How can information and communication technology be used to improve mental health?

According to a 2022 World Health Organization (WHO) report, the COVID-19 pandemic led to a 25 percent increase in the prevalence of mental disorders worldwide, particularly anxiety and depression. The explanations for this increase included the unexpected stress caused by social isolation during the pandemic. Additionally, limitations on people’s ability to work and seek support from family, friends and loved ones were also major stressors contributing to the deterioration in mental health during the pandemic. These effects have been particularly severe for young people, who are at disproportionately higher risk for suicide and self-harm. All of these findings are worrying, especially given the relatively little research available on mental health and the existing evidence that unexpected economic shocks can negatively impact mental health. What policy interventions could improve mental health outcomes? The answer to this question is of urgent policy interest, as mental disorders result in staggeringly large economic losses, particularly in low-income countries where people often face unexpected income and health shocks.

We answer this question using evidence from a communication intervention in Ghana to test whether improved communication using information and communication technologies such as mobile phones can improve mental health. In our study, we partnered with a large telecommunications company and implemented low-cost communications interventions that provide cell phone credit to a nationally representative group of low-income adults in Ghana during the COVID-19 pandemic. We find that individuals’ inability to make unexpected calls and borrow SOS airtime and seek digital credit decreased significantly compared to a control group. As a result, the programs led to a significant reduction in mental stress (-9.8 percent) and the probability of severe mental stress by -2.3 percentage points (a quarter of the mean prevalence). The effects occurred only through the reduction in mental distress, and there was no impact on consumer spending. A simple cost-benefit analysis shows that providing communication credit to low-income adults is a cost-effective mental health intervention. Communication—the ability to stay connected—improves mental well-being significantly, and interventions on communication are particularly valuable when delivered in multiple installments.

Context: The state of mental health and ICT in Africa and globally

While research on mental health is generally sparse, there is very little research on mental health in Africa, a region that faces the common challenges of a high burden of disease and a severely underfunded health sector. According to the 2014 WHO Atlas of Mental Health Survey, 24 percent of countries worldwide reported that they do not have or have not implemented independent mental health strategies. In Africa, the proportion was almost twice as high at 46 percent. Based on a recent Lancet study, the World Bank estimated government spending in 2017 was just 35 percent of total health spending in countries in Africa, much less than the global average of 60 percent. Africa’s government spending on health is just 2 percent of GDP – less than the world’s 3.5 percent. In addition, out-of-pocket spending as a proportion of health spending in Africa was among the highest in the world at 37 percent of health spending, compared to 18 percent in the rest of the world. If we add this to the fact that Africa has the youngest population in the world, with 60 percent of the population under the age of 25 – and that young people are often identified in the mental health literature as being at high risk for mental health disorders, including suicide and self-harm – then this presents a very worrying picture. At the same time, more people worldwide now have access to information and communication technology (ICT) such as mobile phones than at any other point in human history, with the majority of the population in Africa having access to a mobile phone (and more than 80 percent of the population in Africa’s most populous country). Nigeria and the study country Ghana (as of 2015) have access to a mobile phone). So, can we use this near-universal access to cell phones to improve mental health? The study answers this question using evidence from Ghana.

An experimental approach: The impact of ICT on mental health

Administrative data on mobile financial transactions from a major provider in Ghana in 2020 highlights the potential value of communications during the pandemic. Interestingly and in contrast, after the outbreak of the pandemic and the imposition of lockdown measures in March 2020, while overall market activity declined, the data shows that demand for activities related to mobile airtime (measured by the purchase of data and airtime amounts, and thus their demand) increased sharply over the period. In our most recent article, we use a randomized controlled trial (RCT) to estimate the impact of short-term “mobile phone credit” on a nationally representative group of low-income households in Ghana during the COVID-19 pandemic.

We partnered with a large local telco to conduct our experiment, randomly assigning 1,131 people to two candidate communications programs: 40GHS ($7.0) mobile flat-rate credit (376 people) versus 20GHS ($3.5) monthly Installing mobile credit over two months (371 people) versus a control program (384 people); and then to measure how these affect individuals’ ability to mitigate unexpected communication limitations during the pandemic, with implications for well-being, i.e. mental health, domestic violence and consumer spending. The various communication programs provide an opportunity to examine how communication programs can be provided: one-time large communication transfer versus numerous small installments. Conceptually, programs that facilitate communication during unexpected pandemics could be transformative for people, especially when bound by internal constraints. Not having to worry about the inability to stay connected could free up the mental and emotional bandwidth needed to weather a pandemic and its prevailing uncertainty. Providing communication credits during these hardships can also directly free up a person’s resources that would otherwise have been allocated to communication for other consumer spending. Our interventions aim to both relax such communication restrictions and test their impact on mental health, domestic violence, and consumer spending.

We find five groups of results, three of which are listed below:

  • The interventions significantly reduced unexpected communication limitations. That is, our experimental interventions mitigate individuals’ inability to meet unexpected communication needs and stay connected. These effects are greater and more sustainable over time with the installment communication loan program compared to the lump sum loan.
  • We find a significant improvement in psychological well-being, which is measured using the Kessler Psychological Distress Scale (K10). Mental stress decreased (-9.8 percent). Severe psychological distress decreased compared to a control group (-2.3 pp = -24 percent). The installment loan program had greater and more lasting effects than the lump sum loan. Accordingly, only the installment program resulted in a significant -6.3 percent reduction in the overall likelihood of people threatening their partners (but with no impact on the overall likelihood of people hitting their partners—our second measure of domestic violence).
  • We see no improvement in direct economic well-being. The overall effect on overall consumption is zero, which is reassuring since the size and specificity of our intervention were not large enough to meaningfully change consumption. Only the rate communication intervention increases the consumption expense, but the size is very small economically.

The results suggest that an important policy response to improve mental health, especially in times of unexpected shocks such as epidemics that can negatively impact individual and societal well-being, should be to use access to ICT and provide communication credit that make it easier for people to communicate and stay connected to their networks. This is an effective and cost-effective means of improving mental health, particularly in low-income settings where government spending on health and mental health is low.

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