Researchers and educators in the Arab world are getting signals that they need to focus on support for isolated young people who are reporting higher levels of anxiety as they try to study online during the Covid-19 emergency.
Arab academics have been tackling this issue in a series of new research projects, which may add much-needed data to the discussion.
“Interest in mental health has shot up—it’s propelled people who don’t normally talk about this issue to think about it,” says Rania Atalla, a psychotherapist and mental health professional based in Amman who spoke at a webinar on Monday on the mental health effects of Covid-19 that was organized by the Amman branch of the Columbia Global Centers. “I think a lot of us are hoping this will continue after the pandemic.”
One of the studies actually started out as a way to gauge the mental health consequences of Lebanon’s ongoing economic and political quagmire. “In any kind of crisis there’s anxiety because you might lose your job and money, so there’s often an increase of depression,” explains Ismael Maatouk, a researcher at the Clemenceau Medical Center, in Beirut.
But as the novel coronavirus crisis unfolded, the research quickly morphed to also look into the effects of the pandemic on mental health. Maatouk has so far surveyed 225 individuals—he is aiming for at least 400—asking questions via WhatsApp about whether participants have been isolating themselves, and if so to what degree, along with other questions to estimate their anxiety levels.
Using WhatsApp to conduct the survey is a weakness in the study design, the researcher acknowledges, because it means the sample is not random. Someone with a smartphone and a data plan is more likely to be wealthy than poor. But Maatouk says that’s the best he can do, given the lockdown rules. “We can’t exactly go and meet people these days,” he says.
Similar studies in Ethiopia, China, and Canada of both the general population and health care workers have shown rising mental health problems. Women have been found to be at particularly high risk. In Canada, 20 percent of people ages 15 to 49 have consumed more alcohol during the pandemic, according to national statistics. In the United States, a survey of 2,086 college students during April found that 80 percent of them said the pandemic had negatively affected their mental health. (The World Health Organization has published Basic Psychosocial Skills: A Guide for Covid-19 Responders.)
“In any kind of crisis there’s anxiety because you might lose your job and money, so there’s often an increase of depression.”Ismael Maatouk
A researcher at the Clemenceau Medical Center, in Beirut
Maatouk, in Lebanon, says his survey will give “a general idea of the scope of things and whether the population has new signs or symptoms of mental health problems due to Covid-19.”
Assessment studies like Maatouk’s are important, says Hady Naal, a clinical psychologist and research coordinator at the American University of Beirut’s Global Health Institute, who was not involved with the research. It’s best, he says, to “Start with a needs assessment to understand what and how to target.”
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Such assessments are key because sometimes preconceptions that seemed safe to assume turn out not to be true. For example, it may have been reasonable to think that people with existing mental health problems would be more likely to suffer during the Covid-19 lockdowns. But that’s not necessarily the case, says Atalla, who moved her patients to online consultations following quarantine restrictions. “Some of them under lockdown have made leaps of progress,” she says. “I’m hypothesizing, but maybe it’s because the lockdown has forced us to look inwards and examine our emotions in a situation with fewer distractions.”
Youth Are Not Immune
Recent surveys have shown that despite efforts by universities to move towards a comprehensive online education system, students are not invulnerable from increased feelings of isolation and anxiety caused by these changes. (See a related article, “The Acceleration of Online Education: What Can We Learn from the Crisis and Beyond?”)
For example, the Abdulla Al Ghurair Foundation for Education—which provides scholarships for Arab students from underserved backgrounds —questioned 335 of its students about their experience since the pandemic began.
“One finding we want to highlight is the increased anxiety reported by many of the respondents,” said Rawan Yasmin, scholarship program manager at the Al Ghurair Foundation, during a recent online conference organized by Al-Fanar Media and SPARK, a nongovernmental organization that focuses on jobs for youth in fragile states. “One-third of students who answered the survey said they were more anxious than they were at the start of the pandemic.”
“One-third of students who answered the survey said they were more anxious than they were at the start of the pandemic.”Rawan Yasmin
Scholarship program manager at the Al Ghurair Foundation
When asked about the type of support they might need to get through the pandemic, psychosocial or mental health support was frequently cited. That agrees with the findings of another questionnaire carried out by SPARK in which 809 students in Iraq, Jordan, Lebanon, Palestine and Turkey were asked about the challenges they face in moving to online education. Overall, 41 percent said they needed psychosocial support.
“We know that these students are dealing with more than just transitioning online,” explained Yasmin. “Many of their families have been impacted by the pandemic, making it really hard to just focus on their studies.”
Ian Grey, an associate professor of clinical psychology at the Lebanese American University, is also studying the prevalence of psychological outcomes linked to the pandemic. The stark difference between the frequent social interactions of everyday life on campus and the solitude of working entirely online has an impact, he says. “Young people are actually having higher levels of issues than older people,” he says. “I imagine it’s because the majority of younger people might be in university where they’re used to hanging out with people.”
Some institutions, such as Zayed University in Dubai, have support in place to help students cope with the psychological stresses.
“The university’s counseling services have delivered online mental health workshops and set up support networks,” says Zoe Hurley, assistant dean for student affairs in the College of Communication and Media Sciences at Zayed University. “We have been making deliberate attempts to ensure that vulnerable students and isolated faculty are not forgotten.”
Maatouk’s study is still ongoing but he hopes that his findings will also reveal what coping mechanisms could help people to stay resilient during the crisis. “Religious groups and family support are proven to be helpful in studies before Covid-19,” he says. “But during the lockdown people were forbidden from going to mass or the mosque, so it’s taken one of those support mechanisms away. How will people cope? We don’t know yet, it’s impossible to predict but we hope to find out.”
That question also interested Grey. “When the first studies of people in China and elsewhere came out, they showed that more or less 30 percent of people were experiencing elevated symptoms of anxiety,” he says. “But that means a large majority aren’t. You can be under quarantine but that doesn’t necessarily mean you feel psychologically alone, and so we decided to look at people’s ability to cope with the added stressors.”
“I would expect that besides the added stressors caused by Covid on the general population, LGBT individuals may also face unique stressors.”Hady Naal
A clinical psychologist and research coordinator at the American University of Beirut’s Global Health Institute
In a study yet to be reviewed by other scientists and published, Grey and colleagues pooled the findings of 28 papers from around the world, which reported on the prevalence of psychological issues since the beginning of the pandemic. The results show the overall prevalence of anxiety and depression were 28 percent and 22 percent, respectively. Additionally, 70 percent of people reported fears and 68 percent reported worries. Collectively the study shows that 34 percent of people had some sort of psychological outcome associated with the pandemic, which Grey says is probably higher than in normal times.
“The simplistic way to look at this is to assume that isolation alone is influencing the outcome, but of course it’s much more nuanced than that,” he says. “It’s about support. If you have support, then you’re far less likely to suffer.”
He can back that statement up with data from a second study—also awaiting publication and review—in which over 2,000 individuals completed an online survey. While those in self-isolation were significantly more likely to show signs of depression, that is only part of the picture. For example, the risk of increased levels of depression is 63 percent lower for people with high levels of social support. A similar pattern was observed for insomnia. (See related article “Sleepless in Beirut: a Health Risk.”)
LGBT People May Be More Vulnerable
Not everyone has access to these types of support structures and that puts them more at risk of mental health problems such as depression and anxiety. “I would expect that besides the added stressors caused by COVID on the general population, LGBT individuals may also face unique stressors,” says Naal. “As an example, individuals who are exposed to household abuse due to their sexual or gender identity, which is very common here, may be experiencing more of that given the lockdown.”
Maatouk—whose previous work focuses on the health needs of Lebanon’s lesbian, gay, bisexual and transgender community—agrees. (See a related article: “Arab Researchers Face Challenges in Studying Sexual Orientation.”)
“I don’t have any data, but qualitatively, I can say that the LGBT community could be different in terms of coping mechanisms. The religious support often isn’t there and neither is the family support if they disapprove of being LGBT,” he says.
One thing is for sure, the more data and research produced on this topic, the better placed society will be to deal with the problem with far reaching consequences.
“We are social beings and connection is important for us,” says Atalla. “Lockdown and isolation can take its toll on us.”