Discussion
COVID-19-related stigmatisation, post-traumatic, post-traumatic stress
EVENTS, RECRUITMENT, DISORDERS
This is a cross-sectional observational research that examines the psychosocial impacts of the COVID-19 pandemic across seven LMICs using a novel CPIS and measures of well-being, psychological distress, post-traumatic stress and post-traumatic growth. Despite LMICs being significantly impacted by COVID-19, few studies have been published from these regions. This study will therefore provide findings to address this important gap in the literature. The multi-centre design of the study will allow comparisons between the empirical distributions across countries. Furthermore, by including individual and country-level factors, multi-level modelling will enable us to understand the role of demographic and study variables. The findings have the potential to contribute to the understanding of the psychosocial impacts of the COVID-19 pandemic in countries that have not been well studied and to allow cross-cultural, multi-site comparisons.Several multinational studies have been carried out examining the psychosocial impacts of COVID-19 among the general population using either standardised measures aloneAgainst this background, our study will comprehensively examine the psychosocial impacts of COVID-19 using standardised measures in combination with novel CPIS across seven LMICs examining both sociodemographics and study variables. Our study has the potential to make several contributions to the existing literature. The 32-item CPIS is a novel scale that comprehensively assesses the psychosocial impacts of the pandemic, with the scale design allowing assessment of both the number of exposures to specific pandemic-related life events and the associated level of stress related to each of these events. The psychosocial impacts of the pandemic-related life events will be examined cross-culturally in this study, which distinguishes it from the existing multinational studies that mainly focus on the prevalence of mental health disorders and do not examine the adverse personal, social and economic consequences that followed COVID-19 pandemic. Importantly, the multi-lingual nature of the study is an important contribution. An underlying factor to the lack of studies in LMIC has been the lack of availability of measures translated into appropriate languages, which this study addresses. Hence, our findings will contribute to a growing body of mental health measures that can be used for cross-cultural comparison.In addition, the study will also correlate outcomes on the CPIS with other validated measures of well-being and psychological distress and provide essential psychometric information on scale reliability and validity. Although, using pandemic-related scales in combination with standardised measures has been adopted by a few studies,There are, however, limitations associated with the proposed study design. This study makes use of a novel CPIS developed during the COVID-19 pandemic and a cross-sectional design. As a consequence, there is no prepandemic comparison data. Repeated use of the CPIS over time and during different phases of the pandemic is needed to inform whether the CPIS is responsive to changing impacts of the pandemic. As the data will be gathered through an online survey, it will only include participants with access to the internet. As a result, the sample might be less representative of persons who are illiterate or have limited access to or proficiency with computers or mobile phones. Since none of the sites systematically recruit, there are limitations associated with selective recruitment. As a result, we are unable to generalise the findings to the population of the relevant sites. In addition, the exposure and response rate will vary between countries, making cross-country comparisons challenging. These limitations will be mitigated with the use of multi-level modelling techniques to understand country-wise or cross-cultural predictor variables to obtain meaningful findings. Even though random sampling would be ideal for providing an unbiased representative sample of the overall population, this is not always possible due to resource and time constraints, as the majority of multinational studies relied on non-representative samples. Finally, to minimise participant burden, the survey did not include an assessment of certain relevant variables—such as COVID-19-related stigmatisation, resilience, religious coping or pre-existing mental health conditions.