Prevalence and changes in boredom, anxiety and well-being among Ghanaians during the COVID-19 pandemic: a population-based study

During a pandemic, the fear of spread and lethality of a disease can create anxiety, stress and depression with lasting psychological impact on the overall health and well-being of the population [1]. To contain the spread of this highly contagious novel coronavirus disease (COVID-19), many countries imposed various preventive measures including social distancing, isolation measures, mandatory and self-quarantine for persons who traveled from affected countries or those suspected to have been in contact with exposed or infected persons. While these containment measures might have contributed to the protection of the public’s health, they have implications for mental health outcomes such as anxiety, stress, boredom, negative religious coping, extreme hopelessness, suicidal ideation, and the well-being of populations at the individual, household and community levels [2].

The scale of the pandemic, the fatality of the disease, the widespread misinformation about the disease, media scrutiny and constant reporting of the deaths rather than recoveries can create fear of the unknown (anxiety), feelings of emotional and physical tensions (stress) which results from the body’s response to threats [3]. These stresses and anxieties are also associated with fears about family safety and contamination, fears about economic consequences such as job losses, fears about wage loss, and an increase in compulsive checking and search for reassurance [4‐6]. These psychological effects could lead to an increase in stigmatization and xenophobia [4]. Next, a pandemic of this magnitude exposes many people to the death of loved ones and friends, including the death of their children, which can be traumatizing [4‐7]. Furthermore, the prolonged time in solitude due to quarantine measures could have detrimental consequences on the psychological well-being of the most vulnerable in society [8‐10]. This has been associated with high stress levels, depression, irritability and insomnia, and boredom as people are limited in their desires and engagement in social activities [8‐11], impacting on their overall psychological well-being.

Psychological well-being refers to the inter- and intra-individual levels of positive function that include one’s relatedness with others and self-referent attitudes such as one’s sense of mastery and personal growth [3]. This takes two forms: subjective well-being, which focuses on the hedonic principles of pleasure and happiness of the individual. The other aspect of psychological well-being is rooted in living a good life or having a good spirit. Subjective well-being is commonly assessed by life satisfaction, the presence of positive mood, and the absence of negative mood [12, 13]. Living a good life or having a good spirit is measured in terms of autonomy, personal growth, self-acceptance, purpose in life, environmental mastery, and positive relatedness. In both cases, a sudden life event or a crisis situation could threaten the well-being of the individual, with contemporaneous health consequences [12, 13].

The fear of getting infected with the coronavirus threatens not only psychological well-being of populations, but also their physical, intellectual, emotional, occupational and spiritual well-being [14]. The effect of the disease on the psychological well-being can vary geographically and across population groups. In low-and-middle income countries where the healthcare delivery system is generally inadequate and emergency health care may be limited, the presence of a pandemic such as the COVID-19 poses a real threat [15], which may affect mental health and well-being [16]. To date, there is a dearth of research on the effect of the pandemic on the psychological well-being of populations living in low- and middle-income countries although there is a burgeoning evidence of a decline in people’s living standards and overall well-being [10‐17]. Emerging studies on COVID-19 have focused primarily on the factors influencing the well-being of populations in high income countries. Evidence of the effect of the COVID-19 pandemic on the mental health and well-being in low-and middle-income countries is critical for interventions, which could facilitate the prevention of the long-term impact of the pandemic in these countries. This study examined prevalence and changes in boredom, anxiety and well-being among Ghanaians before and during the outbreak of the COVID-19 pandemic.

To our knowledge, this study is the first to investigate the predictors and conditions around COVID-19 pandemic on boredom, anxiety, and well-being in Ghana’s population. Our data suggest an increase in symptoms of boredom and anxiety, and a decrease in well-being during the COVID-19 pandemic compared to before COVID-19. These findings are consistent with previous studies which suggest that public levels of anxiety increase during major disease outbreaks or pandemics [28‐30].

The increase in anxiety and boredom is an important finding in understanding the mental health conditions of Ghanaians during the COVID-19 pandemic. The fear of contracting the disease or dying, stigmatization against persons who contract the disease or their close acquaintances, shortage of essential supplies, the uncertainty of the pandemic and feeling helpless during the lockdown period may have created anxiety [6]. Similarly, the strict social distancing regulations, isolation and quarantine, and partial lockdowns associated with the COVID-19 protocol in Ghana might have reduced social contacts and can explain the increase in boredom. Thus, disruption in social contacts is likely to have contributed to the anxiety in the population [4‐6]. Boredom can lead to loneliness and this can have indirect effect on population health; for example, engagement in health compromising behaviours such as substance use/drug abuse may have direct effects on psychological health [31].

Some earlier studies also reported increase in boredom during the COVID-19 pandemic [32, 33]. In the Ghanaian society where close social contact is pervasive in the culture [34], isolation, quarantine, and lockdown can be very traumatic to the people thereby creating negative effects on their mental health in general [35]. Boredom can lead to surfing of social network sites, which usually carry “doomsday” news, as evident with the COVID-19 pandemic [36, 37]. Boredom can also lead to poor psychological health [32].

Next, our study findings suggest a significant amplification of symptoms of psychological disorders in the Ghanaian population during the COVID-19 pandemic. Specifically, the results attest to the worsening of experiences related to boredom and anxiety during the pandemic relative to participants experiences before the pandemic. In both cases, those with existing medical conditions experienced increased forms of boredom and anxiety symptomatology. Furthermore, anxiety scores before the pandemic and having prior medical condition were found to be associated with a decline in the well-being of participants. Furthermore, people who were extremely concerned about the disease had increased anxiety whereas older people experienced a decline in boredom and an increase in well-being.

Another significant finding, related to the effect of pre-existing health conditions on the well-being of the Ghanaian population. Indeed, prior studies show that people with pre-existing comorbidities have a higher risk of severe COVID-19 infection or related deaths [38, 39]. People with underlying medical conditions might have initiated self-imposed quarantine, social and physical distancing measures long before official lockdowns were imposed. Consequently, those with a medical condition might have longer social disruptions and subsequently higher levels of boredom than those without pre-existing medical conditions. This is consistent with the findings in our study, as participants with pre-existing chronic conditions had higher boredom and anxiety scores but lower well-being scores. It is also possible because persons with pre-existing medical conditions have an increased risk of COVID-19 infection and death. Further research that investigates the mechanisms linking pre-existing chronic conditions, boredom and anxiety during the pandemic will shed light on the present findings. Additionally, boredom during a disaster is known to lead to stress and anxiety [40, 41]. Hence, it is not surprising that we found increased anxiety among people with medical conditions during the pandemic.

Surprising to the research team, participants with higher levels of education including those with post-secondary to doctoral education had lower well-being scores compared with those having secondary school or lower levels of education. Also, an increasing change in well-being during the pandemic was found among those who had post-secondary education while those who had Bachelor’s degree had a decreasing change in their well-being when compared to those with secondary or lower education. These findings are at odds with the social gradient of health theory which suggests that those with poor social status have worse health while those with a better social status would have better health outcomes. In this study, the opposite is what is noted as those with lower educational levels have better well-being than those with Bachelor’s or doctoral degrees. While we did not investigate this finding, it is possible that the poorly educated had become immune to social and economic shocks facilitating their ability to cope and respond adequately to the COVID-19 due to availability of interpersonal support or resources [42] while the well-educated, who may have experienced an abrupt change in their income and style of living had difficulty adjusting to the pandemic, leading to a decline in their well-being. This notwithstanding, these counterintuitive findings warrant further investigation.

Furthermore, our data suggested that males had lower levels of anxiety and boredom than females. This was consistent with earlier studies [42‐44]. One plausible explanation is that females in this context may spend a great deal of time worrying about the pandemic because of their caring role at home which might have increased during the pandemic as schools were closed and children stayed home. Our finding however differed from a Chinese study which found no difference in anxiety disorders and mood by sex during the COVID-19 pandemic [45]. Also, married persons had a decreased change in anxiety compared to those who were single. This is consistent with the buffering hypothesis which suggests that under some conditions social support protects individuals from the harmful effects of stressful conditions [42]. In this study, our findings show that spousal support may have served as a buffer against the stress and anxiety associated with the pandemic.

Next, our study also highlights the validity and reliability of existing scales which can be adapted successfully for use in research on mental health correlates of COVID-19. In this study, we successfully adapted, tested and validated the hypothetical factor structure of the boredom proneness scale, the generalized anxiety disorder scale, and the WHO-5 well-being scale to COVID-19 conditions. These scales exemplified satisfactory model fitness and acceptable reliability thresholds, making them user friendly for studies related to infectious diseases.

Generally, our study provides important findings which can inform preparedness for future outbreak; however, there are some limitations which provide opportunities for future research. The cross-sectional nature of the study does not allow for causal inferences. Future studies may consider a longitudinal study with a randomized controlled design to establish causal effects. Indeed, the study design in subsequent research should actually assess participants health status before and during an outbreak. Second, because of the lockdown and to avoid the possible spread of the virus during data collection, the survey was web-based. Therefore, there is a possibility of selection bias which should be taken into consideration in the interpretation of the findings. However, web-based surveys are valid and reliable [46]. Also, best practice suggests the use of a longitudinal study with a randomized controlled design that actually assessed participants before and during the pandemic. However, in this study, measures on participants psychological well-being were assessed at a single timepoint and based on a retrospective assessment, which may have been biased either as a result of social desirability or forgetfulness. Finally, our study was limited to adults in their reproductive ages with the exclusion of minors. We propose that future studies should investigate the effect of the pandemic on the mental health of other populations such as school children.

These findings underscore the indirect associations of the COVID-19 pandemic on the mental health and well-being of the Ghanaian population. In particular, people who had prior medical conditions were at increased risk of poor psychological well-being. This study has implications for policies and programs aimed at reducing the surge in COVID-19 infections. Principally, it highlights the need to provide psychological interventions especially for those with existing high risk COVID-19-related medical conditions, in addition to the routine precautionary measures. Public health preparedness towards infectious disease outbreaks should include mental health interventions in order to avert the long-term effects of such catastrophes on health and well-being.