Analysis of Mental Health Trajectories in Relation to Sustainable Development Goals

This report details the findings on the evolution of psychopathological variables among different population groups exposed to sequential stressors. The analysis places significant emphasis on the implications for achieving the United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), SDG 5 (Gender Equality), SDG 4 (Quality Education), SDG 8 (Decent Work and Economic Growth), and SDG 16 (Peace, Justice and Strong Institutions).

Socio-Demographic Profile and SDG Implications

Participant Characteristics

The socio-demographic composition of the study’s respondent groups reveals critical disparities that align with key SDG targets.

• Nonexposed Group: This group was predominantly female (56.5%), with an average age of 37.3 years. The majority held an intermediate level of education (73.9%) and occupation (56.5%).
• PTSD- Group: This group was majority male (59.6%), with an average age of 40.3 years. A high percentage (53.2%) held a Master’s degree or higher, and a significant majority were represented in occupations (91.5%).
• PTSD+ Group: Women were predominant in this group (63.0%), with an average age of 38.9 years, an intermediate level of education (55.6%), and a high representation in occupations (77.8%).

Relevance to Sustainable Development Goals

• SDG 5 (Gender Equality): The gender disparities across the groups, particularly the higher prevalence of women in the Nonexposed and PTSD+ groups, underscore the differential gendered impacts of trauma and crises, a core concern for achieving gender equality.
• SDG 4 (Quality Education) & SDG 8 (Decent Work): The varying levels of education and occupation across the groups highlight how educational attainment and employment status can be associated with different resilience and vulnerability profiles, linking directly to the goals of ensuring quality education and decent work for all.
• SDG 10 (Reduced Inequalities): These demographic differences illustrate the inequalities in exposure and outcome that SDG 10 seeks to address.

Longitudinal Assessment of Mental Health and Well-being (SDG 3)

The study’s findings on mental health variables directly inform progress toward SDG 3: Good Health and Well-being, which includes a specific target to promote mental health. The long-term psychological impact of violence, as referenced in SDG 16 (Peace, Justice and Strong Institutions), is a central theme.

Evolution of Post-Traumatic Stress Disorder (PTSD) Symptoms

PTSD symptoms, linked to the 2015 terrorist attacks, showed different trajectories, highlighting the long-term mental health burden that impedes the achievement of SDG 3.

• Nonexposed and PTSD- Groups: PCL-5 scores for PTSD symptoms remained stable over time (T2 to T4), with no statistically significant changes.
• PTSD+ Group: A statistically significant decrease in mean PCL-5 scores was observed between T2 (pre-pandemic) and T4 (pandemic period), from 33.84 to 29.96 (p
• Lockdown-Related PTSD: PCL-5 scores related to the lockdown period remained constant across all groups. The prevalence of probable PTSD was notably higher in the PTSD+ group during the lockdown compared to the post-lockdown period.

Evolution of Anxiety Symptoms

Anxiety levels increased significantly during the pandemic, representing a major challenge to public well-being (SDG 3).

1. Nonexposed Group: Mean STAI-YA scores increased significantly from T2 (26.51) to T3 (34.48) and T4 (32.15).
2. PTSD- Group: Mean STAI-YA scores increased significantly from T2 (28.82) to T3 (36.34) and T4 (35.38).
3. PTSD+ Group: This group showed a substantial increase in anxiety from T2 (35.55) to T3 (45.51) and T4 (46.37). The prevalence of high anxiety was significantly greater in this group during the pandemic periods.

Evolution of Depression Symptoms

While BDI scores for depression remained constant over time for all groups, the pre-existing disparities between groups are noteworthy for SDG 3 and SDG 10.

• No instances of high depression were observed in any group during the study period.
• Despite stability, the PTSD+ group consistently exhibited higher baseline depression scores, indicating a persistent mental health inequality.

Evolution of Well-being

A universal decline in well-being was observed, directly contravening the core objective of SDG 3.

• All Groups: WHO-5 scores for well-being decreased significantly for all three groups between the pre-pandemic period (T2) and the pandemic periods (T3 and T4).
• Nonexposed Group: Decreased from 74.93 at T2 to 65.86 at T3.
• PTSD- Group: Decreased from 67.65 at T2 to 59.57 at T3.
• PTSD+ Group: Showed the most significant impact, with well-being scores decreasing from 54.66 at T2 to 44.29 at T3. The prevalence of ill-being was highest in this group.

Predictors of Anxiety Severity and Links to Broader SDGs

The analysis of anxiety predictors within the vulnerable PTSD+ group reveals factors that intersect with multiple SDGs, including SDG 8 (Decent Work), SDG 10 (Reduced Inequalities), and SDG 16 (Strong Institutions).

Predictors During Lockdown

1. Key Indicators in PTSD+ Group: High anxiety was associated with COVID-19 symptoms, concentration difficulties, boredom, low acceptance, self-blame, and behavioral disengagement. A regression model explained 33% of the variance, with COVID-19 symptoms and self-blame being significant contributors.
2. Comparative Factors:
   • In the Nonexposed group, anxiety was linked to financial consequences (SDG 8) and distrust in media/government information (SDG 16).
   • In the PTSD- group, distrust in media/government information (SDG 16) was also a significant factor.

Predictors During Post-Lockdown

1. Key Indicators in PTSD+ Group: High anxiety was linked to boredom, disappointment with professional situation improvement (SDG 8), low positive reinterpretation, low acceptance, self-blame, and behavioral disengagement. A regression model explained 33% of the variance, with positive reframing and self-blame being significant predictors.
2. Comparative Factors:
   • In the Nonexposed group, fear of infection and concerns about public reopening were associated with higher anxiety.
   • In the PTSD- group, sleeping disorders and boredom were linked to higher anxiety, while positive reinterpretation and acceptance were associated with lower anxiety, highlighting coping mechanisms crucial for SDG 3.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article discusses issues related to mental health, well-being, and the socio-demographic impacts of traumatic events and a pandemic. Based on this, the following SDGs are addressed:

• SDG 3: Good Health and Well-being: This is the primary goal addressed, as the article extensively analyzes mental health conditions such as PTSD, anxiety, depression, and overall well-being.
• SDG 5: Gender Equality: The article provides a gender-disaggregated analysis of the participants, highlighting differences between men and women in the studied groups.
• SDG 4: Quality Education: The educational attainment of the participants is mentioned as a key sociodemographic characteristic, linking education levels to the studied population.
• SDG 8: Decent Work and Economic Growth: The article touches upon the professional and financial situations of the participants, identifying them as factors influencing mental health.
• SDG 16: Peace, Justice and Strong Institutions: The study’s context, which is the aftermath of the November 13, 2015 terrorist attacks, directly relates to the impact of violence on individuals. It also mentions distrust in institutions as a factor affecting anxiety.

2. What specific targets under those SDGs can be identified based on the article’s content?

Several specific targets can be linked to the content of the article:

1. Target 3.4: “By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.”
   • Explanation: The entire study is dedicated to understanding and measuring mental health and well-being. It examines the “Evolution of psychopathological variables,” including PTSD, anxiety, and depression, and explicitly measures well-being using “WHO-5 scores.” This aligns directly with the goal of promoting mental health and well-being.
2. Target 3.d: “Strengthen the capacity of all countries… for early warning, risk reduction and management of national and global health risks.”
   • Explanation: The article analyzes the psychological impact of two major health-related crises: a terrorist attack (“attacks of 13 November 2015”) and a global pandemic (“lockdown and after lockdown period”). This research contributes to understanding and managing the mental health risks associated with such national and global events.
3. Target 5.1: “End all forms of discrimination against all women and girls everywhere.”
   • Explanation: The article’s sociodemographic data reveals potential gender disparities in the impact of trauma. For instance, it states that in the “PTSD + group, women were predominant (63.0%).” This data is crucial for identifying and addressing how women may be disproportionately affected by such events.
4. Target 8.5: “By 2030, achieve full and productive employment and decent work for all women and men…”
   • Explanation: The article links professional life to mental health. It notes that “disappointing expectations regarding the improvement of their professional situation” was an indicator of high anxiety. Furthermore, it mentions that “financial consequences related to the COVID-19 pandemic” were associated with higher anxiety scores in the nonexposed group, connecting economic well-being and employment to mental health outcomes.
5. Target 16.1: “Significantly reduce all forms of violence and related death rates everywhere.”
   • Explanation: The study is rooted in the consequences of violence. The PTSD symptoms measured are directly “related to the attacks of 13 November 2015.” By studying the long-term psychological impact on victims, the article highlights the lasting harm caused by violence, which is a key aspect of this target.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article mentions and implies several specific indicators used to measure the concepts discussed.

1. Indicators for Target 3.4 (Mental Health and Well-being):
   • Prevalence and severity of PTSD: The article uses “PCL-5 scores” to measure PTSD symptoms. It reports on the “prevalence of probable PTSD” and tracks changes in mean scores over time (e.g., “a notable decrease in mean PCL-5 score between T2 and T4 for the PTSD + group”).
   • Prevalence and severity of anxiety: The study uses “STAI-YA scores for anxiety symptoms” and reports on the “prevalence of higher anxiety.”
   • Prevalence and severity of depression: “BDI scores for depressive symptoms” are used to measure depression levels.
   • Level of well-being: The article explicitly uses “WHO-5 scores for well-being” and reports on the “prevalence of well-being and ill-being.”
2. Indicators for Target 5.1 (Gender Equality):
   • Proportion of population affected by trauma, disaggregated by sex: The article provides this data by stating, “Women constituted the majority (56.5%)” in the Nonexposed group and were “predominant (63.0%) in the PTSD + group,” while “men comprised the majority (59.6%) in the PTSD- group.” This serves as an indicator of gender-specific vulnerability.
3. Indicators for Target 8.5 (Decent Work):
   • Perception of professional situation: This is implied as an indicator when the article identifies “disappointing expectations regarding the improvement of their professional situation” as a predictor of anxiety.
   • Prevalence of negative financial impacts: This is implied through the finding that “financial consequences related to the COVID-19 pandemic” were associated with higher anxiety.
4. Indicators for Target 16.1 (Reduce Violence):
   • Proportion of population suffering from psychological consequences of violence: The existence of the “PTSD-” and “PTSD+” groups, whose condition is linked to the “events of November 13, 2015,” and the measurement of their symptoms serve as a direct indicator of the psychological harm resulting from violence.

4. Table of SDGs, Targets, and Indicators

Source: bmcpsychiatry.biomedcentral.com