10.1101/2022.12.28.22284012 doi: medRxiv preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint   All relevant data are available from within the manuscript as well as a supplementally information 256 file.

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The authors have declared that no competing interests exist is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted December 30, 2022. ; https://doi.org/10.1101/2022.12.28.22284012 doi: medRxiv preprint