The COVID-19 pandemic has led to a 25% increase in the prevalence of mental disorders, particularly anxiety and depression worldwide, according to a 2022 World Health Organization (WHO) report. explanations given for this increase included unexpected levels of stress caused by social isolation during the pandemic. Additionally, limitations in people’s ability to work and seek support from family, friends and loved ones were also major stressors that contributed to declining mental health during the pandemic. These effects were particularly severe in young people, who are at a disproportionately higher risk for suicide and self-harming behaviors. All of these findings are concerning, especially given the limited research available on mental health and the existing evidence that unexpected economic shocks can negatively impact mental health. What policy interventions could improve mental health outcomes? The answer to this question is of pressing political interest since mental health disorders result in incredibly large economic losses, especially in low-income countries where people often face unexpected shocks to income and health.
We answer this question using evidence from a communication intervention in Ghana to test whether better communication, using information and communication technologies like mobile phones, can improve mental health. In our study, we partner with a large telecommunications company and implement low-cost communication interventions that provide mobile call credit to a nationally representative set of low-income adults in Ghana during the COVID pandemic. -19. We find that individuals’ inability to make unexpected calls and borrow SOS airtime and seek digital loans has decreased significantly compared to a control group. As a result, the programs resulted in a significant decrease in mental distress (-9.8%) and the likelihood of severe mental distress by -2.3 percentage points (a quarter of the average prevalence). The effects were felt only through reduced mental distress, and there was no impact on consumer spending. A simple cost-benefit analysis shows that providing communication credits to low-income adults is a cost-effective policy for improving mental health. Communication – the ability to stay connected – significantly improves mental well-being, and communication interventions are particularly useful when implemented in multiple installments.
Context: The state of mental health and ICTs in Africa and the world
While mental health research is generally sparse, there is very little mental health research in Africa, a region that faces the joint challenges of a high disease burden and a critically ill health sector. underfunded. According to the 2014 WHO Mental Health Atlas survey, globally, 24% of countries reported that they had no or had not implemented stand-alone mental health policies . In Africa, the share was almost double, at 46%. Based on a recent Lancet study, according to World Bank estimates, in 2017 public expenditure accounted for only 35% of total health expenditure for countries in Africa, well below the global average of 60%. Africa’s public spending on health is only 2% of GDP, less than the global share of 3.5%. Furthermore, out-of-pocket expenditure as a share of health expenditure in Africa was among the highest in the world, at 37% of health expenditure, compared to 18% in the rest of the world. When we add this to the fact that Africa has the youngest population in the world, with 60% of the population under the age of 25, and young people are often identified in mental health literature as being at high risk of mental disorders, including suicide and self-harm – then this presents a very disturbing picture. At the same time, there are more people today with access to information and communication technologies (ICTs) such as mobile phones than at any other time in human history, with the majority of the population in Africa with access to a mobile phone (and over 80% of the population of Africa’s most populous country, Nigeria, and Ghana, the study country, having access to a mobile phone in 2015) . So can we leverage this near-universal access to cellphones to improve mental health? The study answers this question using evidence from Ghana.
An experimental approach: the effects of ICT on mental health
Administrative data on mobile financial transactions from a major provider in Ghana in 2020 highlights the potential value of communication during the pandemic. The data shows that after the onset of the pandemic and the institution of containment measures in March 2020, while overall market activity decreased, interestingly and in contrast, the demand for weather-related activities d Mobile antenna (as measured by the purchase of data and amounts of airtime, and therefore their demand) increased sharply over the period. In our recent article, we use a randomized controlled trial (RCT) to estimate the impacts of short-term “mobile phone call credit” among a nationally representative set of low-income households in Ghana during the COVID-19 pandemic.
We partnered with a large local telecommunications company to conduct our experiment by randomly assigning 1,131 people to two candidate communication programs: GHS 40 ($7.0) flat-rate mobile credit (376 people) versus GHS 20 (3 $.5) monthly mobile credit payments over two months (371 individuals) versus a control program (384 individuals); then measure how these affect individuals’ ability to mitigate unexpected communication stresses during the pandemic, with impacts on well-being, i.e. mental health, domestic violence and consumer spending . The various communication programs provide a way to examine how communication programs might be delivered: large communication transfer at one time versus many small instalments. Conceptually, programs that facilitate communication during unexpected pandemics could be transformative for people, especially if bound by internal constraints. Not having to worry about being unable to stay connected could free up the mental and emotional bandwidth needed to thrive during a pandemic and its current uncertainty. The provision of communication credits during these hardships can also directly free up an individual’s resources that would otherwise have been allocated to communication for other consumer expenditures. Our interventions are designed both to ease these communication constraints and to test their impact on mental health, domestic violence and consumer spending.
We find five sets of results, of which three main ones are detailed below:
- Interventions significantly reduced unexpected communication constraints. In other words, our experimental interventions mitigate individuals’ inability to meet unexpected communication needs and stay connected. These effects are greater and more sustained over time for the installment communication credit program compared to the flat-rate credit.
- We see a significant improvement in psychological well-being, which is measured using the Kessler Psychological Distress Scale (K10). Mental distress decreased (-9.8%). Severe mental distress decreased (-2.3 pp = -24%) compared to a control group. The installment communication credit program had greater and longer lasting effects compared to the lump sum credit. Similarly, only the installment program resulted in a significant decrease in the overall likelihood of individuals threatening their partner by -6.3% (but no impact on the overall likelihood of individuals hitting their partner – our second measure of domestic violence).
- We see no improvement in direct economic well-being. The overall effect is nil on total consumption, which is reassuring since the size and specificity of our intervention were not large enough to significantly modify consumption. Only the installment communication intervention increased consumer spending, but the size is very small economically.
Findings suggest that a major policy response to improve mental health, especially during times of unexpected shocks like epidemics that can negatively impact individual and societal well-being, should be to leverage access to ICTs and issue communication credits that allow people to communicate and stay connected to their networks. It is an effective and inexpensive way to improve mental health, especially in low-income settings where public spending on health and mental health is low.