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      Psychological Distress and Access to Mental Health Services Among Undergraduate Students During the COVID-19 Lockdown in Uganda

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          Abstract

          Background

          Lockdown is an important public health approach aimed at curbing the raging effect of the coronavirus disease-2019 (COVID-19). This study aimed at determining the impact of prolonged lockdown on mental health and access to mental health services among undergraduate students in Uganda.

          Methods

          An online cross-sectional study was conducted anonymously among undergraduates across 10 universities in Uganda. The Distress Questionnaire-5 (DQ-5) and the Patient Health Questionnaire-2 (PHQ-2) were used. Logistic regression analysis was conducted to determine factors associated with psychological distress.

          Results

          We enrolled 366 participants with a mean age of 24.5 ± 4.6 years. The prevalence of psychological distress was 40.2% ( n = 147) (cut off 14/25 based on DQ-5) while depression stood at 25.7% ( n = 94; cut off 3/6 based on PHQ-2) with mean scores of 12.1 ± 4.6 and 1.7 ± 1.6 respectively. Female gender (aOR: 1.6, 95%CI: 1.0–2.6, p = 0.032), pursuing a non-medical program (aOR: 2.2, 95%CI: 1.3–3.7, p = 0.005) were factors associated with psychological distress while non-medical program (aOR: 2.2, 95%CI: 1.3–3.7, p = 0.005) was associated with increased depression. Access to mental health services was associated with both reduced distress (aOR: 0.5, 95%CI: 0.3–0.8, p = 0.005) and depression (aOR: 0.6, 95%CI: 0.3–0.9, p = 0.034). A majority (65.3%) of the participants reported knowing how to access mental health care and 188 (51.4%) reported having needed emotional support but, only 67 (18.3%) ever sought care from a mental health professional. Of those who had access, only 10 (7%), and 13 (9%) accessed a counselor or a mental health unit, respectively. The barriers to accessibility of mental health care included financial limitations (49.5%), lack of awareness (32.5%), lack of mental health professionals (28.4%), and stigma (13.9%).

          Conclusion

          Among university students in Uganda during the COVID- 19 lockdown, the burden of psychological distress and depression was substantial. However, access to mental health services was limited by several factors.

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          Most cited references17

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          The psychological impact of quarantine and how to reduce it: rapid review of the evidence

          Summary The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.
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            The Benefits and Costs of Using Social Distancing to Flatten the Curve for COVID-19

            We examine the net benefits of social distancing to slow the spread of COVID-19 in USA. Social distancing saves lives but imposes large costs on society due to reduced economic activity. We use epidemiological and economic forecasting to perform a rapid benefit–cost analysis of controlling the COVID-19 outbreak. Assuming that social distancing measures can substantially reduce contacts among individuals, we find net benefits of about $5.2 trillion in our benchmark case. We examine the magnitude of the critical parameters that might imply negative net benefits, including the value of statistical life and the discount rate. A key unknown factor is the speed of economic recovery with and without social distancing measures in place. A series of robustness checks also highlight the key role of the value of mortality risk reductions and discounting in the analysis and point to a need for effective economic stimulus when the outbreak has passed.
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              The Distress Questionnaire-5: Population screener for psychological distress was more accurate than the K6/K10.

              The K6 and K10 are well-validated screening measures for psychological distress and are widely used. However, the accuracy of these scales in identifying common mental disorders may be suboptimal. This study aimed to develop a brief scale of psychological distress--the Distress Questionnaire-5 (DQ5)--and validate its diagnostic accuracy in identifying common mental disorders, relative to the K6 and K10.
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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                02 June 2022
                2022
                02 June 2022
                : 13
                : 792217
                Affiliations
                [1] 1School of Medicine, College of Health Sciences, Makerere University , Kampala, Uganda
                [2] 2School of Clinical Medicine and Dentistry , Kampala International University Western, Bushenyi, Uganda
                [3] 3Faculty of Health Sciences, Busitema University , Mbale, Uganda
                [4] 4Faculty of Medicine, Gulu University , Gulu, Uganda
                [5] 5School of Medicine, Uganda Christian University , Kampala, Uganda
                [6] 6School of Medicine, Soroti University , Soroti, Uganda
                [7] 7Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University , Gulu, Uganda
                Author notes

                Edited by: Yuka Kotozaki, Iwate Medical University, Japan

                Reviewed by: Manjeet Singh Bhatia, University of Delhi, India; Mohammed A. Mamun, CHINTA Research Bangladesh, Bangladesh

                *Correspondence: Nelson Ssewante nelson.ssewante1@ 123456gmail.com

                This article was submitted to Public Mental Health, a section of the journal Frontiers in Psychiatry

                Article
                10.3389/fpsyt.2022.792217
                9201074
                35722591
                138c612e-1ca8-49ca-9e0b-1deb7405d8e1
                Copyright © 2022 Nantaayi, Ndawula, Musoke, Ssewante, Nakyagaba, Wamala, Makai, Wannyana, Wamala, Kanyike, Akech, Ojilong, Agira, Nakimuli, Asiimwe and Bongomin.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 09 October 2021
                : 11 May 2022
                Page count
                Figures: 3, Tables: 3, Equations: 0, References: 19, Pages: 8, Words: 4768
                Categories
                Psychiatry
                Original Research

                Clinical Psychology & Psychiatry
                psychological distress,depression,access mental health services,covid-19,lockdown

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