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COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health
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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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“54 At the same time, scalable approaches could be implemented, such as mobilising community health and social workers, engaging in religious and spiritual practices by community services, and maintaining national hotlines to provide timely access to mental health services.”
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InfluentialEditorial: The Nine Grand Challenges in Global Mental Health
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“According to the World Bank report, the COVID-19 pandemic has a greater negative impact on the mental health of children and adolescents in LMIC (Kola et al .”
de Vargas, D., Ramírez, É. G. L., Pereira, C. F., Volpato, R. J., & de Oliveira, S. R. (2022) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-022-00785-2 · Cited by 10
“…(Maulik et al., 2020; Rogers et al., 2020), and its long-term consequences on mental health will be especially severe in regions of the globe with limited resources, such as Brazil (Mari & Oquendo, 2020), where mental health care deficits were evident even before the outbreak (Kola et al., 2021).”
BackgroundBravo-Sanzana, M., Miranda, R., & Oriol, X. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20031958 · Cited by 11
“An increase in domestic violence as a result of COVID-19 [84], especially in middle-low-income countries due to significant structural violence [35,36], could explain the prevalence values found in this study.”
BackgroundTeachers as School Mental Health Professionals and their Daily Practices
Andrade, R. M. R., Zurita, S. A., & Bravo, G. P. (2024) · School Mental Health · doi:10.1007/s12310-024-09664-8 · Cited by 13
“In low-and middle-income countries, including Chile, school SMHS are increasingly receiving recognition and becoming integrated into educational policies (Kola et al., 2021; Rojas-Andrade et al., 2023).”
Murphy, J., Saker, S., Chakraborty, P. A., Chan, Y. M., Michalak, E. E., Irarrázaval, M., Withers, M. H., Ng, C. H., Khan, A., Greenshaw, A. J., et al. (2024) · PLOS Global Public Health · doi:10.1371/journal.pgph.0002661 · Cited by 21
“In LMICs during this time however, a majority of DMH options targeted general distress or mild to moderate common mental health conditions, meaning that people living with serious mental illness often lacked access to the necessary supports [54].”
BackgroundGeopolitical determinants of mental health and global health inequities
Valsraj, K. M., Moura, H. F., Anantapong, K., Ventriglio, A., Persaud, A., Tribe, R., Pemberton, M., Poulter, D., & Bhugra, D. (2024) · Industrial Psychiatry Journal · doi:10.4103/ipj.ipj_32_24 · Cited by 10
“[32] This suggests that social care policies can be as important as healthcare policies to protect mental health in the context of a crisis.”
Histone demethylases in autophagy and inflammation
Ma, Y., Lv, W., Guo, Y. C., Yin, T., Bai, Y., Liu, Z., Chen, C., WenjuanYang, Feng, J., Qian, W., et al. (2025) · Cell Communication and Signaling · doi:10.1186/s12964-024-02006-w · Cited by 11
Walker, A., Alkasaby, M. A., Baingana, F. K., Bosu, W. K., Abdulaziz, M., Westerveld, R., Kakunze, A., Mwaisaka, R., Saeed, K., Kéita, N., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19159313 · Cited by 10
Self-citationSifat, M. S., Tasnim, N., Stoebenau, K., & Green, K. M. (2022) · International Journal of Qualitative Studies on Health and Well-Being · doi:10.1080/17482631.2022.2113015 · Cited by 14
Sánchez‐Sánchez, F. J., & Sánchez, A. M. S. (2022) · International Journal of Environmental Research · doi:10.1007/s41742-022-00474-x · Cited by 10
“2021), in mental health (Jones et al. 2021; Kola et al. 2021), or in tourism (Vaishar and Šťastná 2022; Senbeto and Hon 2020), with the tourism and leisure sector being one of the most affected (RobinaRamírez et al.”
BackgroundA confirmatory factor analysis of a cognitive model of COVID-19 related anxiety and depression
Delz, L. A. K., Gaynor, K., O'Connor, R., Schmieder, L., & Somers, E. (2023) · Acta Psychologica · doi:10.1016/j.actpsy.2023.103861 · Cited by 11
Ramos‐Vera, C., O’Diana, A. G., Basauri-Delgado, M., Calle, D., & Saintila, J. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1124257 · Cited by 15
“This makes sense if we consider that this period originated disruptive events such as family estrangement and the adoption of new self-care health measures, events for which many older adults were not prepared to face, or even imply new burdens to pre-existing ailments or other difficulties (95, 96).”
BackgroundDecolonising Mental Health and Psychosocial Support (MHPSS) Interventions in the Humanitarian System
Hillel, R. S. (2023) · Intervention · doi:10.4103/intv.intv_20_22 · Cited by 10
Physicians’ mental health and coping during the COVID-19 pandemic: One year exploration
Adams, G. C., Le, T., Alaverdashvili, M., & Adams, S. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e15762 · Cited by 10
The other pandemic: Mental illness in young people from low and middle-income countries
Lux, M. E., Merino, M. M., Viviescas, A., & Escobar, J. M. (2023) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2023.101642 · Cited by 12
Ortega, A. C., Valtierra, E., Rodríguez-Cuevas, F. G., Aranda, Z., Preciado, G., & Mohar, S. (2021) · Global Health Action · doi:10.1080/16549716.2021.1997410 · Cited by 12
“Several interventions are being undertaken to address mental health in LMICs during the pandemic [9], but attention is still focused on the Global North”
BackgroundGong, W. J., Sit, S. M.-M., Lai, A. Y. K., Yu, N. X., Wang, M. P., Ho, S. Y., & Lam, T. H. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04198-2 · Cited by 10
“Disruptions to daily routines, physical isolation, and financial insecurity have caused an increase in global mental health burdens [1].”
BackgroundAbdel‐Halim, H., Hajar, M., Hasouneh, L., & Abdelmalek, S. M. A. (2022) · Drug Design Development and Therapy · doi:10.2147/dddt.s366423 · Cited by 10
“520 million people infected and around 6 million reported deaths, COVID-19 represents a serious menace to the world’s public health and economies.(2) Many of the treatment approaches that have been employed since the beginning of the”
BackgroundThe Silent Pandemic: the Impact of COVID-19 on the Mental Health of Adolescents Living with HIV
Anabwani-Richter, F., Swanson, T., Dlamini, S., Katulege, K., Daire, C., & Singhal, G. (2022) · Current Tropical Medicine Reports · doi:10.1007/s40475-022-00270-9 · Cited by 10
Kim, A. W., Mohamed, R. S., Norris, S. A., Naicker, S. N., Richter, L., & Kuzawa, C. W. (2023) · American Journal of Biological Anthropology · doi:10.1002/ajpa.24791 · Cited by 10
“…fear of COVID-19 infection, and the exacerbation of societal problems like food insecurity and unemployment, had deleterious impacts on mental health among populations in South Africa (Hunt et al., 2021; Kim, Nyengerai, & Mendenhall, 2022; Posel et al., 2021) and worldwide (Kola et al., 2021).”
Juan, N. V. S., Gronholm, P. C., Heslin, M., Lawrence, V. C., Bain, M., Okuma, A., & Evans-Lacko, S. E. (2021) · medRxiv · doi:10.1101/2021.05.13.21257172 · Cited by 10
Paredes-Angeles, R., Cavero, V., Vilela-Estrada, A. L., Cusihuaman-Lope, N., Villarreal-Zegarra, D., & Diez-Canseco, F. (2024) · SSM - Mental Health · doi:10.1016/j.ssmmh.2023.100287 · Cited by 9
Disability inclusion in African health systems’ responses during COVID-19: A scoping review
Engelbrecht, M., Ngqangashe, Y., Mduzana, L. L., Sherry, K., & Ned, L. Y. (2023) · African Journal of Disability · doi:10.4102/ajod.v12i0.1284 · Cited by 9
“Mental health concerns during COVID-19 related not only to care and intervention for persons with existing mental health conditions but also to health system planning to handle a ‘second pandemic’ of mental health crises as a result of the COVID-19 pandemic (Choi et al. 2020:340; Kola et al. 2021).”
BackgroundGenovesi, E., Gaches, A., McKenzie, J., Hanlon, C., & Hoekstra, R. A. (2024) · Review of Educational Research · doi:10.3102/00346543241288247 · Cited by 9
“…2022), echo calls for research led by low-and middle-income countries (LMICs) and development efforts and partnerships in the global mental health field, relevant to interventions for psychosocial disabilities in LMICs (Breuer et al., 2020; Dalglish, 2020; Gautier et al., 2018; Kola et al., 2021).”
Self-citationPhilip, S., Patley, R., Chander, R., Varshney, P., Dosajh, A. C., Vinay, B., Manjunatha, N., Kumar, C. N., & Math, S. B. (2021) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2021.102967 · Cited by 9
“With the pandemic, these numbers, according to many experts have only risen while the accessibility and availability of mental health (MH) care resources have suffered strictures (Kola et al., 2021; Tandon, 2021a).”
COVID-19 vaccine hesitancy and GAD: The role of risk perception and vaccination status
Wang, B., Zhong, X.-L., Fu, H., He, M.-T., & Hu, R. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.994330 · Cited by 9
Brooks, C., Mirzoev, T. N., Chowdhury, D., Deuri, S. P., & Madill, A. (2023) · Health Policy and Planning · doi:10.1093/heapol/czad038 · Cited by 11
“, 2011), The coronavirus disease (COVID)-19 pandemic has given rise to a ‘global crisis for mental health’ (World Health Organization, 2022, para 3) with long-term and profound effects most acute in lowresource settings (Kola et al., 2021).”
BackgroundInfluentialGul, M., Javaid, Z. K., Khan, K., & Chaudhry, H. A. (2023) · International Journal of Human Rights in Healthcare · doi:10.1108/ijhrh-08-2023-0072 · Cited by 9
Stigma and Discrimination: the Twain Impact on Mental Health During COVID-19 Pandemic
Chaturvedi, S., Susmitha, R., Nayak, D., Digal, G., & Singh, T. (2022) · Trends in Psychology · doi:10.1007/s43076-022-00179-2 · Cited by 9
Brown, D. M. Y., Hill, R. M., & Wolf, J. K. (2022) · Mental health and physical activity · doi:10.1016/j.mhpa.2022.100484 · Cited by 9
COVID-19 and global mental health
Kohrt, B. A. (2021) · The Lancet Psychiatry · doi:10.1016/s2215-0366(21)00073-0 · Cited by 9
Self-citationCOVID-19 and global mental health
Abas, M., Weobong, B., Burgess, R. A., Kienzler, H., Jack, H. E., Kidia, K. K., Musesengwa, R., Petersen, I., Collins, P. Y., & Nakimuli‐Mpungu, E. (2021) · The Lancet Psychiatry · doi:10.1016/s2215-0366(21)00155-3 · Cited by 9
Villar, J. C., Gumisiriza, N., Abreu, L. G., Maude, R. J., & Colebunders, R. (2022) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(22)00060-3 · Cited by 9
Murphy, J., Chau, L. W., Nguyen, V. C., Minas, H., Anh, D. V., & O’Neil, J. (2024) · BMC Health Services Research · doi:10.1186/s12913-023-10518-3 · Cited by 9
“The scope of the pandemic and its impact on health systems and mental health needs globally represents an unprecedented indicator of the universal and urgent need to strengthen mental health systems [37].”
A Global Call for Two-Generation Approaches to Child Development and Caregivers' Livelihoods
Sommer, T. E., Franchett, E. E., Yoshikawa, H., & Lombardi, J. (2024) · Child Development Perspectives · doi:10.1111/cdep.12516 · Cited by 10
“Data from many countries show substantial increases in families' material hard-ship and psychological distress (Kola et al., 2021; McCoy et al., 2021; Racine et al., 2021; RAPID, 2023).”
The Role of AI Counselling in Journaling for Mental Health Improvement
Jain, A., Sandhu, R., Singh, G., & Rakhra, M. (2024) · International Conference on Electrical Electronics and Computing Technologies (ICEECT) · doi:10.1109/iceect61758.2024.10739128 · Cited by 8
“Mental health concerns are pervasive and multifaceted, affecting individuals across demographics and geographies [1].”
BackgroundCaputo, A., Tron, A., Sassetti, S., Giakoumelou, A., & Colantoni, F. (2025) · Management Decision · doi:10.1108/md-05-2024-1144 · Cited by 8
Das, S., Grant, L., & Fearon, D. (2025) · Critical Public Health · doi:10.1080/09581596.2025.2501495 · Cited by 10
“Publications peaked in 2021, spurred by the pandemic’s effect on MH (Kola et al., 2021; Kopelovich & turkington, 2021; Kormendi & Brown, 2021; Ortega et al., 2021). with rising caseloads and limited resources, tS/S enabled frontline HRH to provide support (Das et al., 2023a). this highlights tS/S’s…”
Faro, A., Tejada, J., & Al‐Delaimy, W. K. (2025) · JMIR Public Health and Surveillance · doi:10.2196/72591 · Cited by 13
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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