Mental health and life-course shocks in a low-income country: Evidence from Malawi

SSM Popul Health. 2022 Apr 26:19:101098. doi: 10.1016/j.ssmph.2022.101098. eCollection 2022 Sep.

Abstract

Economic insecurity has been widely hypothesized to be an important determinant of mental health, but this relationship has not been well-documented in low-income countries. Using data from the Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC), we investigate the association of negative economic shocks with mental health outcomes such as depression and anxiety among adults aged 45+ years living in a low-income country. Using fixed effects estimates that control for time-invariant unobserved individual heterogeneity, we find that increased economic instability caused by events such as death of a family member, yield loss, or income loss is positively associated with worse mental health outcomes as measured by the PHQ-9 and GAD-7 instruments. Our results suggest that costly economic events are a key component to worsening mental health in settings characterized by pervasive poverty and underscore the importance of mental health as a public health and development target.

Keywords: Anxiety; Depression; Economic shocks; GAD-7, General Anxiety Disorder-7; LIC, Low-income country; LMICs, Low- and middle income countries; MLSFH, Malawi Longitudinal Study of Families and Health; MLSFH-MAC, Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health; Malawi; Mental health; PHQ-9, Patient Health Questionnaire-9; Poverty; SSA, Sub-Saharan Africa; Sub- saharan Africa; WHO, World Health Organization.