This study employed the methodological framework by Arksey and O’Malley to conduct the scoping review.¹¹ The steps followed were: identifying a clear objective(s) to be addressed in this review; identifying relevant literature by conducting a literature search on EBSCOhost and Google Scholar electronic databases; screening of literature to be used in the synthesis and data extraction and recording and reporting the findings of the synthesis and review.

Relevant articles and literature were searched from EBSCOhost and Google Scholar electronic databases; the search engine was set during the early stages of the COVID-19 pandemic from November 2019 until May 2021. An academic search of keywords was conducted using Boolean operators ‘OR, AND’ and search strategy, title (TI) (COVID-19 OR coronavirus OR 2019-nCoV OR nCoV OR ‘SARS-Cov2’) AND (‘healthcare workers’ OR ‘health care assistan*’ OR ‘general public’ OR ‘adult general population’ OR ‘general populace’ OR ‘Ordinary people’) AND TI (‘mental health’ OR ‘mental stab*’ OR ‘mental-hygiene’ OR ‘mental disab*’). One researcher conducted the electronic search and a librarian assisted in finalising the key term search strategy and obtaining relevant study documents, which were not easily accessible to the researcher.

The inclusion criteria included all primary research literature published on the mental health impact of COVID-19 on HCWs and the adult general population. Only studies that focussed on the African population and published during November 2019 and May 2021 were included in this review. All study designs with only articles written in the English language were included. The literature that did not meet the above criteria and commentaries and editorials were excluded.

Once the librarian had completed the comprehensive literature search, the researchers went through the literature to identify eligible studies. Duplicate studies were excluded from the selected studies. A total of 143 publications were retrieved from EBSCOhost (138) and Google Scholar (5) database platforms. Sixteen (16) duplicate publications were excluded from the review. Of the 127 remaining publications, 88 studies were excluded as they did not meet the inclusion criteria as set out in the study’s eligibility criteria. After reading full texts of the eligible 39studies, 34 more were excluded as they did not meet the methodological or geographical inclusion criteria. Therefore, five publications were included in this review study. This screening process has been indicated in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram as shown in Figure 1.

Once the screening process was completed, the relevant publications were extracted and populated in a data extraction sheet under the domains: author, study design, time period of study, focus, symptoms or signs, risk factor, assessment tool and country (Table 1).

The data were analysed using descriptive analysis for the five studies that were included in the review. In the first analysis, the studies were described by study population, region or country and study design. A second analysis described the impact of COVID-19 on each study population. This was done by identifying the mental health conditions that affected each of the HCWs and adult general population as well as the associated risk factors. Where data was available, the prevalence for each condition for each study population was described. The final analysis compared the impact of COVID-19 on mental health between HWCs and the general population by conditions and their risk factors.

Ethics waiver was obtained from the Health Sciences Research Ethics Committee, University of the Free State (reference number UFS-HSD2021/0501/2505). There were no human participants, and therefore no consent was violated.

The five studies that were included in the review were conducted in South Africa; 31 global countries including 10 sub-Saharan African countries (Ethiopia, Kenya, Lesotho, Mozambique, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Zimbabwe), globally including North Africa and globally including four Southern African countries (Angola, South Africa, Namibia and Uganda). One study used mixed methods (study 1), while the others used either quantitative (studies 2, 3 and 5) or qualitative study designs (study 4). In terms of the study population, four studies focussed on the adult general population and one studied on HCWs (Table 2).

The conclusions from the data extraction sheet were summarised and compared under the domains: HCW mental health impact of COVID-19, adult general population mental health impact of COVID-19 and HCW mental health impact versus adult general population mental health impact of COVID-19.

From the five studies included in this review, one study looked at HCWs’ mental health impact of COVID-19, four looked at the adult general population mental health impact of COVID-19. It is reported that in the 2097 HCWs recruited from 31 LMICs, the prevalence of anxiety was 60% and depression was 53%, which were mainly in mild and moderate levels. These conditions are reported to have emerged as a result of physical exhaustion, loss of infected patients, concern for personal safety and passing of the COVID-19 infection to their loved ones (Table 3).

Among the adult general population, a higher perceived risk of COVID-19 infection was associated with greater depressive and anxiety symptoms in individuals. It is reported that these mental health conditions were accompanied by a five-fold increase in the number of suicide cases from 418 before the pandemic to 2 114 during the pandemic because of joblessness. In South Africa, it is indicated that suicide cases were further exacerbated by the low numbers of mental healthcare service usage and limited access. It is reported that only 27% of patients with severe mental illness received treatment and there were only 0.31 psychiatrist per 10 000 uninsured population (Table 3). The mental health distress among the adult general populations is said to be related to financial insecurity, fear of contracting infection, rumination and isolation. The risk factors identified were childhood trauma, poor diet and sleep, lack of social support, low levels of education and psychological inflexibility, living alone or in a nursing home or existence of chronic diseases (Table 3).

The results of this study indicate a significant impact of COVID-19 on the mental health of HCWs. According to Xiong et al.,⁴ there has been a rise in psychological distress among HCWs. This is also evidenced in Htay et al.¹⁶ global perspective study, which included 2097 HCWs from 31 LMICs and revealed that HCWs’ mental health was impacted by the COVID-19 pandemic. Another study agreed with Htay et al.¹⁶ that HWCs were mainly impacted by the COVID-19 pandemic because of loss of their infected patients, concern over their own personal safety and fear of passing infections to family members.³ A different study showed that battling COVID-19 in the frontlines made HCWs vulnerable to psychological distress with them exhibiting high levels of depression, stress, anxiety, distress, anger, fear, insomnia and PTSD.¹ These findings support those from previous outbreaks such as the Middle East Respiratory Syndrome (MERS) in 2006 and the Severe Acute Respiratory Syndrome (SARS) in 2011, which showed that frontline HCWs were afraid of stigmatisation in addition to the fear of infecting family members.¹ This further contributed to their psychological distress.

According to Kim et al.,¹⁰ higher perceived risk of COVID-19 infection was associated with greater depressive symptoms in individuals. There was markedly an increase in the number of suicide cases as shown in a Canadian study with a five-fold increase of suicide cases during the pandemic as a result of joblessness.⁴ In South Africa, suicide cases were further exacerbated by the low numbers of usage and limited access to public mental healthcare.¹⁰

The findings of this study indicate that the impact on HCWs’ mental health has relatively been similar to the impact on the adult general population.³ Furthermore, this impact has been traced back to previous epidemics such as SARS in which both HCWs and the adult general population displayed signs of anxiety. Both HCWs and adult general population were plagued by concerns and fears of infecting their family members and loved ones. In addition to loved ones, HCWs had the added weight of being concerned about their patients, long working hours as well as media scrutiny.³

Among the adult general population, adults such as parents have experienced the pandemic differently, for example, they have had to endure role confusion as they had to double as both care providers and home-school teachers.⁵ This has led to higher parenting dissatisfaction and lower distress tolerance.

Although suicide cases appear to have been neglected before COVID-19 as they were not necessarily in the spotlight, these cases appear to have remained equal and neutral during the pandemic because of the social support received by individuals speedily.⁵ However, that may be because of the scarce data from previous pandemics. Nonetheless, depression that was noted as a response to loss was precipitated during COVID-19 primarily because of the loss of loved ones.⁵