Comparing the psychosocial impacts of COVID-19 in seven low- and middle-income countries: A cross-sectional study

The COVID-19 pandemic inflicted widespread and prolonged stress, particularly in low- and middle-income countries (LMICs). Similar events are likely in the future, and understanding moderators of the effects in LMICs may be helpful. An observational study of adults aged ≥18 years in Türkiye, Indonesia, Iraq, Malaysia, Pakistan, Somaliland, and Iran was conducted using an online survey between 2021 and 2023. Data were collected on sociodemographic and pandemic-related variables along with standardized measures of psychological distress (Kessler Psychological Distress Scale 10, K10; Posttraumatic Stress Disorder Checklist for DSM-5, PCL5), wellbeing (World Health Organization-Five Well-Being Index, WHO-5), post-traumatic growth (Posttraumatic Growth Inventory, PTGI), and pandemic-related distress (COVID-19 Psychosocial Impacts Scale, CPIS). Modified Poisson multilevel mixed-effect models were used to explore associations. Cumulative distribution function plots were used to visually compare sites, followed by ANCOVA to assess statistical differences while controlling for covariates. Overall, 2,574 adults aged 18-73 years (M = 28.0 years, SD = 10.6) participated. They were predominantly female (64.6%), single (58.0%), and Muslim (92.2%), with 81.2% having at least a tertiary qualification. The CPIS score range was 5-144 (M = 47.7, SD = 24.0). Psychological outcomes revealed substantial distress on K10 (32.2%), PCL5 (37.8%), and WHO-5 (45.0%) measures. Being female, married, studying full-time, and unemployed were consistently linked to higher psychological distress. The PTGI scores ranged from 0-105 (M = 53.3, SD = 23.3), showing a wide spectrum of posttraumatic growth in responses to COVID-19. Country-wise comparisons indicated variations in distress, well-being, and post-traumatic growth in response to COVID-19. The variation in distress scores appeared to be influenced by individual (e.g., gender, marital status, education, employment) and contextual (e.g., lockdown) factors. These findings suggest that strategies aimed at mitigating long-term psychosocial impacts of pandemics in resource-constrained settings may have population-health beneficial. Registration details: The study is registered with the Clinical Trial Registry (NCT05052333).