Mental health experiences of youths with psychosis during the COVID-19 pandemic in Zimbabwe

Imagine the human mind as a complex, bustling city. For most people, the streets are wide, the traffic flows smoothly, and when a storm hits, there are plenty of sturdy bridges and emergency shelters to help everyone get through. But for some, the city is built on shaky ground, with narrow alleys and fragile structures. These are people living with psychosocial disabilities, like psychosis, where the mind's "city" can sometimes feel overwhelmed by noise, confusion, or fear. Now, imagine a massive, invisible fog rolls in, shutting down the whole world. This is the COVID-19 pandemic. When the world stops moving, everyone feels the impact, but for those whose mental cities are already fragile, the fog doesn't just block the view; it can make the whole city feel like it's collapsing. Scientists and doctors have long known that disasters hit vulnerable groups the hardest, but they needed to know exactly how this played out for young people with psychosis in a place like Zimbabwe, where resources are already stretched thin. They wanted to understand if the fog made the city crumble, or if there were ways to build stronger bridges for the future.

This study, conducted by researchers from the University of Zimbabwe and the London School of Hygiene & Tropical Medicine, zooms in on 30 young people aged 18 to 24 who had been diagnosed with psychosis but were currently stable. The researchers didn't just look at medical charts; they picked up the phone and had deep, one-on-one conversations with these young people to hear their stories. Think of it as listening to the residents of that fragile mental city describe what it felt like when the lockdowns turned the streets into dead ends.

The first thing the young people talked about was a deep, pervasive fear they called kukwata covid—a local phrase that captures the feeling of "catching" the virus. It wasn't just a worry; it was a constant, buzzing anxiety. Much of this fear came from the "infodemic," a term the researchers use to describe a flood of information that is so overwhelming it's hard to tell what's real. Social media was the main source of this flood. For these young people, scrolling through their phones wasn't just a pastime; it was a window into a world where they saw terrifying videos of people collapsing and dying. It was like trying to learn how to swim while being shown endless clips of shipwrecks. They knew they needed to protect themselves, but the information was often conflicting or impossible to verify. One young person described the horror of seeing people die "every second" on their screens, making it hard to focus on how to actually stay safe.

Then there was the problem of the "rules." The government and health experts gave instructions like "stay six feet apart" or "use your own bathroom." But for many of these young people living in crowded high-density suburbs, these rules were like trying to fit a square peg into a round hole. One participant pointed out the absurdity: "Eleven of us use one bathroom. How do you do that?" It wasn't that they didn't want to follow the rules; it was that the rules didn't fit the reality of their lives. The lockdowns turned their homes into cages, and the lack of space made the fear of the virus feel even more suffocating.

Perhaps the most painful part of the story was the silence. In Zimbabwe, community is everything. Churches, family gatherings, and support groups are the safety nets that catch people when they start to fall. But the lockdowns cut these nets. The young people described a profound sense of isolation. For some, church was their only source of strength, and suddenly, they weren't allowed to gather to pray. For others, the "Friendship Bench" support groups—where they used to sit together, share stories, and even work on income-generating projects—were forced to move to WhatsApp. But a digital chat group isn't the same as sitting in a circle with friends. One participant said it felt like "everything is collapsing" because you can't really share your feelings or emotions through a screen the way you do face-to-face. The physical connection that helped them heal was gone, replaced by a digital void.

The study also shone a light on the economic storm. Zimbabwe's economy is largely informal, meaning most people, including the families of these young people, rely on daily work like vending or barbering to eat. When the lockdowns hit, the markets closed, and the streets emptied. It was like someone suddenly turned off the water supply to a garden. One young man explained that his father, a barber, couldn't work, leaving the family struggling to pay for rent and food. Another young woman, who was about to start a business selling clothes, found her plans frozen because she couldn't travel to get her stock. The pandemic didn't just stop the virus; it stopped the money, and without money, the stress of daily life skyrocketed, making it even harder to keep their mental health stable.

The researchers found that these young people were disproportionately affected. Their disability, combined with poverty and a lack of disaster preparation, meant they faced a higher risk of depression, relapses, and even hunger. The study suggests that when a crisis hits, the most vulnerable are often the first to fall through the cracks. The "infodemic" of confusing information, the impossibility of following strict social distancing in crowded homes, and the sudden loss of community support created a perfect storm of anxiety.

However, the paper doesn't just list problems; it points toward a way forward. The researchers argue that future crisis plans must include people with psychosocial disabilities from the very beginning. They suggest using "Community-Based Rehabilitation" (CBR), which is like building a local team of helpers who know the neighborhood and the people in it. These helpers, or case managers, could coordinate support, ensuring that when a crisis hits, the right people get the right help—whether it's food, medicine, or just someone to talk to. The study emphasizes that we can't just throw generic solutions at everyone; we need targeted, inclusive mechanisms that understand the unique needs of those living with mental health challenges.

In the end, this paper is a reminder that when the world stops, the people who need the most support are often the ones who get the least. The young people in Zimbabwe didn't just survive the pandemic; they navigated a maze of fear, confusion, and isolation that was far more complex for them than for others. Their stories tell us that to build a world that is ready for the next crisis, we need to make sure the bridges are strong enough for everyone, especially those whose cities are the most fragile.