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COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health
Open accessAbstract
Most of the global population live in low-income and middle-income countries (LMICs), which have historically received a small fraction of global resources for mental health. The COVID-19 pandemic has spread rapidly in many of these countries. This Review examines the mental health implications of the COVID-19 pandemic in LMICs in four parts. First, we review the emerging literature on the impact of the pandemic on mental health, which shows high rates of psychological distress and early warning signs of an increase in mental health disorders. Second, we assess the responses in different countries, noting the swift and diverse responses to address mental health in some countries, particularly through the development of national COVID-19 response plans for mental health services, implementation of WHO guidance, and deployment of digital platforms, signifying a welcome recognition of the salience of mental health. Third, we consider the opportunity that the pandemic presents to reimagine global mental health, especially through shifting the balance of power from high-income countries to LMICs and from narrow biomedical approaches to community-oriented psychosocial perspectives, in setting priorities for interventions and research. Finally, we present a vision for the concept of building back better the mental health systems in LMICs with a focus on key strategies; notably, fully integrating mental health in plans for universal health coverage, enhancing access to psychosocial interventions through task sharing, leveraging digital technologies for various mental health tasks, eliminating coercion in mental health care, and addressing the needs of neglected populations, such as children and people with substance use disorders. Our recommendations are relevant for the mental health of populations and functioning of health systems in not only LMICs but also high-income countries impacted by the COVID-19 pandemic, with wide disparities in quality of and access to mental health care.
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“and the pressure of the pandemic on health-care systems in the future.”
From Strengthening public mental health during and after the acute phase of the COVID-19 pandemic (2022) · cites this paper as [5]
Experimental — accuracy not yet measuredIn the citing paper
“It has been the focus of recent calls for a paradigm change in the field of global mental health (106–108), particularly in the context of the COVID-19 pandemic (109).”
From Recovery from Severe Mental Health Problems: A Systematic Review of Service User and Informal Caregiver Perspectives (2021) · cites this paper as [109]
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“Digital technologies and Artificial Intelligence (AI) have been proposed as potential solutions to these challenges [Rudd and Beidas, 2020, Taylor et al., 2020, Kola et al., 2021].”
From Closing the accessibility gap to mental health treatment with a personalized self-referral chatbot (2024) · cites this paper as Kola et al., 2021
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“Furthermore, the COVID-19 pandemic could have affected the care of patients with mental illness among LMICs either by creating a barrier to reach health facilities for fear of COVID19 infection or due to redirecting mental health care facilities for COVID-19 care leading to greater severity of anxiety [37,38].”
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“344 he coronavirus disease 2019 (COVID-19) pandemic has caused enormous psychosocial strain for families and individuals and highlighted the weaknesses of mental health systems worldwide.(1) In the first years of the pandemic, nearly every country imposed lockdowns, to varying degrees, to contain the virus.”
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“Safety measures like social distancing, business, and school closures have resulted in challenges for children across multiple well- being domains, including health, education, care, and protection (Katz et al., 2021; Kola et al., 2021; UNICEF, 2020; Wong et al., 2020).”
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COVID-19 Infection among Family and Friends: The Psychological Impact on Non-Infected Persons
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“The COVID-19 pandemic increased the number of anxiety and depression disorders by 25% during its first year, and the latest data from the World Health Organization estimate that 71% of people with depression do not receive mental health services [2,3].”
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ACE2 and Innate Immunity in the Regulation of SARS-CoV-2-Induced Acute Lung Injury: A Review
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“Poor mental health is an increasing global challenge [1,2], with the prevalence of depression and anxiety reaching a peak during the COVID-19 pandemic [3-5].”
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“This should include mental health support services, considering that the prevalence of mental health conditions has increased as a result of the pandemic, social isolation and loneliness [32].”
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“In addition, qualitative work is needed to understand how people living with mental illness and their primary care-takers coped without access to mental health care – whether they self-managed or sought support from social networks, traditional healers, or religious communities (Kola et al. 2021).”
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“These principles are increasingly employed in GMH such that the field is moving toward a focus on partner building and involvement of people with lived experience (Bemme & Kirmayer, 2020; Kola et al., 2021).”
BackgroundTrends and projection in the proportion of (heavy) cannabis use in Germany from 1995 to 2021
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“LIEM populations are disproportionately affected by stressors such as the COVID-19 pandemic and they also have even more challenges accessing care to address these heightened needs (Cubrich et al., 2022 ; Kola et al., 2021).”
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ResultData-driven assessment framework of health cities for elderly individuals in China
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“The COVID-19 pandemic caused unprecedented disruption, and the response of governments and local authorities was far from coordinated in following the best practices based on current evidence [1].”
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“Internationally, specific MHPSS guidance on behalf of general populations affected by the COVID-19 pandemic was formulated based on, among others, the IASC guidelines [64,65].”
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“Third, the freedom of girls may be further curtailed in line with patriarchal norms as the pandemic pulls them out of work and educational institutions (Kola et al., 2021; Plan International, 2020; UNFPA, 2020).”
Mental Health Mobile Apps in the French App Store: Assessment Study of Functionality and Quality
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“New technologies have the potential to overcome these challenges by providing large-scale health literacy programs, low-threshold approaches [18], or education for the population and health care workers [19].”
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“Since the inception of the field, the locus of knowledge and power in global mental health has been under scrutiny guided by the question “Whose knowledge counts?” in the production of evidence [1–4].”
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Soares, C. G. D. S., Honorato, E., & Lemos, S. (2021) · International Journal for Innovation Education and Research · doi:10.31686/ijier.vol9.iss8.3269 · Cited by 6
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“However, a large number of studies on pandemic-related psychopathology have since been published, mostly focusing on populations from specific cities or countries [43-45].”
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“Studies from low and middleincome countries (LMICs) indicated that containment measures have tremendously affected the mental health of migrant workers [11, 12].”
BackgroundOyenubi, A., Kim, A. W., & Kollamparambil, U. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.04.072 · Cited by 20
“Based on the same data we use for this analysis, Kollamparambil & Oyenubi (2021) showed that subjective risk perception of COVID-19 infection increased by 17% between April and June 2020.”
Tran, D. N., Ching, J., Kafu, C., Wachira, J., Koros, H., Venkataramani, M., Said, J. A., Pastakia, S. D., Galárraga, O., & Genberg, B. L. (2023) · Journal of the International Association of Providers of AIDS Care (JIAPAC) · doi:10.1177/23259582231152041 · Cited by 19
“In difficult work conditions and environments where resources are extremely limited, these challenges become magnified.(33) Our current study adds to the limited literature detailing the mental health impacts of COVID-19 on healthcare providers in Kenya, which is built upon an already constrained clinical work environ…”
BackgroundFoo, C. Y. S., Tay, A. K., Yang, Y., & Verdeli, H. (2023) · Conflict and Health · doi:10.1186/s13031-023-00512-1 · Cited by 19
Patient Engagement in a Multimodal Digital Phenotyping Study of Opioid Use Disorder
Campbell, C. I., Chen, C.-H., Adams, S. R., Asyyed, A. H., Athale, N., Does, M. B., Hassanpour, S., Hichborn, E. G., Jackson-Morris, M., Jacobson, N. C., et al. (2023) · Journal of Medical Internet Research · doi:10.2196/45556 · Cited by 19
Mitigating the Impacts of COVID-19 on Global Child Health: a Call to Action
Garcia‐Prats, A. J., McAdams, R. M., Matshaba, M., Thahane, L., Butteris, S. M., Conway, J. H., Slutsker, M., Clair, N. E. S., & Haq, H. A. (2021) · Current Tropical Medicine Reports · doi:10.1007/s40475-021-00241-6 · Cited by 19
COVID-19 and Poverty in South America: the Mental Health Implications
Bassey, E. E., Gupta, A., Kapoor, A., & Bansal, A. (2022) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-022-00765-6 · Cited by 19
Immersive technologies for depression care: scoping review
Reategui-Rivera, C. M., Villarreal-Zegarra, D., De La Cruz-Torralva, K., Díaz-Sánchez, P., & Finkelstein, J. (2024) · JMIR Mental Health · doi:10.2196/56056 · Cited by 19
Evangelista, E. G., Bélisle‐Pipon, J., Naunheim, M. R., Powell, M., Gallois, H., & Bensoussan, Y. E. (2024) · Otolaryngology · doi:10.1002/ohn.830 · Cited by 18
Progressing towards the 2030 health-related SDGs in ASEAN: A systematic analysis
Si, Y., Guo, L., Chen, S., Zhang, X., Dai, X., Wang, D., Liu, Y., Tran, B. X., Pronyk, P., & Tang, S. (2025) · PLoS Medicine · doi:10.1371/journal.pmed.1004551 · Cited by 18
“Finally, the COVID pandemic has substantially contributed towards excess deaths [33–36], declines in life expectancy [37], and rising mental health problems [38].”
Patel, N. M., Savaliya, G. V., Mehta, P. J., & Kataria, L. (2025) · Indian Journal of Psychological Medicine · doi:10.1177/02537176251379999 · Cited by 24
Chu, H., Park, W., Hu, Y., Huang, Z., Shi, R., Li, J., Li, Z.-Y., Wu, M., Gao, Y., Zhao, G., et al. (2025) · ACS Nano · doi:10.1021/acsnano.5c12395 · Cited by 19
Stewart, L., McConnell, B. B., Darboe, B., Glover, V. A. S., Huma, H. B., Sanfilippo, K. R. M., Cross, I. R. M., Ceesay, H., Ramchandani, P. G., & Cornelius, V. R. (2021) · Health Promotion International · doi:10.1093/heapro/daab210 · Cited by 18
“In general, the approach of measuring the health impact of initiatives or interventions that emerge from existing traditional cultural practices aligns well with broader recommendations [e.g. (Kola et al. , 2021)] to move to a strengths-based assessment of a community’s resources.”
eHealth Services and SDG3: Increasing the Capacity of Care
Wyllie, J., Carlson, J., Heinsch, M., Kay-Lambkin, F. J., & McCoy, A. (2022) · Australasian Marketing Journal (AMJ) · doi:10.1177/18393349211069114 · Cited by 20
“The mental health ramifications of COVID-19 continue to emerge, with elevated rates of depressive and anxious symptoms and AOD usage when compared with the pre-COVID era (Kola et al., 2021).”
ResultXie, X., Liu, Q., Zhu, K., Jiang, Q., Feng, Y., Xiao, P., Wu, X., & Song, R. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.809107 · Cited by 20
Williams, L. D., Lee, E., Latkin, C. A., Mackesy‐Amiti, M. E., Kaufmann, M., Copulsky, E., Kaplan, C., & Boodram, B. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19095351 · Cited by 18
Aznar, M. P. M., del Pino, M. J., Pérez, J. M. B., & Hernández-Lorenzo, D. E. (2022) · Applied Research in Quality of Life · doi:10.1007/s11482-022-10140-1 · Cited by 18
“Studies from several countries around the world during the first months of the COVID-19 pandemic have reported high rates of psychological distress (Kola et al., 2021; Petzold et al., 2020; Qiu et al., 2020; Xiong et al., 2020), although results indicated substantial heterogeneity among studies, even in studies that u…”
BackgroundStress, anxiety, depression and long COVID symptoms
Bautista, E., Cortés-Álvarez, N. Y., Vuelvas-Olmos, C. R., Reyes‐Meza, V., González-López, T., Ángeles, C. F. D. L., Pérez‐Silva, N. B., Aguirre‐Alarcón, H., Cortez-Sánchez, J. L., Rocha–Rocha, V. M., et al. (2022) · Fatigue Biomedicine Health & Behavior · doi:10.1080/21641846.2022.2154500 · Cited by 20
Hossain, M. R., Parray, A. A., Sultana, R., Aktar, B., & Rashid, S. F. (2023) · PLOS Global Public Health · doi:10.1371/journal.pgph.0000382 · Cited by 18
Li, J., Fong, D., Lok, K. Y. W., Wong, J. Y. H., Ho, M. M., Choi, E. P. H., Pandian, V., Davidson, P. M., Duan, W., Tarrant, M., et al. (2023) · Journal of Global Health · doi:10.7189/jogh.13.06031 · Cited by 17
He, J., Lin, J., Sun, W. J., Cheung, T. C. C., Cao, Y., Fu, E., Chan, S. H., & Tsang, H. W. H. (2023) · Scientific Reports · doi:10.1038/s41598-023-45839-0 · Cited by 21
Aborode, A. T., Corriero, A. C., Mehmood, Q., Nawaz, A., Aayush, Upadhyay, P., Badri, R., & Hasan, M. M. (2021) · The International Journal of Health Planning and Management · doi:10.1002/hpm.3394 · Cited by 18
Stevanović, D., Başay, B. K., Başay, Ö., Leskauskas, D., Nussbaum, L. A., & Zirakashvili, M. (2021) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2021.2013531 · Cited by 18
“Considering that the spread of the virus differed across countries during the ‘first wave’ of the pandemic in 2020, there was great diversity regarding the aspects and levels of lockdown measures and reactions to it globally [2], with swifts and diverse responses to address mental health across countries [23].”
BackgroundReview of the impact Covid-19 has on the Psychosocial factors affecting Well-Being
Menon, S., & Bhagat, V. (2021) · Research Journal of Pharmacy and Technology · doi:10.52711/0974-360x.2021.00592 · Cited by 17
García, K. L., Vichique, H. C., Ramírez, J. H., Figueroa, J. A. G., & Mendoza, S. C. (2022) · Revista Iberoamericana de Ciencias de la Actividad Física y el Deporte · doi:10.24310/riccafd.2022.v11i2.14701 · Cited by 17
Joo, S. W., Kim, H., Jo, Y. T., Ahn, S., Choi, Y. J., Choi, W., & Lee, J. S. (2022) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-022-02382-z · Cited by 17
“1 3 in low- and middle-income countries, which lack the infrastructure required to employ telemedicine into their mental health services, the COVID-19 pandemic profoundly disrupted essential mental health services [10, 11].”
BackgroundIdentifying Core Competencies for Remote Delivery of Psychological Interventions: A Rapid Review
Pedersen, G. A., Pfeffer, K. A., Brown, A. D., Carswell, K., Willhoite, A., Schafer, A., & Kohrt, B. A. (2022) · Psychiatric Services · doi:10.1176/appi.ps.202100677 · Cited by 19
Self-citationVillarreal‐Zegarra, D., Segovia-Bacilio, P., Paredes-Ángeles, R., Vilela-Estrada, A. L., Cavero, V., & Diez‐Canseco, F. (2023) · International Journal of Social Psychiatry · doi:10.1177/00207640231185026 · Cited by 17
Belachew, E. A., Getachew, D., Netere, A. K., Addisu, E. G., & Sendekie, A. K. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1234436 · Cited by 19
Curran, E., Rosato, M., Ferry, F. R., & Leavey, G. (2022) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-022-00820-2 · Cited by 17
Licher, S., Terzikhan, N., Splinter, M. J., Velek, P., van Rooij, F. J. A., Heemst, J. V., Haarman, A. E. G., Thee, E. F., Geurts, S., Mens, M. M. J., et al. (2021) · European Journal of Epidemiology · doi:10.1007/s10654-021-00789-7 · Cited by 17
Ribeiro, F. S., Santos, F. H., Anunciação, L., de Andrade, L. B., Landeira-Fernández, J., & Leist, A. K. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18094847 · Cited by 16
“For this reason, in the context of the COVID-19 pandemic, the prevalence of anxiety and depression symptoms is expected to be higher than in high-income countries due to increased inequalities, a vulnerable population, and limited resources to deal with the pandemic [24].”
BackgroundThe path to global equity in mental health care in the context of COVID-19
Kola, L., Kohrt, B. A., Acharya, B., Mutamba, B. B., Kieling, C., Kumar, M., Sunkel, C., Zhang, W., & Hanlon, C. (2021) · The Lancet · doi:10.1016/s0140-6736(21)02233-9 · Cited by 16
Self-citationAssociation of Poor Mental-Health Days With COVID-19 Infection Rates in the U.S.
Ransome, Y., Luan, H., Song, I., Fiellin, D., & Galea, S. (2021) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2021.08.032 · Cited by 14
Protocol for individual participant data meta-analysis of interventions for post-traumatic stress
Wright, S. L., Karyotaki, E., Bisson, J. I., Cuijpers, P. J., Papola, D., Witteveen, A. B., Seedat, S., & Sijbrandij, M. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-054830 · Cited by 16
Hidden within a pandemic: how is international funding supporting mental health during COVID-19?
Gribble, R. S. F., Durham, J. R., & Roy, S. F. (2022) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2022.19 · Cited by 17
Clarke‐Deelder, E., Rokicki, S., McGovern, M. E., Birabwa, C., Cohen, J. L., Waiswa, P., & Abbo, C. (2022) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2022.28 · Cited by 17
“Thus far, the vast majority of data available on psychological distress during COVID-19 are from high-income countries, while evidence from low-and middle-income countries (LMICs) has been scarce (Vindegaard and Benros, 2020; Xiong et al ., 2020; Chen et al ., 2021; Kola et al ., 2021).”
InfluentialXiao, Z., Zhao, Y., Zheng, Y., Bao, Y., & Zhang, C. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191610179 · Cited by 16
Koerbel, K., Rosenow, F., Maltseva, M., Müller, H., Schulz, J., Tsalouchidou, P., Langenbruch, L. M., Kovac, S., Menzler, K., Hamacher, M., et al. (2022) · Neurological Research and Practice · doi:10.1186/s42466-022-00209-5 · Cited by 16
Matić, T., Pregelj, P., Sadikov, A., & Prelog, P. R. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20010339 · Cited by 17
“Introduction The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing the coronavirus disease 2019 (COVID-19) pandemic has resulted in an array of negative effects on many aspects of societal functioning and has affected the physical and mental health of the population across the world [1].”
BackgroundEnsuring equity in mental health and psychosocial support during the COVID-19 pandemic and beyond
Armijos, A., Bonz, A. G., Brown, F. L., Charlet, D., Cohen, F., Greene, M. C., Hermosilla, S., James, L. E., Roch, K. L., & Collaborative, M. I. S. L. (2023) · Conflict and Health · doi:10.1186/s13031-023-00500-5 · Cited by 22
“Many safe spaces for women and children, including schools and emergency shelters, were closed, and many group programs were suspended or moved to alternative platforms [2, 14].”
BackgroundAlqahtani, I. M., Al-Garni, A. M., Abumelha, M. S., Alsagti, S. A., Alshehri, F. A. D., Alqahtani, A. A., & Alkhidhran, S. S. S. (2023) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_1943_22 · Cited by 22
“Journal of Family Medicine and Primary Care 1031 Volume 12 : Issue 6 : June 2023 The emergence of the COVID‐19 pandemic has raised questions about the impact of the pandemic on the mental health of individuals,[5] as it is not only causing physical impacts but also causing serious impacts on the mental health of indiv…”
Background
Metadata
- Authors
- Kola, L., Kohrt, B. A., Hanlon, C., Naslund, J. A., Sikander, S., Balaji, M., Benjet, C., Cheung, E. Y. L., Eaton, J., Gonsalves, P., Hailemariam, M., Luitel, N. P., Machado, D. B., Misganaw, E., Omigbodun, O., Roberts, T., Salisbury, T. T., Shidhaye, R., Sunkel, C., Ugo, V., van Rensburg, A. J., Gureje, O., Pathare, S., Saxena, S., Thornicroft, G., & Patel, V.
- Affiliations
- University of Ibadan (NG)
- George Washington University (US)
- King's College London (GB)
- Harvard University (US)
- University of Liverpool (GB)
- Sangath (IN)
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (MX)
- International Federation of Red Cross and Red Crescent Societies (CH)
- University of Sussex (GB)
- Michigan State University (US)
- Pravara Institute of Medical Sciences (IN)
- Corresponding author
- Kola, Lola
- ORCID
- Kola, Lola
- Kohrt, Brandon A
- Hanlon, Charlotte
- Naslund, John A
- Sikander, Siham
- Balaji, Madhumitha
- Benjet, Corina
- Cheung, Eliza Yee Lai
- Eaton, Julian
- Gonsalves, Pattie
- Hailemariam, Maji
- Luitel, Nagendra P
- Machado, Daiane B
- Misganaw, Eleni
- Omigbodun, Olayinka
- Roberts, Tessa
- Salisbury, Tatiana Taylor
- Shidhaye, Rahul
- Sunkel, Charlene
- Ugo, Victor
- Gureje, Oye
- Pathare, Soumitra
- Saxena, Shekhar
- Thornicroft, Graham
- Patel, Vikram
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2021-06
- Volume
- 8
- Issue
- 6
- Pages
- 535-550
- ISSN
- 2215-0366 (ISSN-L)
- PMC
- PMC9764935
- OpenAlex
- W3129779558
- Cited by
- 835
- References
- 147
- Citations by year
- 2026: 71 · 2025: 108 · 2024: 148 · 2023: 199 · 2022: 207 · 2021: 99
- FWCI
- 21.75
- Type
- journal article
- Language
- en
- Update notices
- erratum (2021-05-01)
- Open access
- bronze
- doi.org
- Licence
- Locations
- The Lancet Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Arca - Repositório Institucional da Fiocruz (submittedVersion, other-oa)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
- Funders
- Wellcome Trust
- National Institutes of Health (5u19mh113211-05)
- Economic and Social Research Council (ES/T007125/1)
- National Institute of Mental Health (R01MH120649, U19 MH-113211, R01MH100470, R01MH127767)
- Fogarty International Center (K43TW011046)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Keywords
- COVID-19 pandemic, mental health, low- and middle-income countries, psychological distress, mental health services, global mental health, universal health coverage, task sharing, digital mental health, coercion in mental health care, child mental health, substance use disorders, psychosocial interventions, mental health system strengthening
- MeSH terms
- COVID-19, Developing Countries, Health Promotion, Health Services Accessibility, Humans, Mental Health, Mental Health Services, Socioeconomic Factors, Global Health, Telemedicine, Social Determinants of Health
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