Persistent depressive symptoms during COVID-19: a national, population-representative, longitudinal study of U.S. adults

Abstract

Background The COVID-19 pandemic and its consequences have been associated with an increase in poor population mental health. We assessed how depressive symptoms changed among U.S. adults over the course of the COVID-19 pandemic and identified the key risk factors for these symptoms. Methods Longitudinal panel study of a nationally representative group of U.S. adults ages 18 years and older surveyed in March-April 2020 (Time 1; N=1441) and March-April 2021 (Time 2; N=1161) in the COVID-19 and Life Stressors Impact on Mental Health and Well-being study (CLIMB). The Patient Health Questionnaire-9 (PHQ-9) was used to define elevated depressive symptoms (cut-off ≥10) and depressive symptoms score (0-27). Findings The prevalence of elevated depressive symptoms persisted from 27.8% in 2020 (95% CI: 24.9, 30.9) to 32.8% in 2021 (95% CI: 29.1, 36.8). Over time, the central drivers of depressive symptoms were low household income, not being married, and experiencing multiple stressors during the COVID-19 pandemic. The odds ratio of elevated depressive symptoms for low income relative to high income persons increased from 2.3 (95% CI: 1.2, 4.2) in 2020 to 7.0 (95% CI: 3.7, 13.3) in 2021. Fewer people reported experiencing 4 or more COVID-19 stressors in 2021 than in 2020 (47.5% in 2020 vs 37.1% in 2021), but the odds ratio of elevated depressive symptoms associated with 4 or more stressors relative to 1 stressor or less increased from 1.9 (95% CI: 1.2, 3.1) in 2020 to 5.4 (95% CI: 3.2, 9.2) in 2021. Interpretation The burden of depressive symptoms in the U.S. adult population increased over the course of the COVID-19 pandemic. Mental health gaps grew between populations with different assets and stressor experiences during the COVID-19 pandemic. Funding CLIMB Time 1 was sponsored by the Rockefeller Foundation-Boston University 3-D Commission. CLIMB Time 2 was sponsored by the de Beaumont Foundation.

Assets, stressors, and symptoms of persistent depression over the first year of the COVID-19 pandemic

“…This study used a nationally representative sample of U.S. residents ages 18 years and older followed longitudinally over 1 year of the COVID-19 pandemic. Participants were surveyed in March and April 2020 (T1) and in March and April 2021 (T2) as part of the CLIMB study ( 11 ). Participants were drawn from the AmeriSpeak panel, which is a nationally representative standing panel whose sampling frame covered 97% of U.S. households and used a two-stage probability-based sample design to recruit members.…”

“…Participants were contacted over email and over the telephone if they did not respond to email outreach. The CLIMB survey completion rate for participants at T1 was 64.3% ( 8 ), and among those participants, the response rate at T2 was 81.1% ( 11 ). Details on sampling, demographics, and characteristics can be found in other published work ( 8 , 11 , 22 , 43 ).…”

“…The CLIMB survey completion rate for participants at T1 was 64.3% ( 8 ), and among those participants, the response rate at T2 was 81.1% ( 11 ). Details on sampling, demographics, and characteristics can be found in other published work ( 8 , 11 , 22 , 43 ). The final analytic sample in this paper included 1139 participants who responded to all depression questions at T1 and T2.…”

“…Vahratian et al ( 10 ) reported a continued increase in symptoms of depressive disorder from 24.5% in August 2020 to 30.2% in December 2020. Ettman et al ( 11 ) reported that 32.8% of U.S. adults reported elevated symptoms of probable depression in March and April 2021.…”

COVID-19 Exposure, Stress, and Mental Health Outcomes: Results From a Needs Assessment Among Low Income Adults in Central North Carolina

“…However, low socioeconomic status is a critical social risk factor that may heighten the risk for negative mental health outcomes, warranting research with low socioeconomic status populations. For example, longitudinal research indicates that overall depressive symptoms among U.S. adults increased from early in the pandemic compared to 1 year later, with low household income exacerbating depressive symptoms ( 27 ). An important aim of the present study is to examine a range of stressors attributed to COVID-19 among individuals who are disproportionately affected by socioeconomic systems that lead to poverty.…”