Exploring Sedentary Time as a Moderator in the Relationship Between COVID-19 Symptom Burden and Mental Health Outcomes in 4 African Countries

Background : Physical inactivity and mental distress were prevalent across African populations during COVID-19. However, limited research has explored the role of sedentary time in shaping mental health outcomes during the pandemic. In this study, sedentary time during COVID-19 and its moderating role in the relationship between COVID-19 symptom burden and mental health outcomes were examined in Botswana, Ghana, Nigeria, and Tanzania. Methods : Cross-sectional data (April 2020 to November 2022) from 3125 adults (male = 52.3%, M age  = 27.05, SD = 8.91) were analyzed. Participants completed self-report measures of COVID-19 symptoms (eg, persistent cough and unusual fatigue), physical activity and sedentary time (International Physical Activity Questionnaire-Short Form), as well as anxiety (Generalized Anxiety Disorder 7) and depressive symptoms (Patient Health Questionnaire). Results : Median sedentary time per day was lower in Nigeria (median = 120, interquartile range = 150) and Tanzania (median = 120, interquartile range = 180) than in Botswana and Ghana (median = 180, interquartile range = 180). Overall, sedentary time moderated the positive relationship between COVID-19 symptom burden and depressive symptoms ( B  = 0.60, P  = .012), with stronger associations at higher sitting time (simple slope: B  = 2.27, P  < .001). At the country level, this moderating effect was observed only in Ghana ( B  = 1.38, P  < .001; simple slope: B  = 2.40, P  < .001). Conclusions : These findings highlight cross-country variation in sedentary time during the pandemic and suggest that greater sedentary time exacerbated the relationship between COVID-19 symptom burden and depressive symptoms, particularly in Ghana. Context-specific factors and differing pandemic responses may help explain these country-level differences.