INTRODUCTION

The global Covid-19 pandemic has shaken the whole world since the beginning of 2020 ( Holmes et al., 2020 ) . Society was introduced to the novel concept of self-isolation ( ) which mentally traumatised the population, and the regular functioning of the society was severely affected ( Editorial, 2020 ) . Millions of people died and committed suicide during the isolation phase ( Rogers et al., 2020 ) and global mental health ( ) was adversely impacted ( Vigo et al., 2020 ) ( Adhanom, 2020 ) . The United Nations (UN) formulated a policy to address these global mental concerns ( UN, 2020 ) , but failed to constructively intervene ( Mahmood et al., 2020 ) ( Sachs et al., 2020 ) . Marginal communities were neglected and had to go through this disastrous context without any public provision ( Mediavilla et al., 2021 ) .

However, many believe the worse is yet to come. After another unstable year ( Jowarder, 2022 ) , the economy is looking uncertain. We are on the verge of a looming economic recession ( Conerly, 2020 ) . According to a published research report, financial experts are predicting that this economic depression is inevitable ( ) . It is not unexpected considering how the industrial sectors had to sit idle during the COVID-19 outbreaks, but this is a potentially alarming context for the global community which is still trying to recover from the pandemic aftermath ( ) . Financial experts are advising us to emphasise savings as we are heading toward a potential economic disaster. Although the global population has gone through significant changes such as online schooling and the introduction of novel technologies ( Drew et al., 2020 ) , this has not reduced global mental health conditions such as anxiety and depression ( D’Agostino et al., 2020 ) . In this scenario, experts are worried about the emerging context of a financial depression that will impact the mental health of already emotionally vulnerable and fragile populations ( ).

METHODOLOGY

This research conducted a qualitative analysis followed by cross-national interviews of medical professionals. To perceive the global context, 35 leading health experts from multiple continents, each having more than 10 years of practical experience in treating mental health traumas, were selected. Many participants were directly involved in spearheading medical campaigns during the pandemic crisis at national levels in various countries including the US, India, and Nepal. Interviews were conducted virtually via Zoom software and two live interviews took place in the US. The virtual interviews took place between October 15 to January 5 according to the regional time of the participants. The physical interviews as well as the FGD organised in the US were conducted in the described timeframe. Ethics approval committee’s acceptance was obtained to ensure the highest quality study. Four FGDs were conducted to explore this phenomenon in depth.

This study was also undertaken in accordance with the Declaration of Helsinki and with Australian National Statement on Ethical Conduct in Human Research. As the study progressed, participants began to share valuable information regarding the global mental health context along with their prior experience and expertise which assisted the researcher to analyse the context for determining the results.

RESULTS

Human psychology is fragile and cannot be accurately assessed using conventional standards. While many solutions can be proposed, the effectiveness will only be achieved if the intended population reaps the benefits. In our discussion, health experts focused on the diverse mental concerns which may prevail in 2023.

All experts agreed that depression is a factor associated with the loss of monetary assets. Dr Richardson has been treating psychological traumas for 10 years in the US. During COVID-19, he led the mental awareness campaign to prevent suicides across North America. He believes that depression will be more frequent than ever since people are still recovering from the devastating aftermath of the global pandemic.

Dr Nelson from the US, a licensed clinical psychologist with 15 years’ experience in treating post-traumatic stress disorders (PTSDs) also agreed. According to Dr Richardson’s statement:

“2020 was a traumatic experience for the world. We have been exposed to psychological threats while trying to cope without social communication which deteriorated our mental health conditions gradually. Though various efforts were made, these did not significantly improve the conditions. With the news of an upcoming economic recession, psychological conditions will further destabilise. In my practice recently, more patients are coming showing symptoms of hyper-anxiety. It is simple to assume this condition is the indirect result of future economic uncertainty.”

Dr Cristopher from Colombia, and Dr Jenna from Australia were directly involved with a UN programme to formulate policies to address the mental challenges for African nations and Asian countries at the beginning of 2021. The duo believes it is not possible to intervene when negative news is circulating in the media. In our interview, these health experts sharply criticised the media outlets and elaborated that hypertension is becoming more common among adults with the spread of adverse information. If there is an economic recession, it can have a lethal effect even if a person prepares adequately. Both agree that hypertension along with severe depression will be more common if the economy collapses. As Asian countries neglect their mental healthcare systems, it will pose a challenge if an economic crisis takes place in society. According to their perspectives, Western people would also be impacted as they tend to live alone more frequently and in smaller households, so therefore have fewer interactions. Having a pessimistic period can prolong the recovery in the post-pandemic period.

Indian psychologists Dr Raghavan and Japanese psychiatrist Dr Zhang conducted 30 mental awareness campaigns across Asia including in India, Nepal, Myanmar, Thailand and Bangladesh. From their observations, they found that during 2020 many individuals were made homeless – making them more vulnerable to mental health disorders.

The concept of working from home on a more permanent basis did not come into effect immediately so this left many people without money, especially in Southeast Asian nations such as Bangladesh, Nepal, India, Bhutan, Malaysia, mainland China and Hong Kong. Although studies were conducted globally to assess the mental health impacts, these have not reduced the traumas. The respondents believed if this context arises again, this will immediately create a vulnerable community in the Asian countries who will experience severe mental anxiety.

From our study, we found that experts believed that African citizens would be affected the most. As the data from World Bank and United Nations Development Program (UNDP) revealed African countries as the most affected nations, both in mortality rate as well as in basic provisions ( Whetton, 2009 ; Visser, 2006 ) . Even during the pandemic, the citizens received the least amount of provisions compared to the counterparts of the world.

It is commonly perceived that children are immune to mental traumas since their cognitive functions are not well developed to assess the trauma. However, COVID-19 has shown that even children can be left with emotional distress ( Fegert et al., 2019 ). In this regard, all participants of this study said that young people are going to be adversely impacted worldwide, regardless of geographic location.

Many explained that African healthcare systems often don’t have the necessary means to provide mental health assistance. Most of the citizens expected to return to normalcy, however, they don’t have any timeframe. It was evident from the participants that government play a pivotal role in their health policies since fund distribution is centrally governed by the officials. In our FGDs, psychiatrists expected that by the end of 2025, the situation will return to prepandemic, however, the looming economic conditions may have a profound impact on parents due to financial uncertainty. This in turn will affect children. The respondents also believed it will affect their cognitive development. It is of utmost importance that children socialise to reduce stress and to cope with social challenges. However, the repetition of crises may pose a threat to social development, especially in South Africa. The health experts forecast 2023 is going to be the worst year if the economic predictions turn true. In this aspect, young people will have a difficult period addressing mental challenges in African nations.

In our FGDs, it was evident that eating disorders are going to be common at the beginning of 2023 all across the nation. Notably, diseases and psychological disorders are common among obese children. Dr Fontenot from Spain has been treating children’s obesity due to increased anxiety and depression since 2006. In her long career, she has come across various medical cases of trauma leading to severe consequences. She explains:

“People tend to eat more during distress. This has become a normal trend in society to cope with anxiety regardless of culture. However, children are the worst victims. They tend to view adults as a role model and when exposed to such adverse habits, it gradually takes away their goodwill of consumption. However, they initially reject food but soon turn to overconsuming as a means of getting over the depression. I have been treating obese children for a long time but since the beginning of the pandemic, it has gotten worse. I fear that 2023 will be the most difficult year for psychologists to treat mental wounds.”

The European Union (EU) has been dealing with Brexit along with the global pandemic. The term “Brexit” literally refers to taking exit from the EU, a body of which Britain has been a longstanding member. Not only has Britain provided billions of pounds as compensation to the EU, but it has been also suffering since Brexit as it affected economic stability, which in turns impacts healthcare provisions. We talked with four psychologists and one director of the Mental Association who explained that Europe is adequately prepared to tackle the concerns, especially Hungary, France, Italy, Croatia, Germany, Denmark and Finland. From practicing adequate measures to stocking up medical equipments to render emergency assistance, these nations are leading the medical campaigns in the EU.

From the discussion, we found they have deployed medical teams at high schools and at university level to monitor students’ mental health status. The governments are spending considerably to develop online solutions to boost the spirit of returnees to education after the pandemic. Should the economy go down, they are also formulating policies to maintain the normalcy of society without affecting mental health or causing panic.

The following table illustrates the major psychiatric disorders which are anticipated to be observed among the population based on continental locations. The data has been generated by the interviews and FGDs with the experts, along with examining the relevant data.

Table 1 illustrates the major psychological impacts that global citizens are expected to face from diverse continents. In Asia, we observe evidence of every major psychological distress such as anxiety, hypertension and even insomnia. Given the socioeconomic conditions of most Asian countries, it is not surprising that developing nations will have to struggle the most to get out of this situation. African citizens are expected to experience chronic tension and acute depression. From experts’ perspectives, we can find Europe to be experiencing a turbulence period consisting of anxiety and depression. Given the present condition of Europe based on the Russia-Ukraine war (starting February 2022) and an ever-increasing price of gasoline, we can understand that citizens of UK and European nations will have a difficult time coping with these changes.

Nonetheless, North America, South America and Australia exhibits the least psychological concerns in the indicators whereas Antarctica shows none since it is the least populated continent. Notably, depression can be expected to become more common throughout the world in 2023 regardless of geographical locations, and there is predicted to be a rise in obsessive-compulsive disorder (OCD).

With the progression of the interviews, the experts elaborated on how the pandemic has affected global demography. Many respondents actively participated in cross-national research with professionals from other countries. Interesting information was found from those studies such as adults who have lost employment in the pandemic demonstrated symptoms of PTSD. Inadequate levels of government support hindered national support. It has also been reported especially among Asian countries such as Bangladesh, India, Nepal, and Myanmar where mental health is considered a taboo, no assistance was provided to uplift spirits during the isolation period. Six respondents stated that measures undertaken by Western nations included mental crises as an important factor while the scenario remains unchanged for Eastern countries. It is evident as most campaigns focused on prioritising the importance of isolating from the virus with no focus on the mental helath aspects of the crisis. In this regard, global mental health suffered as the result of governmental neglect due to emphasis on the physical well-being of people based on a multitude of factors. This paper also revealed that not all countries have undertaken similar measures.

DISCUSSION

Mental health directly impacts the physical well-being of a person. The novel COVID-19 pandemic has forever altered society globally. As people began to spend time indoors without human communication, it has taken a toll on their mental health. Death rates soared and suicides were common, especially among the youth. While the officials were expecting normalcy, economic conditions are signalling a recession which has become a concern for medical professionals.

From the interviews, we can find the diverse impacts that society is experiencing. The most vulnerable citizens are from low to middle-income countries. As these nations have limited resources, addressing mental concerns is often a neglected area. Individuals from these countries were showing symptoms of hypertension while anxiety was common among adults. The indirect result was eating disorders being common since 2020, especially among children from Southeast Asian regions, notably from India and Malaysia.

The South American and North America countries have performed significantly better. Mental health diseases were observed in at least several countries which was also evident from the World Health Organization’s report ( Torres et al., 2022 ; Tandon, 2020 ; Cenat et al., 2022 ) as well as reported in scholarly articles ( Guerrero et al., 2022 ; Crivelli et al., 2021 ; Gato et al, 2021 ) .

Various campaigns took place to uplift the spirits. However, experts predict increased anxiety will prevail from the beginning of 2023. Many experts believe the spread of potential recession will worsen the existing mental health conditions. However, improved measures addressing mental health will improve the situations gradually, but to some extent, professionals will have to deal with psychological concerns such as OCD and overthinking in the future should uncertainty arises.

The EU was found to be the most prepared. It has addressed this concern and has put in place measures to mitigate the mental health crisis. It is also prepared for the economic recession. This explains why citizens are feeling safer knowing they are in good care. From our findings, it collaborates when we learn of various awareness campaigns taking place at the national levels. Other nations can learn from these examples and follow these strategies.

CONCLUSION

Mental health is a critical factor in determining the well-being of society. From our research, it was evident that health experts are forecasting a potential outbreak of a variety of psychological disorders at the beginning of 2023 considering the current economic predictions. This research identified that not all countries had taken adequate measures to address the mental health challenges for the upcoming situations. Moreover, this study reveals the different physical and psychological symptoms which may prevail in 2023 such as hypertension, anxiety, suicidal thoughts, and even mental breakdowns. It is the responsibility of the government to implement strategic actions to promote and maintain the highest level of mental well-being in society. Asian and African countries should undertake the necessary steps to remove the social stigma associated with mental health disorders and promote a healthy lifestyle. While North and South American countries have earned respect for addressing the mental health crisis, the rest of the globe is yet to follow in their footsteps. Further research is encouraged, and intermittent follow-up, to monitor the global mental health context.

DECLARATIONS

Acknowledgement: the author expresses gratitude to the clinical psychologists, psychiatrists and participating medical professionals for sharing their professional insights and practical lessons learned during their services give during the global pandemic.

Data ava ilability statement: primary data was gathered by the author. The secondary data that supports the findings of this study are openly available in the listed references.

Disclosure statement: no potential conflict of interest was reported by the author.

Ethics approval and consent to participate: the Institutional Review Board (IRB) of Rice University approved this research (Approval Ref: HGR-2Y-FDG). All the interviews conducted in this research have been carried out with informed consent.

Funding: the author received no financial assistance for the research/authorship or the publication of this article.

Informed consent: Informed consents were obtained from the participants before the research was conducted. All procedures performed in this study involving human participants followed the ethical standards with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

ACKNOWLEDGEMENT OF EXPERTS’ CONTRIBUTIONS

All the participants were informed adequately, and the study followed Helsinki 1964 protocols and its later amendments for involving human participants with ethics approval from Rice University.

Names are provided in sequence as per the interviews conducted. Affiliations are given as of the research conducting phase between 15 October 2022 to 5 January 2023 by the author.

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