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

According to a 2022 World Health Organization (WHO) report, the COVID-19 pandemic has led to a 25 percent increase in the prevalence of mental disorders, especially anxiety and depression, worldwide. Among the explanations given for this increase are unexpected levels of 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 that contributed to poor mental health during the pandemic. These effects are particularly severe for young people, who have a disproportionately higher risk of suicide and self-injurious behavior. All of these results are troubling, especially given the relatively little available research on mental health and the existing evidence that unexpected economic shocks can negatively affect 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 staggering economic losses, particularly in low-income countries, where people often face unexpected shocks to income and health.

We answer this question by using evidence from a communication intervention in Ghana to examine whether improved communication using information and communication technologies such as mobile phones can improve mental health. In our study, we partnered with a major telecommunications company and implemented a low-cost communication intervention that provided mobile call credits to a nationally representative sample of low-income adults in Ghana during the COVID-19 pandemic. We found that people’s inability to make unexpected calls and the need to borrow SOS airtime and search for digital loans decreased significantly compared to the control group. As a result, the programs produced a significant reduction in mental distress (-9.8%) and the likelihood of severe mental distress by -2.3 percentage points (one quarter of the average prevalence). The effects were only through a reduction in mental stress and there was no impact on consumption expenditure. Simple cost-benefit analysis shows that providing communication credit to low-income adults is a cost-effective policy for improving mental health. Communication—the ability to stay connected—significantly improves mental well-being, and communication interventions are especially valuable when implemented at multiple levels.

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

While research on mental health in general is scarce, there is very little research on mental health in Africa, a region that faces the combined challenges of a high burden of disease and a severely underfunded health sector. According to the 2014 WHO Mental Health Atlas survey, globally 24 percent of countries reported that they did not have or did not implement stand-alone mental health policies. In Africa, the proportion is almost double at 46 percent. Based on a recent Lancet study, according to World Bank estimates, as of 2017, government spending was only 35 percent of total health spending for African countries, much lower than the world average of 60 percent. Africa’s government spending on health is just 2 percent of GDP — less than the global share of 3.5 percent. In addition, out-of-pocket costs as a share of health spending in Africa are among the highest in the world at 37 percent of health spending, compared to 18 percent in the rest of the world. When 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 of mental disorders, including suicide and self-harm – then this presents a very worrying picture. At the same time, globally today there are more people with access to information and communication technology (ICT) such as mobile phones than at any other time in human history, with the majority of the population in Africa having access to a mobile phone (and over 80 percent of the population in Africa’s most populous country, Nigeria, and study country Ghana, have access to a cell phone as of 2015). So can we use this almost universal access to mobile phones to improve mental health? The study answers this question using evidence from Ghana.

An experimental approach: The effects of ICT on mental health

Administrative data on mobile financial transactions from a major provider in Ghana in 2020 sheds light on the potential value of communication during the pandemic. The data shows that since the start of the pandemic and the introduction of lockdown measures in March 2020, while overall market activity has decreased, interestingly and in contrast, demand for mobile airtime activities (measured by purchasing data and amount of airtime, and therefore their demand) increased sharply during the period. In our recent paper, we use a randomized controlled trial (RCT) to assess the impact of a short-term “mobile phone call credit” among a nationally representative sample of low-income households in Ghana during the COVID-19 pandemic.

We partnered with a large local telecommunications company to conduct our experiment, randomly assigning 1,131 individuals to two candidate communication programs: 40GHS ($7.0) one-time mobile credit (376 individuals) versus 20GHS ($3.5) monthly installments for mobile credit for two months (371 individuals) compared to control program (384 individuals); and then measuring how they affect individuals’ ability to mitigate unexpected communication constraints during the pandemic, with impacts on well-being, that is, mental health, domestic violence and consumption expenditure. Different communication programs provide a means of exploring how communication programs can be delivered: A one-time large communication transfer versus multiple small installments. Conceptually, programs that facilitate communication during unexpected pandemics could be transformative for people, especially if they are bound by domestic constraints. Not having to worry about not being able to stay connected can free up the mental and emotional bandwidth needed to thrive during a pandemic and prevailing uncertainty. Providing communication credits during these hardships may also directly free up an individual’s resources that would otherwise be allocated to communication for other consumer expenditures. Our interventions are designed both to alleviate such communication constraints and to test their impact on mental health, domestic violence, and consumption expenditure.

We find five sets of results, with three main ones detailed below:

  • The interventions significantly reduced unexpected communication limitations. This means that our experimental interventions moderated individuals’ inability to respond to unexpected communication needs and remain connected. These effects are larger and more persistent over time for 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 decreases (-9.8%). Severe mental distress decreased (-2.3pp=-24 percent) compared to the control group. The installment communication loan program had larger and more sustainable effects than the one-time loan. Relatedly, the contribution program alone produced a significant reduction in the overall likelihood of individuals threatening their partners by -6.3 percent (but with no effect on the overall likelihood of individuals hitting their partners—our second measure of domestic violence).
  • We find no improvement in direct economic welfare. The overall effect was zero on total consumption, which is reassuring because the size and specificity of our intervention were not large enough to significantly change consumption. Only the installment communication intervention increased consumption expenditure, but the amount was very small economically.

The results suggest that a major policy response to improving mental health, especially during periods of unexpected shocks such as epidemics that can negatively impact individual and societal well-being, should be to increase access to ICTs and the issuance of communication credits. that make it easy for people to communicate and stay connected to their networks. It is an effective and inexpensive means of improving mental health, particularly in low-income settings where government spending on health and mental health is low.

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