Covid’s toll on sample of Soweto residents

SOUTH Africa’s response to the novel coronavirus outbreak was swift and assertive. We conducted a study to capture how people were coping during lockdown in Soweto. Psychological assessments were done between April last year and March this year; and again in the first six weeks of the lockdown.

We called 957 adults living in Soweto who had been enrolled in studies on the epidemiology of syndemics, or synergistic epidemics. We spoke to them about how they experienced lockdown and Covid-19.

Most of our sample were female, middle aged (average age was 43 years old) and shared a room at home. Nearly 91% of adults in our sample reported having at least one underlying health condition or more – a potential risk factor for Covid-19 infection.

We had some information about them, such as early childhood trauma and mental and physical health as they are were participants in research we are undertaking. We also conducted a brief mental health questionnaire on the phone during lockdown.

Our results show that people who viewed their risk of Covid-19 infection to be higher than others exhibited greater depressive symptoms. Furthermore, people who reported histories of childhood trauma had worse depressive symptoms as a result of their perceived risk of getting Covid-19. The findings confirm the research that shows that people who face more adversity during childhood may be more vulnerable to the effects of stress and trauma in the future – such as the stressors of the pandemic.

We found a strong relationship between Covid-19 risk perceptions and depressive symptoms. But most (74%) of respondents didn’t think their life under lockdown and wider pandemic conditions affected their mental health.

The discrepancy potentially highlights the stigma and lack of awareness around mental health. Our study re-emphasises the importance of prioritising and providing accessible mental health services for resourcelimited communities.

PUBLIC PERCEPTIONS

Many people called it a “virus that kills” and suggested they feared the virus. This probably inspired people to say they frequently used preventative measures, such as “I wash my hands and stay home”, “wear a mask” or “keep my distance from people”. Many described feeling some anxiety because they are “always thinking about it”. Most worried about those with pre-existing conditions like HIV, diabetes or heart disease. They considered these community members most at risk.

Social challenges were common. Many had lost their jobs and worried about putting food on the table. Others worried because “since lockdown, movement is very difficult”. Residents were scared to leave the house.

One participant was scared because a neighbour’s house was bulldozed and his family had nowhere to go.

Few cases of Covid-19 were detected in Soweto during the first month of lockdown, although many people perceived their risk to be high. Many described anxiety and fear over personal well-being, and caring for those they love.

We found people perceived their own risk for Covid-19 infection differently relative to others in their community. About 58% of adults thought they were at lower risk of Covid-19 than others, while 29% reported having the same risk, and 14% having more risk. Risk perception was unaffected by personal characteristics such as age, finances, education or household density. Greater knowledge of how to prevent coronavirus transmission and keep their families safe was associated with lower perception that they were at risk of infection.

One in three people in South Africa is expected to experience a common mental disorder like anxiety or depression in their lifetimes. During lockdown, most did not think Covid-19 had affected or could hurt their mental health. Nevertheless, we found a variety of stressors that caused deep worry, anxiety and rumination (“thinking too much”) in approximately 20% of adults.

Those who perceived their risk to be higher had more depressive symptoms and more severe histories of childhood trauma. This was true regardless of people’s mental health before lockdown, what they knew about Covid-19, how they coped, and their family and financial backgrounds.

But the measures were collected simultaneously. We don’t know if the adults were depressed because they felt at risk, or whether they felt at risk because they were depressed. We