Adverse Mental Health Symptoms Related To COVID-19 Remained High 6 Months Into Pandemic

As of September 2020, the prevalence of adverse mental health symptoms remained high among Americans, a new survey finds.

Rates of suicidal ideation, substance abuse, and symptoms of depression and anxiety in August and September were elevated above prepandemic estimates, especially among survey participants under age 65, according to the results published in JAMA Network Open.

The late-summer survey also found that adverse mental health symptoms had not declined compared to a similar study looking at data from late spring.

"The purpose of this study was to try to determine whether the elevated prevalence of adverse mental health symptoms was sustained compared to the (levels) observed earlier in the pandemic," said the study's lead author, Mark Czeisler, a Fulbright Scholar at the Turner Institute for Brain and Mental Health, Monash University, in Australia, and a research trainee in the department of psychiatry at Brigham and Women's Hospital in Boston. "At least through September 2020, they continue to be disproportionately born by younger adults, unpaid caregivers, Hispanic persons, Black persons, essential workers, people with disabilities and those with psychiatric conditions. While this was not unexpected, it's not great."

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The new study was a follow-up to one conducted in June 2020, and published in the Centers for Disease Control and Prevention's MMWR in August. In the late spring, 40.9% of respondents reported at least one adverse mental or behavioral health condition, including symptoms of anxiety disorder or depressive disorder (39.9%), symptoms of a trauma- and stressor-related disorder (TSRD) related to the pandemic (26.3%), having started or increased substance use to cope with the stress or emotions related to COVID-19 (13.3%), and suicidal ideation (10.7%).

For the new study, Czeisler and his colleagues asked adults aged 18 and older to complete a 139-item internet-based survey through Qualtrex for The COVID-19 Outbreak Public Evaluation (COPE) initiative. Symptoms of anxiety disorder and depressive disorder were assessed using the four-item Patient Health Questionnaire and symptoms of COVID-19-related TSRD were assessed using the six-item Impact of Event Scale.

Among the respondents, 46.8% were first-time participants and the rest had been recontacted after the April or June surveys.

Overall, 5,285 of 11,953 potential participants completed the September 2020 survey. Of the respondents included in the analysis, 1,710 (33%) reported anxiety or depression symptoms, 1,536 (29.6%) reported COVID-19-related TSRD symptoms, 781 (15.1%) reported increased substance use, 618 (11.9%) reported having seriously considered trying to kill themselves in August, and 2,237 (43.1%) reported at least one of these symptoms.

Adverse mental or behavioral health symptoms were more prevalent among adults younger than 65 versus those aged 65 and older, among multigenerational caregivers versus noncaregivers, and among respondents with prior psychiatric diagnoses versus those with on prior diagnoses.

Prevalence of adverse mental or behavioral health symptoms was also higher among those with disabilities or insomnia symptoms versus those without, and among essential workers and unemployed respondents versus nonessential workers. Symptoms were also more common among respondents who were lesbian, gay or bisexual compared to those who were heterosexual.

This study adds to the mounting evidence that the stresses caused by the pandemic have been felt more intensely by some demographic groups than others, said Dr. Paul Nestadt, an assistant professor of psychiatry at the Johns Hopkins School of Medicine, in Baltimore.

While the study found an increased rate of suicidal ideation, "data from many states, including my own, show that suicides have not gone up," Dr. Nestadt said. "In fact, where there are data available, it looks like they've gone down compared to previous years except in certain subpopulations. For example, Black suicides are up in Maryland and also in Connecticut and Chicago even though they've generally gone down."

It's possible that the higher rates of adverse mental health symptoms in younger people may be related to the fact that they view mental health issues as less stigmatized compared to older adults, Dr. Nestadt added.

—Linda Carroll

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