The COVID-19 pandemic led to a 25 percent increase in the prevalence of mental disorders, particularly anxiety and depression globally, according to a World Health Organization (WHO) Report 2022. Among the explanations given for this increase were the unexpected levels of stress caused by social isolation during the pandemic. Additionally, limits on people’s ability to work and seek support from family, friends, and loved ones were also major stressors that contributed to declines in mental health during the pandemic. These effects were particularly severe for young people, who have a disproportionate increased risk of suicide and self-injurious behavior. All of these results are concerning, especially given the relatively little research available on mental health and the existing evidence that unexpected Economic crises can have a negative impact on mental health. What policy interventions could improve mental health outcomes? The answer to this question is of compelling political interest, as mental health disorders translate into staggeringly large economic losses, particularly in low-income countries where people often face unexpected impacts on income and health.
We answer this question using evidence from a communication intervention in Ghana to test whether improving communication, using information and communication technology such as mobile phones, can improve mental health. in our studio, we partnered with a major telecommunications company and implemented low-cost communication interventions that provide mobile calling credits to a nationally representative set of low-income adults in Ghana during the COVID-19 pandemic. We found that people’s inability to make unexpected calls and the need to borrow SOS airtime and seek digital loans decreased significantly relative to a control group. As a result, the programs led to a significant decrease in mental distress (-9.8 percent) and the probability of experiencing severe mental distress by -2.3 percentage points (a quarter of the mean prevalence). The effects were only through the reduction of mental distress, and there was no impact on consumption expenditure. A simple cost-benefit analysis shows that providing communication credit 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 valuable when implemented across so many deliverables.
Context: The state of mental health and ICTs in Africa and the world
While mental health research is scarce overall, there is very little mental health research in Africa, a region that faces the joint challenges of a high burden of disease and a severely underserved health sector. According to the 2014 WHO Mental Health Atlas SurveyGlobally, 24 per cent of countries reported that they did not have or had not implemented stand-alone mental health policies. In Africa, the proportion was nearly double, at 46 percent. Based on a recent lancet Study, according to World Bank estimates, as of 2017, public spending was only 35% of total health spending in African countries, well below the global average of 60%. Africa’s government spending on health is just 2 percent of GDP, lower than the global share of 3.5 percent. Furthermore, out-of-pocket spending as a share of health spending in Africa was among the highest in the world at 37% of health spending, 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 percent of the population under the age of 25, and that young people are often identified in mental health literature like being at high risk for mental health disorders, including suicide and self-harm, then this presents a very worrying picture. At the same time, there are more people with access to information and communication technologies (ICTs) such as mobile phones around the world today than at any other time in human history, with the the majority of the population in Africa have access to a mobile phone (and more than 80 percent of the population in Africa’s most populous country, Nigeria, and the study country Ghana, who have access to a mobile phone as of 2015). So can we take advantage of this near-universal access to mobile phones to improve mental health? The study answers this question using evidence from Ghana.
An experimental approach: The effects of ICTs on mental health
Administrative data on mobile financial transactions from a major provider in Ghana in 2020 sheds light on the potential value of communication during the pandemic. The data shows that after the start of the pandemic and the institution of confinement measures in March 2020, while the general activity of the market decreased, interestingly and in contrast, the demand for activities related to mobile airtime (measured by the purchase of data and amounts of airtime, and therefore their demand) increased considerably during the period. In our recent article, we used a randomized controlled trial (RCT) to estimate the impacts of a short-term “mobile phone calling credit” among a nationally representative set of low-income households in Ghana during the COVID-19 pandemic. 19.
We partnered with a major local telecommunications company to conduct our experiment by randomly assigning 1,131 people to two candidate communication programs: 40 GHS ($7.0) mobile lump sum credit (376 people) versus 20 GHS ($3.5) monthly mobile credit installments for two months (371 people) versus a control program (384 people); and then measure how these affect people’s ability to mitigate unexpected communication limitations during the pandemic, with impacts on well-being, namely mental health, domestic violence, and consumer spending. The different programs on communication provide a means of examining how communication programs can be delivered: one large single communication transfer versus numerous small deliveries. Conceptually, programs that facilitate communication during unexpected pandemics could be transformative for people, especially if they are constrained by internal constraints. Not having to worry about the inability to stay connected could free up the mental and emotional bandwidth needed to thrive during a pandemic and its prevailing uncertainty. The provision of communication credits during these hardships can also directly free up an individual’s resources that would have otherwise been allocated to communication for other consumption expenses. Our interventions are designed both to relax such communication restrictions and to test their impact on mental health, domestic violence, and consumer spending.
We found five sets of results, with three main ones detailed below:
- Interventions significantly reduced unexpected communication limitations.. That is, 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 communication installment credit program compared to the lump sum credit.
- We found a significant improvement in psychological well-being, which is measured by the Kessler Psychological Distress Scale (K10). Mental anguish decreased (-9.8 percent). Severe mental distress was decreased (-2.3 pp = -24 percent) relative to a control group. The communication installment loan program had larger and more sustainable effects compared to the lump sum loan. Relatedly, only the installment program led to a significant decrease in the overall probability of people threatening their partners by -6.3 percent (but with no impacts on the overall probability of people hitting their partners, our second measure of domestic violence).
- We find no improvement in direct economic well-being. The overall effect is nil for total consumption, which is reassuring as the size and specificity of our intervention were not large enough to significantly change consumption. Only installment communication intervention increased consumption expenses, but the size is very small economically.
The results suggest that an important policy response to improve mental health, especially during periods of unexpected shocks such as epidemics that can negatively affect individual and social well-being, should be to harness access to ICTs and issue communication credits that make it easier for people to the communication. communicate and stay connected to their networks. This is a low-cost and effective means of improving mental health, especially in low-income settings where public spending on health and mental health is low.
