How Depression and Anxiety Impact Adherence to COVID-19 Prevention Practices in Urban Liberia.
Laura Jean Ridge, Stephen Kennedy, Matthew Davis and 1 others
PMID 38343034WHAT IT FOUND
Adults in Liberia with more depression or anxiety symptoms reported lower overall adherence to COVID prevention practices, especially masks, hand hygiene and avoiding handshakes.
The survey cannot show cause.
Key findings
01Participants with depression had a mean overall COVID prevention practice score of 32.95, compared with 35.25 for participants without depression; participants with anxiety had a mean score of 32.9, compared with 35.3 for participants without anxiety.
02People with depression or anxiety reported less adherence to wearing a mask, practicing hand hygiene at home, and avoiding handshakes, and these differences remained after adjustment for employment status and number of cohabitants.
03Participants with depression or anxiety reported using deferral of health care as a COVID-19 prevention strategy more than other participants.
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What it does not show
This was a cross-sectional survey, so it shows an association between mental health symptoms and self-reported prevention practices, not that depression or anxiety caused lower adherence. Mental health and prevention practices were self-reported, not diagnosed or observed. The sample was drawn from Montserrado County, Liberia's most urban county, although 100 rural participants were included, so results may not apply to all of Liberia. Missing responses were coded as 0, which could affect scores. The study summed Likert answers into a 55-point scale, an approach the authors note has been debated. Bonferroni correction made individual practice comparisons stricter, so some differences may not have reached significance.
Declared interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of the article.
The easy way to misread this
Do not conclude that depression or anxiety caused poor adherence to COVID prevention practices. The survey measured mental health symptoms and self-reported practices at the same time, so the direction of the relationship cannot be established.