skip to main content
US FlagAn official website of the United States government
dot gov icon
Official websites use .gov
A .gov website belongs to an official government organization in the United States.
https lock icon
Secure .gov websites use HTTPS
A lock ( lock ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.


Title: Mental health during the COVID-19 pandemic: Impacts of disease, social isolation, and financial stressors
BackgroundAlthough research shows that the Covid-19 pandemic has led to declines in mental health, the existing research has not identified the pathways through which this decline happens. AimsThe current study identifies the distinct pathways through which COVID-induced stressors (i.e., social distancing, disease risk, and financial stressors) trigger mental distress and examines the causal impact of these stressors on mental distress. MethodsWe combined evidence of objective pandemic-related stressors collected at the county level (e.g., lack of social contact, infection rates, and unemployment rates) with self-reported survey data from over 11.5 million adult respondents in the United States collected daily for eight months. We used mediation analysis to examine the extent to which the objective stressors influenced mental health by influencing individual respondents’ behavior and fears. ResultsCounty-level, day-to-day social distancing predicted significantly greater mental distress, both directly and indirectly through its effects on individual social contacts, worries about getting ill, and concerns about finances. Economic hardships were indirectly linked to increased mental distress by elevating people’s concerns about their household’s finances. Disease threats were both directly linked to mental distress and indirectly through its effects on individual worries about getting ill. Although one might expect that social distancing from people outside the home would have a greater influence on people who live alone, sub-analyses based on household composition do not support this expectation. ConclusionThis research provides evidence consistent with the thesis that the COVID-19 pandemic harmed the mental well-being of adults in the United States and identifies specific stressors associated with the pandemic that are responsible for increasing mental distress.  more » « less
Award ID(s):
2001851 1952085
PAR ID:
10469269
Author(s) / Creator(s):
; ;
Editor(s):
Nabi, Mohammad Hayatun
Publisher / Repository:
PLOS
Date Published:
Journal Name:
PLOS ONE
Volume:
17
Issue:
11
ISSN:
1932-6203
Page Range / eLocation ID:
e0277562
Format(s):
Medium: X
Sponsoring Org:
National Science Foundation
More Like this
  1. Kwon, Young Dae (Ed.)
    Despite the profound health and economic implications of Covid-19, there is only limited knowledge to date about the role of economic concerns, health worries and social distancing for mental health outcomes during the pandemic. We analyze online survey data from the nationally representative “Understanding America Study” (UAS) covering the period of March 10-31st 2020 (sample size: 6,585). Mental health is assessed by the validated PHQ-4 instrument for measuring symptoms of depression and anxiety. About 29% (CI:27.4-.30.4%) of the US adult population reported some depression/anxiety symptoms over the study period, with symptoms deteriorating over the month of March. Worsening mental health was most strongly associated with concerns about the economic consequences of the pandemic, while concerns about the potential implications of the virus for respondents’ own health and social distancing also predicted increases in symptoms of depression and anxiety during the early stages of the pandemic in the US, albeit less strongly. Our findings point towards the possibility of a major mental health crisis unfolding simultaneously with the pandemic, with economic concerns being a key driving force of this crisis. These results highlight the likely importance of economic countermeasures and social policy for mitigating the impact of Covid-19 on adult mental health in the US over and above an effective public health response. 
    more » « less
  2. ImportanceMarked elevation in levels of depressive symptoms compared with historical norms have been described during the COVID-19 pandemic, and understanding the extent to which these are associated with diminished in-person social interaction could inform public health planning for future pandemics or other disasters. ObjectiveTo describe the association between living in a US county with diminished mobility during the COVID-19 pandemic and self-reported depressive symptoms, while accounting for potential local and state-level confounding factors. Design, Setting, and ParticipantsThis survey study used 18 waves of a nonprobability internet survey conducted in the United States between May 2020 and April 2022. Participants included respondents who were 18 years and older and lived in 1 of the 50 US states or Washington DC. Main Outcome and MeasureDepressive symptoms measured by the Patient Health Questionnaire-9 (PHQ-9); county-level community mobility estimates from mobile apps; COVID-19 policies at the US state level from the Oxford stringency index. ResultsThe 192 271 survey respondents had a mean (SD) of age 43.1 (16.5) years, and 768 (0.4%) were American Indian or Alaska Native individuals, 11 448 (6.0%) were Asian individuals, 20 277 (10.5%) were Black individuals, 15 036 (7.8%) were Hispanic individuals, 1975 (1.0%) were Pacific Islander individuals, 138 702 (72.1%) were White individuals, and 4065 (2.1%) were individuals of another race. Additionally, 126 381 respondents (65.7%) identified as female and 65 890 (34.3%) as male. Mean (SD) depression severity by PHQ-9 was 7.2 (6.8). In a mixed-effects linear regression model, the mean county-level proportion of individuals not leaving home was associated with a greater level of depression symptoms (β, 2.58; 95% CI, 1.57-3.58) after adjustment for individual sociodemographic features. Results were similar after the inclusion in regression models of local COVID-19 activity, weather, and county-level economic features, and persisted after widespread availability of COVID-19 vaccination. They were attenuated by the inclusion of state-level pandemic restrictions. Two restrictions, mandatory mask-wearing in public (β, 0.23; 95% CI, 0.15-0.30) and policies cancelling public events (β, 0.37; 95% CI, 0.22-0.51), demonstrated modest independent associations with depressive symptom severity. Conclusions and RelevanceIn this study, depressive symptoms were greater in locales and times with diminished community mobility. Strategies to understand the potential public health consequences of pandemic responses are needed. 
    more » « less
  3. Abstract Objective:Comprehensive studies examining longitudinal predictors of dietary change during the coronavirus disease 2019 pandemic are lacking. Based on an ecological framework, this study used longitudinal data to test if individual, social and environmental factors predicted change in dietary intake during the peak of the coronavirus 2019 pandemic in Los Angeles County and examined interactions among the multilevel predictors. Design:We analysed two survey waves (e.g. baseline and follow-up) of the Understanding America Study, administered online to the same participants 3 months apart. The surveys assessed dietary intake and individual, social, and neighbourhood factors potentially associated with diet. Lagged multilevel regression models were used to predict change from baseline to follow-up in daily servings of fruits, vegetables and sugar-sweetened beverages. Setting:Data were collected in October 2020 and January 2021, during the peak of the coronavirus disease 2019 pandemic in Los Angeles County. Participants:903 adults representative of Los Angeles County households. Results:Individuals who had depression and less education or who identified as non-Hispanic Black or Hispanic reported unhealthy dietary changes over the study period. Individuals with smaller social networks, especially low-income individuals with smaller networks, also reported unhealthy dietary changes. After accounting for individual and social factors, neighbourhood factors were generally not associated with dietary change. Conclusions:Given poor diets are a leading cause of death in the USA, addressing ecological risk factors that put some segments of the community at risk for unhealthy dietary changes during a crisis should be a priority for health interventions and policy. 
    more » « less
  4. null (Ed.)
    Objectives. To assess the impact of the COVID-19 pandemic on mental distress in US adults. Methods. Participants were 5065 adults from the Understanding America Study, a probability-based Internet panel representative of the US adult population. The main exposure was survey completion date (March 10–16, 2020). The outcome was mental distress measured via the 4-item version of the Patient Health Questionnaire. Results. Among states with 50 or more COVID-19 cases as of March 10, each additional day was significantly associated with an 11% increase in the odds of moving up a category of distress (odds ratio = 1.11; 95% confidence interval = 1.01, 1.21; P = .02). Perceptions about the likelihood of getting infected, death from the virus, and steps taken to avoid infecting others were associated with increased mental distress in the model that included all states. Individuals with higher consumption of alcohol or cannabis or with history of depressive symptoms were at significantly higher risk for mental distress. Conclusions. These data suggest that as the COVID-19 pandemic continues, mental distress may continue to increase and should be regularly monitored. Specific populations are at high risk for mental distress, particularly those with preexisting depressive symptoms. 
    more » « less
  5. Objective: During the COVID-19 pandemic, unprecedented collective stressors disrupted assumptions of safety and security. Cognitive strategies like finding benefits during adversity may facilitate coping during such times of social disruption by reducing distress or motivating health protective behaviors. Methods: We explored relationships between benefit finding, collective- and individual-level adversity exposure, psychological distress, and health protective behaviors using four waves of data collected during the COVID-19 era from a longitudinal sample from the NORC AmeriSpeak panel, a representative, probability-based online panel of U.S. residents: Wave 1 (N=6,514, 3/18/2020-4/18/2020, 58.5% completion rate); Wave 2 (N=5,661, 9/24/2020-10/16/2020, 87.1% completion rate); Wave 3 (N=4,881, 11/8/2021-11/24/2021, 75.3% completion rate); and Wave 4 (N=4,859, 5/19/2022-6/16/2022, 75.1% completion rate). Results: Benefit finding was common; k-means clustering (an exploratory, data-driven approach) yielded five trajectories: Always High (15.92%), Always Low (18.13%), Always Middle (29.81%), Increasing (16.84%) and Decreasing (19.30%). Benefit finding trajectories were generally not strong correlates of emotional exhaustion, traumatic stress symptoms, global distress, and functional impairment over time. Rather, benefit finding robustly correlated with health protective behaviors relevant to COVID-19 and another viral threat (the seasonal flu): adjusting for demographics, pre-pandemic mental health, and collective- and individual-level adversity, benefit finding was positively associated with more social distancing (β=0.28, p<.001) and mask wearing (β=.21, p<.001) at Wave 2 and greater COVID-19 (OR=1.37, p<.001) and flu (OR=1.18, p<.001) vaccination at Wave 3. Conclusions: Although benefit finding was not generally associated with lower psychological distress during a collective stressor, it correlated with engagement in stressor-related health protective behaviors. Public significance statement: Finding benefits or “silver linings” during collective stress may not be associated with reduced psychological distress. However, finding benefits may promote cognitive coping strategies that encourage health protective behaviors. 
    more » « less