In recent decades, Haiti has been subject to man-made and natural disasters that have left its citizens vulnerable to a range of shocks. With a weak state unable to protect its populace, Haitians are exposed to some of the highest levels of poverty and violence in the Western Hemisphere. In recent years, Haitians have experienced two crises that this study analyzes: the instability and political violence of “peyi lòk” as well as the global pandemic of COVID-19. This community-based assessment explores the impact of these two crises on the mental health and psychological well-being of 38 Haitian university students in the understudied northern part of the country. Results indicate that both crises had similarities related to their psychological effects on young people, most notably in terms of traumatic experiences related to threats or violence, forced confinement, and large increases in population-wide uncertainty. Additionally, the extreme violence of “peyi lòk” and the widespread unpredictability of COVID-19 and its effects in the early days of the pandemic resulted in high levels of stress and fear. Both crises also resulted in extreme economic hardship for students, with many reporting difficulties accessing basic needs such as food and water. This study highlights how converging population-level crises in “complex emergencies” can heighten trauma and compromise mental health.
Over the last several decades, Haiti has experienced countless crises. These crises range from social, economic, health, political, legal, and environmental, and have impacted every level of Haitian society [
Haiti currently has one of the lowest Human Development Index (HDI) ratings in the world at 0.498—on a scale of 0 to 1—ranking 168th out of 189 countries [
Traditionally, disasters have been characterized as either “man-made” or “natural”—though they are not always mutually exclusive—and Haiti has experienced its share of natural disasters. In the last ten years, much has been written about the 2010 earthquake which killed an estimated 220,000 Haitians, injured another 300,000, and left more than a million homeless in a population of just 11 million [
Aside from natural disasters, Haiti is also confronted with serious “man-made” disasters, particularly in the form of socio-political crises. For example, since the fall of the Duvalier dictatorship in 1986, Haiti has experienced 21 presidents in just 32 years with many of them coups d’états [
The two crises examined for the purposes of this study were the recent political crisis and lockdown of 2019 referred to locally as peyi lòk—or “locked country”—in Haitian Creole (Krèyol). Slowing in early 2020, this crisis was quickly followed by the arrival of the COVID-19 pandemic and the government-imposed national lockdown in Haiti in March 2020.
The origins of the political and social crisis called peyi lòk started following the 2010 earthquake when Haitians elected popular singer Michel Martelly to the presidency in 2011. In 2016, his hand-picked successor Jovenel Moïse was elected after a contested election. In 2017, a probe by the Superior Court of Auditors found that nearly $3 billion of Venezuelan loans through the Petrocaribe program had been embezzled by these two governments, with president Moïse himself receiving millions of dollars in fake contracts [
However, protests increased significantly in 2019 leading Haiti into a period of lockdown referred to as peyi lòk. The country was brought to a standstill for months at a time. These protests culminated in the second half of 2019 with protesters forcing the extended shutdown of roads connecting all regions of the country as well as virtually all of the country’s primary institutions. In this extended period of social and political unrest, many were unable to access sufficient food, water, or medical care for significant periods of time. According to one estimate, 40% of Haitians were in need of emergency food assistance by the end of 2019 [
The COVID-19 pandemic followed quickly with reports of cases in China in late 2019. Global alarm increased after a sharp rise in cases in Northern Italy in February 2020, from which the virus quickly spread to the rest of Western Europe and the Americas [
As millions of Haitians make a living day to day, many were unsure how they would make ends meet, as larger urban areas closed public markets and banned unnecessary movement [
Many studies have demonstrated a strong association between traumatic events and decreased psychological well-being [
In the context of high levels of extreme violence as well as severe political and social unrest in Haiti in recent years, research has found elevated levels of trauma-related disorders [
While much of this research has taken place in and around the capital, Port-au-Prince, only one study examining the relationship between crisis, trauma, and mental health looked at the north of the country [
In order to develop programs for mental health and psychosocial support, it is important to know what people who live in these settings see as the most pressing problems, and where problems related to mental health and psychological well-being are situated in relation to all of the difficulties people are facing. Assessments that use methods derived from qualitative social sciences are based on what people report themselves, providing useful measures of the saliency of local conceptualizations of mental health and well-being and their importance in specific contexts [
This study describes a community-based assessment with focus groups of Haitian public health university students in Cap-Haïtien, Haiti. Cap-Haïtien is the second largest city in Haiti with a population of roughly 500,000 inhabitants. Using qualitative methods, this study consisted of six focus group discussions which were conducted between September and November of 2020 at the Université Publique du Nord au Cap-Haitïen (UPNCH). A population of university students at UPNCH was selected for this study due to an ongoing educational partnership between the department of Washington University in St. Louis and UPNCH since 2017. As one of the largest public universities in northern Haiti, UPNCH started its bachelor’s degree program in Public Health and Social Work in 2017 with the support of Washington University in St. Louis to increase expertise in these domains, as well as to train future public health and social work leaders for the country [
Participants were selected through a convenience sampling process in which all students in the program were offered the opportunity to participate. Inclusion criteria for participation consisted of students currently attending the Public Health and Social Work bachelor’s degree program at UPNCH, students who were present in Haiti for the entirety of the crises, and agreed to informed consent. The six focus groups were composed of between five and eight students and lasted for 45 minutes to one hour. All participants were aged between 18 and 24 years old and all focus groups were a mixture of male and female students, with 38 students interviewed in total—18 male and 20 female. Fourteen students were in the fourth year of the program and 24 students were in the second year of the program. As UNPCH is a public university with low fees for attendance, students interviewed were largely from modest socio-economic backgrounds. Other studies reported that at least 20 interviewees representing both genders were needed to identify salient issues, therefore this study nearly doubled that number to ensure saturation was achieved [
Students were provided a small lunch as compensation for their participation in the study. While they ate, students were explained the purpose of the study, examining the relationship between current crises and mental health in Haiti, and asked if they were interested in participating. After confirming interest, they were then presented with a form explaining the study, and informed consent was obtained. Students were informed that they did not have to speak about any information that they did not feel comfortable sharing. However, they were encouraged to share both the experiences of themselves and their families as well as their perception of the effects on society in general. Once the audio recording was begun, students were first asked, “What is your perception of the relationship between peyi lòk and mental health in Haiti based on your experiences?” After each student had the chance to speak, students were then asked, “What is your perception of the relationship between the COVID-19 pandemic and mental health in Haiti based on your experiences?” Once again all students had a chance to speak. When they were finished students were asked, “Which crisis had a more serious impact on mental health in Haiti based on your experience?” A Haitian research assistant guided each discussion, asked probing questions when more information was needed regarding a student’s account and took notes on the discussion.
All focus group interviews were conducted in Krèyol. Interviews were recorded and transcribed
Several major themes emerged from the focus group discussions on peyi lòk (
Problems | # of respondents who mentioned problem (N = 38) |
---|---|
No work/school | 17 |
Guns/Gunshots | 17 |
Confined/cannot go out/stuck at home | 14 |
No food/hunger | 10 |
No transport | 10 |
Gangs/criminals | 10 |
Increase in prices | 9 |
Roads blocked | 9 |
Protests | 9 |
No money | 8 |
Things are worse in Port-au-Prince | 7 |
Throwing rocks | 7 |
Bribery/Theft | 7 |
Death/Murder | 7 |
Throwing bottles | 6 |
Fights/Assaults | 6 |
Not as bad in rural areas | 5 |
No water | 4 |
Property destruction | 4 |
Rape | 3 |
No gasoline | 3 |
Burning tires | 3 |
Separated from loved ones | 3 |
Kidnapping | 2 |
Tear gas | 2 |
Increased unemployment | 1 |
Increased unwanted pregnancies | 1 |
Difficult accessing money transfers | 1 |
No police | 1 |
Symptoms | # of respondents who mentioned symptom (N = 38) |
---|---|
Stress | 18 |
Worried about safety of self/loved ones | 9 |
Fear ( |
8 |
Discouraged/Frustrated | 7 |
Bored/Nothing to do | 5 |
Anxiety ( |
4 |
Cannot concentrate ( |
4 |
Traumatized ( |
4 |
Feel imprisoned ( |
3 |
Belief in God/Jesus for protection | 3 |
Not at ease ( |
3 |
Distress ( |
2 |
Afraid to go outside | 2 |
Shock ( |
2 |
Suffering ( |
2 |
Wanting to leave Haiti | 2 |
“Haitians are used to political problems” | 2 |
Psychosis | 1 |
As the crisis continued for months, students described an inability to meet basic needs such as finding food and water. With less money and the inability to work, several students stated there was a lack of food and widespread hunger in their homes and communities. Ten students described not having enough food or experiencing hunger, and 8 discussed a lack of money. One student said he felt the “hunger in the body” (grangou nan kòw). Another was unable to find water for an extended period:
“A lot of people couldn’t find food during this period, other times it was hard to find water or you had to go out for water even though the neighborhood was really dangerous” (zòn nan toujou cho).
Others mentioned how even when they could find potable water, the price tripled going from 60-70 gourdes ($1) to 175 gourdes ($3). “Even if you have money, you might not have food or anything to drink since you can’t go outside [to buy anything]” one said. Another remarked that “you can only go out for provisions on certain days, Friday and Saturday usually because on Monday the craziness (tenten) would start again.” Two students described how market sellers were often unable to come into the city with their products, so there was nothing to buy even for those with money.
Widespread violence was another common theme in focus groups. Seventeen students mentioned guns or gunshots which highlighted the level of danger in the streets. Others discussed the use of rocks and bottles as weapons by gangs and protesters, with 7 and 6 mentions, respectively. The primary culprits in this violence were gangs which were cited by 10 students. As one described, in many neighborhoods,
“The gangs have power over life and death…you have to wait until they let you leave your house, and then also when you want to go back home again.”
Similar to other countries, gangs in Haiti are primarily made up of young men from poor backgrounds and have increased significantly in urban areas in recent years [
Brutality increased as the crisis went on, with battles breaking out between different neighborhoods in the city center. Two poor neighborhoods in particular, Shada and Nan Bannann were overrun with gangs that “took advantage of the situation to terrorize the population.” Several students reported seeing killings with their own eyes. One student remarked,
“At one point there were 3 people who were burned alive in the city near my house, and that really affected me. I asked myself, how would a human burn another human to death like that?”
Another reflected on the particular risks for young women among the violence: “[the gangs blocking the roads] would steal people’s cars and take the young girls and rape them in the middle of the road or out in the forest” (fè aksyon sou fiy yo nan mitan wout la ou nan raje).
While several students were in Port-au-Prince during this period and reported even more severe violence and unrest than in Cap-Haïtien—describing “total insecurity” and being unable to sleep due to the gunshots—the violence in Cap-Haïtien still stood in stark contrast to the relative calm of the countryside. Four students described leaving the cities to live in the countryside during this period, in order to escape the violence and unrest. “During peyi lòk I had to return to the countryside, it was getting too hard to go outside in the city and buy things,” one said. Another remarked that while schools and places of business were still closed in the cities, they were open in the countryside, allowing people to resume some normal activities there.
Among psychological problems, the most salient theme discussed was stress which was mentioned by 18 of the 38 students. One student described peyi lòk as a whole as “just a period of intense stress.” After stress, 9 students mentioned worrying about the safety of themselves and their loved ones. One student described how,
“During peyi lòk there were a lot of people who were victims; if it’s not from a rock someone threw, it can be from hunger or thirst, a medication, or just stress. You always ask yourself, if I go out will they throw rocks at me? Will there be gasoline [for transportation]? Will there be people burning tires?”
Fear (pè), feeling discouraged or frustrated, and boredom followed closely behind—with 8, 7, and 5 mentions, respectively. Four students said they were traumatized (tromatize). Three students described peyi lòk as being like a prison (amprizone). Students told stories about being afraid to go out as they were often unable to return home due to protests or violence, forcing them to walk for miles or take long detours. Others reported that even when they tried to get work done, they could not concentrate:
“I couldn’t come to school, and I wasn’t able to concentrate on anything [at home]. This means that every time you’re trying to think about something, the only thing you can think about is what’s going on in the country.”
Three students stated religious beliefs and God (Bondye) helped them make it through this period, with 2 expressing a desire to leave the country.
Peyi lòk was therefore first and foremost characterized by extreme violence and economic hardship. These factors resulted in widespread hunger, stress, and fear in the population at large as people could no longer work or go to school, and often feared simply going out in search of basic necessities. By December 2020, peyi lòk began to ease. Markets reopened, roads were no longer blocked, and travel between large cities recommenced throughout the country. However, this opening would only last for a few months before the government imposed a lockdown due to the COVID-19 pandemic.
Some similar themes were raised with regard to the COVID-19 pandemic and lockdown when compared with peyi lòk. Twenty-one of 38 students cited confinement or being unable to leave home or go outside again in 2020 (
Problems | # of respondents who mentioned problem (N = 38) |
---|---|
Confined/cannot go out/stuck at home | 21 |
High income countries could not handle virus | 18 |
No work/school | 17 |
Poor health system in Haiti | 14 |
High levels of stigma surrounding corona | 14 |
Experienced corona symptoms | 13 |
No transportation/travel | 11 |
No food | 11 |
No money | 9 |
Increase in prices | 9 |
No prevention measures in place in Haiti | 8 |
Used traditional treatments for corona | 8 |
Skeptical about corona/conspiracy theories | 7 |
Information spread on social media | 7 |
Mentioned story of professor in Limonade | 5 |
No personal space | 3 |
Went to live in countryside | 3 |
Mentioned local Belgian woman who had corona | 1 |
Increased unemployment | 1 |
Difficult accessing money transfers | 1 |
Increased unwanted pregnancies | 1 |
Symptoms | # of respondents who mentioned symptom (N = 38) |
---|---|
Fear ( |
27 |
Stress | 19 |
Worried about safety of self/loved ones | 16 |
Avoiding people/cannot visit loved ones | 16 |
Belief in God/Jesus for protection | 8 |
Bored/Nothing to do | 7 |
Discouraged/Frustrated | 6 |
Not at ease ( |
5 |
Relaxed after the first few months | 5 |
Anxiety ( |
5 |
Traumatized | 4 |
Trouble sleeping | 2 |
Egzema due to klorox | 2 |
In the initial months of the pandemic, 18 students cited concern about the fact that high-income countries were unable to handle the influx of patients resulting in significant deaths. “After what happened in France and Italy, I thought it was possible that all Haitians might die of corona if it entered the country,” one student said. Another remarked, “if it [COVID-19] got to Haiti we would die in droves.” These comments highlight the widespread uncertainty in this early period and the fear that COVID-19 could have an even more serious impact in Haiti than in more developed countries.
“When you saw the big countries had people dying, we were worried because Haiti doesn’t really have a health system or good hospitals,” another added.
The poor state of the healthcare system was mentioned by 14 students. In a country where 50% of medical services are provided by NGOs, students noted how Haiti’s medical system does not allow easy access to care, also highlighting the fact that many doctors and nurses were not coming to work in the early weeks of the pandemic out of fear of the virus and due to a dearth of appropriate protective equipment. As participants were all students of public health, their training provided them with extensive knowledge of Haiti’s healthcare system and its weaknesses.
In addition to the lack of appropriate medical services and infrastructure in Haiti, 8 students noted the absence of prevention measures for COVID-19 among the population. One student remarked how “Haiti wasn’t prepared to respond to a pandemic” while another said that “there weren’t good measures in place, and Haitians were negligent in that lots of people didn’t wear masks.” Speaking about his low-income neighborhood near the city center, Baryè Boutey, one student remarked that “out of 100 people, 95 will tell you they won’t wear a mask.” Part of this was related to the unique way stigma developed regarding COVID-19 during the early days of the pandemic and lockdown in Haiti. Fourteen students mentioned stigma as a significant problem during this period. With regards to masks, 3 students described how wearing a mask would make people think they had COVID-19. “If you wore a mask sometimes people would threaten you, they thought you had corona; so people didn’t really wear masks too much,” one described. Fears of threats or violence if you were suspected of having COVID-19 were a particular problem in the early months, according to 6 students. One said,
“There are people that can attack you if they think you represent a danger for them or those around them. They don’t need to know if you have it or not, they will just kill you so you don’t spread the illness (yo ta plis bezwen eliminew pouw pa pwopaje maladi a).”
As 13 students interviewed described having or fearing they had symptoms in the early months of the pandemic, there was considerable fear of both the virus and the stigma.
Several students described threats of violence with regard to fears of COVID-19 infection in the community. One student recounted an instance where someone was suspected of being infected and a group of men with machetes showed up at the house. Another student explained how one of his professors would kick students out of class for a small cough. In one final example, a student had to leave town due to threats from neighbors based on the perception he had been infected and could spread it to them. Perhaps the best illustration of the threats of violence related to COVID-19 stigma, however, was the case of a professor from the State University in the nearby town of Limonade who returned to Haiti on March 9th after a trip to the United States. On March 17th, he taught his classes at the university and came down with a fever and back pain [
“I had a class with him that Monday from 1–4 pm… when students started sharing information about the professor maybe having corona, the school was in upheaval, everyone ran home as fast as they could…I locked myself in my room and told my family to leave my food on the table without telling them anything [about what had happened].”
These experiences led to the professor’s ambulance being attacked when he was finally on his way to the hospital, almost killing him.
Part of the difficulty in a crisis like COVID-19 in the era of pervasive social media use in settings with low levels of education is the rapid spread of false information. Students reported receiving information via WhatsApp in the month of March that predicted 150,000 Haitians to die from COVID-19, with another saying that 1,000 to 2,000 people were expected to die in the country per day by May. Other false information widely shared on social media included “little hair tea” (te ti plim) which was mentioned by 2 students. As one described,
“When you open the Bible you’re supposed to look for a hair in the pages, and when you find one you boil it with water and put it in a kettle. The whole family drinks it and that prevents everyone from getting corona. All Haitians heard about this. If you believe in God, people would say only God can help us now, and this is the solution… Everyone was buying Bibles and searching in the pages, it was like a game.”
While the origins of this social media phenomenon are unclear, the rumor is reported to have been started by a pastor in Ghana where it quickly spread [
The uncertain nature of the COVID-19 pandemic and lockdown led 8 students to express a belief in God or Jesus for protection. Coupled with a fear of hospitals, many Haitians turned to traditional treatments to either prevent or treat COVID-19. Eight students discussed using these remedies. In addition to the 2 that mentioned “little hair tea,” 5 mentioned using leaves for tea, 4 using ginger, 2 using rum, and 1 using aloe. With the surge in demand for many of these items, students described large rises in prices, with one student traveling to the countryside solely to purchase affordable ginger. As the border with the Dominican Republic remained shut due to the pandemic for the rest of 2020, many other prices went up as well as Haiti imports a significant percentage of its goods from its neighbor. Nine students mentioned the problem of an increase in prices, 9 described not having enough money, and 11 not enough food. As one student said, “there was a sort of famine [in this period], some families couldn’t eat… everyone just ate what they had.” With many Haitians living day to day, one student noted how “people [were] more afraid of hunger than corona.” With markets closed most days of the week, many necessities harder to find, and large numbers of people unable to work, the pandemic lockdown resulted in a significant hardship.
“My mom works in the market and my dad works in construction, so when all activities stopped we fell into extreme poverty. It was really hard the way we had to live,” another student said.
Despite the early months of uncertainty around the virus, the wave of deaths experienced in other parts of the world did not flood Haiti’s hospitals. Seven students mentioned the widespread presence of skepticism and conspiracy theories in the country with regard to the virus. Two cited the widespread belief that Haiti was too hot for COVID-19 to survive there. Another 2 discussed the conspiracy theory that the Haitian government invented the crisis to get money from international donors. “Haitians thought the government was trying to get aid money from other countries,” one student said. An additional 3 students described how poor Haitians thought it was just a disease for the wealthy: “people in the lower classes said it’s a disease for the bourgeois, and that they won’t get it.” A final student described the class divide in terms of education, saying,
“People who are educated were more stressed than people who are illiterate; they thought corona was nothing saying, ‘this disease isn’t for Haitians.’”
By October, a large banner appeared over the main road in town stating, “Thank you God for the protection you give us, you protected the country of Haiti against COVID-19 and especially the city of Cap-Haïtien.” This emphasized the widely believed notion that God had protected Haiti from the COVID-19 pandemic.
In terms of psychological problems, the most salient theme was fear (pè) mentioned by 27 out of 38 students. With the combination of factors discussed in the preceding paragraphs, one student described the early weeks of the lockdown as a “climate of fear.” Another student described how “lots of videos were being shared on social media about how the virus is spread… I was so afraid, I thought I had symptoms when I got home and was very anxious.” Next, 19 students described experiencing stress. One student reported how,
“It was so stressful because Haitians are used to living very close to one another, things are dirty, eating wherever, everything at the market is on the ground, not washing hands, dust everywhere,” fearing that these lack of precautions would lead to a more serious outbreak.
Following this, 16 students discussed worrying about the safety of themselves and their loved ones, with students with parents who worked at the hospital particularly concerned. Sixteen students also described avoiding people or being unable to visit loved ones due to the lockdown and/or concerns about the virus. Due to living in close quarters, social distancing was difficult for many: “In the area where I live you can’t go outside without being in close contact with so many other people. We couldn’t know if they were sick,” one student said. Seven students complained of boredom, 6 said they were discouraged or frustrated, 5 said they were not at ease (pa alèz), with an additional 5 expressing anxiety (perez). Four students said they were traumatized (tromatize). One student said during the pandemic lockdown, “I felt panicked, mentally I wasn’t functioning well.” Another said, “sometimes you’re so angry and you don’t even know why.” However, when the country started opening up again in the late Spring, 5 students mentioned the atmosphere relaxing significantly.
“After a few months I saw it wasn’t so bad in Haiti, I became more relaxed, and even started going out with a mask. It doesn’t really have an effect on me now,” one remarked.
Another said, “I got used to it, in any case, everything is open now in the country. I have the impression that we’re living like corona doesn’t exist for us here in Haiti.”
The COVID-19 pandemic in Haiti was therefore characterized by the government lockdown which forced people to stay at home, as well as the economic hardship that followed. Additionally, the pandemic provoked high levels of fear, stress, and uncertainty, as Haitians saw a new and menacing virus that was thrashing the most advanced healthcare systems in the world before it arrived on their shores. In combination with structural weaknesses in the country’s government and healthcare system, misinformation and stigma spread widely occasionally resulting in acts of violence.
When asked which crisis had a more significant impact on mental health in Haiti, 21 students said peyi lòk whereas 16 students said the COVID-19 pandemic, with 1 student undecided. In their justifications for selecting peyi lòk, students used terms like danger, instability, violence, stress, gangs, guns, impunity, and the lack of authority. Students said they felt threatened every day and saw videos of bodies circulating on social media. Several students lost friends or family members to violence and 2 students reported having people killed in front of them. These events in particular resulted in serious self-reported psychological distress for students. In addition, there was the strong presence of gangs in the violence and chaos of peyi lòk. One study on the increasing problem of gangs in Haiti describes them as “omnipresent groups” that can overthrow governments, silence opposition, terrorize entire cities, and facilitate a burgeoning kidnapping industry, adding “it is impossible to discuss Haiti without addressing the issue of gangs” [
In their justifications which minimized the gravity of the COVID-19 pandemic, students mentioned how Haiti has dealt with worse pandemics in the past, such as the 2010 cholera pandemic which infected 900,000 and killed over 9,000 Haitians [
Yet, a significant percentage of students maintained that COVID-19 was more serious than even the violence of peyi lòk. Many of these students live in the countryside, however, where they were less affected by the urban-focused peyi lòk and more impacted by the national COVID-19 lockdown. One student talked about how people in his rural community were afraid of outsiders in the early days of the pandemic, as they thought people could come in and infect them. Others highlighted the general uncertainty surrounding the virus and its potential consequences, emphasizing their fear of the unknown. With peyi lòk they knew it had to come to an end someday, they said, whereas with the COVID-19 lockdown, “we didn’t know when the shutdown would end.” Lastly, the extent to which students resigned themselves to religious beliefs or God also emphasizes the fear that this poorly understood virus instilled in the population, even among the most educated.
The purpose of this study was to describe the mental health and psychological effects of two recent crises on a sample of Haitian public health university students in their own words. This data is intended to inform future studies on the relationship between social and political crises, and mental health care and treatment in Haiti. The results of this study found that both crises were characterized by a shutdown of normal life, such as an inability to go to work or school. Due to this inability to make a living, both crises also resulted in extreme economic hardship for students, with many reporting difficulties accessing basic needs such as food and water. Both crises also resulted in significant increases in stress and fear. However, the extreme violence of peyi lòk resulted in higher levels of reported stress among participants, whereas the widespread uncertainty around COVID-19 and its effects in the early days of the pandemic resulted in high levels of fear.
While this study did not categorize psychological symptoms with corresponding criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), there is significant overlap with many symptoms described and disorders such as depression, anxiety, and post-traumatic stress [
Several recent studies have examined the relationship between mental health and psychological well-being in the context of different crises in places around the world [
Although little has been published about the COVID-19 pandemic in low-income countries thus far, two studies have looked at the extent to which rumors and misinformation were able to spread throughout Haiti, particularly on social media. These studies reflect the accounts presented by students in which 14 remarked on high levels of stigma around the virus, 7 discussed conspiracy theories or skepticism about the existence of the virus, and another 7 highlighted the way information now spreads via social media channels. One study described rumors in Haiti saying that the virus is transmitted by contaminated testing swabs, or that hospitals are using patients for vaccine experiments [
Additionally, the fear of a deadly and unknown global pandemic in places like Haiti results in an “automatic magico-religious response when it comes to diseases like COVID-19” according to one Haitian scholar’s exhaustive analysis of the country’s response to the COVID-19 pandemic [
Perhaps the most significant negative impact on the mental health of young Haitians according to participant accounts in this study was economic challenges including employment and access to food. In this sense, as Etienne describes, food insecurity became severe due to the “combined shocks of peyi lòk in 2019 as well as the COVID-19 pandemic, when the most vulnerable households were exposed” by this accumulation of crises [
With high percentages of young people compared to middle- and high-income countries, low-income countries like Haiti face a continual challenge of providing food, education, housing, jobs, and stability for their future leaders [
Young people in Haiti continue to be forced to live through repeated crises. As the vast majority of Haitians were born since the 1986 departure of the dictator Jean-Claude Duvalier—or “Baby Doc” as he is widely known—they have never known a country without extended periods of crisis. This exposure to chronic stress, fear, and traumatic events such as unrest, extreme violence, and natural disasters, is proven to result in mental illnesses such as depression, anxiety, and other disorders including post-traumatic stress. Several studies have demonstrated this relationship in Haiti itself, showing increased incidents of mental illness and suicidality among young people, and highlighting the inability of existing services to offer adequate treatment or care [
While preventing national or global crises—like that of peyi lòk or COVID-19 respectively—is exceedingly complex and difficult, services that provide effective therapies for survivors can address the wounds on a more individual level, and should be adapted and implemented locally [
This study had several limitations. Firstly, while students were all chosen from the same Public Health program at UPNCH, they were not randomly selected. Rather they were chosen based on their availability and willingness to participate, which opens the possibility for selection bias within UPNCH. Thus, it is unclear whether the sample chosen for this study is generally representative of students at UPNCH. Additionally, as these are students receiving an undergraduate education in public health, they are likely more educated and aware of the relationship between crisis and mental health compared with the broader university population in Haiti. For this reason, they may not be representative of a community of Haitian university students.
Next, there is a potential for reporting bias in this study as students may be underreporting undesirable effects of the crises. As these interviews were conducted in the context of focus groups with their peers, some students may have limited the discussion of difficult experiences they had during these periods. Additionally, as these discussions took place in front of a researcher from the United States, it is possible that this influenced the response patterns of the participants. Social desirability bias may have led them to portray responses that they believe were more socially acceptable rather than those that are reflective of their true feelings or experiences. Lastly, the discussions regarding the COVID-19 pandemic took place while the pandemic was still ongoing in the Fall of 2020. Changes in the consequent months of the pandemic may impact overall perceptions or experiences of this crisis.
This study assessed the impact of two current crises—peyi lòk and the COVID-19 pandemic—on the mental health of youth in Haiti. In particular, this study found strong impacts of these crises on the lived experiences of students interviewed. With regards to peyi lòk, students were severely impacted by widespread violence and insecurity resulting in high levels of stress, as well as concern for the safety of loved ones. During the COVID-19 pandemic, students highlighted substantial uncertainty, fear, and stigma surrounding the new virus. In conjunction with already existing political violence and pervasive poverty, the youth interviewed described significant trauma-related impacts on their lives and Haitian society as a whole. As this study was conducted prior to the assassination of President Jovenel Moïse on July 07, 2021, we did not examine the impacts of this event and its fallout. Future research on mental health and crisis in Haiti could further examine the physical and psychological consequences of large-scale crises in communities, including the impact of Moïse’s assassination and the ramifications for Haitian society.
The authors received no specific funding for this study.
The authors declare that they have no conflicts of interest to report regarding the present study.