International evaluation of modifiable social determinants of health on COVID-related mental health outcomes

Abstract A substantial body of research suggests that the COVID-19 pandemic has contributed to a rising incidence of mental health issues, irrespective of prior history of psychiatric diagnosis. One important driver of this phenomenon appears to be social isolation and loneliness induced by governmental policy responses such as social distancing recommendations, stay-at-home orders, and restrictions on travel. However, results thus far have been mixed across cohorts and geographic regions, and the social and individual factors underlying these differences remain poorly understood. Moreover, existing efforts have largely focused on high-income countries (HIC), which may not generalize to understudied low- and middle-income countries (LMIC), regions most impacted by the pandemic and where 85% of the world population lives. A key opportunity for mitigating future mental health impacts and increasing representation of marginalized groups in COVID-19 mental health research is to leverage individual-level longitudinal data harmonized across existing cohorts to develop a well-powered, large, global evaluation of pandemic-related mental health outcomes. Our proposal capitalizes on existing large international cohorts, establishing a COVID Global Mental Health Consortium (CGMHC) to increase our understanding of the modifiable social and individual risk factors predicting poor mental health in response to the pandemic, and to build an infrastructure to answer broader questions about the local and global determinants of COVID-19 related psychiatric outcomes, ultimately informing public policy, intervention, and prevention strategies. To accomplish this, we will integrate: (1) data from 23 international cohorts comprising mental health, sociodemographic, and social determinants of health (SDoH) from nearly 2.8 million individuals with pre- and post-pandemic assessments; (2) a novel target trial emulation framework to facilitate causal inference about the impact of specific pandemic policy strategies on mental health outcomes; and (3) recent advances in time-series modeling and novel risk prediction methods to understand the heterogeneity of mental health outcomes in response to social restrictions across a diverse range of countries. Our specific aims are to: (1) assemble longitudinal data across global cohorts, harmonizing data for downstream analyses and develop a data visualization platform for the scientific community; (2) characterize pandemic mental health trajectories along with their moderators and evaluate the evidence for a causal impact of social containment policies on psychiatric outcomes. (3) establish and formalize the CGMHC for continued research on the impact of the COVID-19 pandemic on global mental health and SDoH. Successful completion of these aims would provide a unique large-scale global cohort resource for the investigation of COVID-related mental health outcomes, inform intervention and policy strategies to mitigate future adverse impacts, and create an ongoing engine (the CGMHC) for collaborative research that can be sustained through future funding.