Mental Health Trends in India from 2020 to 2022: Association with Financial Stress, Food Insecurity, and COVID-19-related Illness Concerns

This study examines the impact of pandemic-related worries on mental health in the Indian general adult population from 2020 to 2022. Using data from the Global COVID-19 Trends and Impact Survey (N = 2,576,174 respondents aged >= 18 years in India; an average weekly sample size of around 25,000), it explores the associations between worry variables (namely financial stress, food insecurity, and COVID-19-related health worries) and self-reported symptoms of depression and nervousness. The statistical analysis was conducted using complete cases only (N = 747,996). Our analysis used survey-weighted models, focusing on the three pandemic-related worries as the exposures, while also adjusting for various other covariates, including demographics and calendar time. The study finds significant associations between these worries and mental health outcomes, with financial stress being the most significant factor affecting both depression (adjusted odds ratio: 2.36, 95% confidence interval: [2.27, 2.46]) and nervousness (adjusted odds ratio: 1.91, 95% confidence interval: [1.81, 2.01]) during the first phase of the study period (June 27, 2020, to May 19, 2021). The fully adjusted models also identify additional factors related to mental health, including age, gender, residential status, geographical region, occupation, and education. Moreover, the research highlights that males and urban residents had higher odds ratios for self-reported mental health problems regarding the worry variables than females and rural residents, respectively. Furthermore, the study reveals a rise in the prevalence of self-reported depression and nervousness and their association with COVID-19-related health worries during the lethal second wave of the pandemic in May 2021 compared to the onset of the pandemic. This study shows that social media platforms like Facebook can deploy surveys to a large number of participants globally and can be useful tools in capturing mental health trends and uncovering associations during a public health crisis. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The study of BM was funded by NSF DMS 1712933. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This paper is deemed exempt by the Institutional Review Board (IRB) because it involves secondary data analysis based on data from the Global COVID-19 Trends and Impact Survey. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data used in the study are accessed in adherence to a Data Use Agreement (DUA) with the University of Maryland.