The COVID-19 (coronavirus disease 2019) pandemic has greatly affected the lives of millions of people globally, with the likelihood of mental health problems ensuing among those with no existing mental illness as well as aggravating preexisting mental health conditions.¹ Mental health impact of the COVID-19 pandemic is diverse and they differ among different populations as previous research works have recorded. In the United States, about 4 in 10 adults reported symptoms of anxiety or depression during the pandemic, and many were reporting specific negative impacts due to worry and stress over the coronavirus on their mental health and well-being such as insomnia (36%), alcohol and substance abuse (12%).² In the United Kingdom, about one-third of people developed high levels of anxiety from the pandemic¹ while a systematic review showed that 47% and 48% of Africans had anxiety and depression respectively during the COVID-19 pandemic.³ As the pandemic wears on, continuous and necessary public health interventions expose many people to experiencing situations linked to poor mental health, such as physical distancing, isolation, and job loss.²

Generally, the COVID-19 pandemic has increased the likelihood of developing poor mental health, financial insecurity, unemployment, and panic, while protective factors such as social connection, employment, educational involvement, access to physical activity, daily routine, and health care have all declined drastically. This has resulted in a major and unprecedented deterioration in the population’s mental health.⁴ Across countries, unemployed persons and those suffering financial insecurity had poorer mental health than the overall population -a trend that predates the pandemic but appears to have exacerbated in some cases.⁴

The prevalence of mental health issues has remained largely stable for decades; but, with the onset of the COVID-19 pandemic in 2020, this trend began to shift. Anxiety and depression have been more prevalent after March 2020.¹ For example, the prevalence of anxiety in Europe and the United States doubled that of the previous years in early 2020.⁴ This is similar to the prevalence of depression recorded in the same regions within the same year.⁵

When scarce resources are devoted to pandemic control and containment, mental health problems and treatment frequently take a backseat. An infectious disease pandemic, according to history, is followed by a substantial mental health setback. Individuals suffering from substance abuse and dependency disorders may have their mental health deteriorate as a result of a pandemic, as the healthcare system concentrates primarily on emergency services.⁶

Apart from a pandemic, war also plays a major role on the mental health status of individuals.⁷ It adversely affects soldiers and civilians alike, both physically and mentally, and when a pandemic is present, this negative impact is amplified. The mental impacts of war include post-traumatic stress disorder (PTSD), depression, as well as anxiety. The terror and horror spread by war violence disrupts lives and severs relationships and families, leaving individuals and communities emotionally distressed.⁷ Civilians are frequently affected by the combined effects of war, torture, and repression, particularly those caught in war zones or forced to participate in war-related activities such as murder or rape. Elbedour et al dubbed the helplessly victimized children and families caught in the experience of war as the “collaterally damaged” population.⁸ Additionally, war-related emotional suffering can occur not only as a result of direct exposure to life-threatening situations and violence, but also as a result of indirect stressors such as the injury or death of relatives or caregivers, economic hardships, geographic displacement, and continuous disruptions of daily life.^{8, 9}

Furthermore, the existence of war in the midst of a pandemic accelerates the spread of infectious diseases especially as a growing number of individuals are displaced and forced into cramped and dangerous situations.⁵ For example, the Russian-Ukraine war has resulted in Ukraine reporting nearly 900,000 COVID-19 cases between February and March 2022, accounting for more than one-fifth of the pandemic’s total cases.⁵ Also, Ukraine has one of the lowest vaccination rates in Europe with less than 40% of Ukrainians fully vaccinated compared to their neighbours such as Russia, Poland, and Belarus with much higher full vaccination status.¹⁰

Research on the psychological effects of the COVID-19 pandemic and civil war in Libya found a high level of anxiety and depression. The findings revealed that 64.5% of participants had varying degrees of anxiety, 21.6% had moderate to severe depression, and 22.7% had suicidal ideation.¹¹ The high level of anxiety and depression could be linked to the civil war, as well as overwhelming worsening news that heightens their fear of the virus, its transfer to family or friends, complications, and psychological stress caused by quarantine and isolation.¹¹

The effect of war existing with a pandemic is not limited to adults, children have their fair share of it as exemplified in the Democratic Republic of the Congo (DRC), more than 3 million children have been displaced, half of them in the country’s eastern zone, where community health centers and schools have been looted, homes have been burned, and entire villages have been destroyed, forcing children and families to flee for survival. Children have witnessed friends and family members being hacked to death during the conflict. The DRC is known to have the world’s worst health system, which has been aggravated by the country’s battles with the Ebola pandemic and subsequently COVID-19.¹² Similarly, children and their families in South Sudan were facing increased protection risks as a result of rising intercommunal strife, as well as severe food insecurity and malnutrition, during the COVID-19 pandemic. Children who encounter extreme levels of distress, such as those in the DRC and South Sudan, are more likely to develop chronic mental health illnesses or psychosocial impairments. Traumatic events and toxic stress can affect a child’s brain development at a young age. Children who have been exposed to a conflict are more likely to feel high levels of stress when confronted with a new crisis, which is exacerbated by previous traumatic experiences.¹²

Humans as social beings perform best in a healthy environment, and when that milieu is disrupted by war and/or epidemic, persons trapped in this quagmire risk losing their mental health. If these risks that threaten mental health are allowed to fester, they will in the long run affect global health with reduced economic productivity as affected individuals could be maladjusted in such disabling circumstances where there is a paucity of aid to glom onto, giving to the fact that a sizable number of the affected populace would rather feign existence of such malady. Therefore, the awareness of this effect must be greatly emphasized and captured among survivors.

In conclusion, mental health is critical to the functioning of society at the best of times. It must be front and center of country’s response to and recovery from the COVID-19 pandemic and civil unrest. The mental health and well-being of whole societies have been severely impacted by these crises and are a priority to be addressed urgently.

AUTHORS CONTRIBUTION

All authors contributed to the research process.

CONFLICT OF INTEREST

The authors declare no conflict of interest

FUNDING

Funded by the authors