Experiences of COVID-19 Policy Measures and Mental Health in Uganda: Cross-Sectional Evidence From a Mobile Phone-Based Population Survey

Background: Policy measures to slow the spread of COVID-19, such as curfews and business closures, may have negative effects on mental health. Populations in low- and middle-income countries (LMICs) may be particularly affected due to high rates of poverty and less comprehensive welfare systems, but evidence is scarce. We evaluated predictors of psychological distress in Uganda, which implemented one of the world’s most stringent lockdowns. Methods: We conducted a mobile phone-based cross-sectional survey from December 2020 through April 2021 among individuals aged 18+ in Uganda. Psychological distress was measured using the Patient Health Questionnaire (PHQ)-4. We applied linear regression to assess associations between experiences of COVID-19 (including fear of infection, social isolation, income loss, difficulty accessing medical care, school closings, and interactions with police) and PHQ-4 score, adjusted for sociodemographic characteristics. Findings: 29.2% (95%CI 27.8% to 30.6%) of 4,066 total participants reported scores indicating moderate psychological distress, and 12.1% (11.1% to 13.1%) reported scores indicating severe distress. Distress was most common among individuals who were female, had lower levels of education, and lived in households with children. Related to COVID-19, PHQ-4 score was significantly associated with difficulty accessing medical care (p=0.01), worries about COVID-19 (p<0.0001), worries about interactions with police over lockdown measures (p<0.0001), and days spent at home in isolation (p<0.0001). Interpretation: There is an urgent need to address the significant mental health burden associated with COVID-19 and policy responses in LMICs. Pandemic mitigation strategies must consider mental health consequences.Funding Information: Rutgers University, Gamble Family Foundation, and Harvard University.Declaration of Interests: The authors report no conflicts of interest.Ethics Approval Statement: This study received ethical approval at Rutgers School of Public Health (Pro2020001762) and Makerere College of Health Sciences Higher Degrees, Research and Ethics Committee (#814), and the Uganda National Council of Science and Technology (HS1084ES).