Predictors of mental health during the Covid-19 pandemic in the US: Role of economic concerns, health worries and social distancing

Abstract

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.

Post-lockdown depression and anxiety in the USA during the COVID-19 pandemic

“…For example, a study of 5065 US adults in March indicated that among the states with more than 50 COVID-19 cases, each additional day was associated with a 11% increase in the odds of moving up a category of psychological distress. 5 Another March 2020 study of 9687 Americans with no prior history of a mental health condition asked about psychological distress within the past week (compared to this study of past 2 weeks experience) and found that the major symptoms of psychological distress experienced for at least 3 days in the past week were feeling nervous, anxious or on edge (39%) and feelings of depression (19%). 13 Despite the variation in scales/measures and study period, across most studies, anxiety was more common than depression in the US population (a finding that is confirmed in this study).…”

“…These numbers closely resemble the US population distribution as per the census and labor statistics, making our study sample representative of the US population to a great extent. 4 , 5 , 24…”

“… 1–5 Given these circumstances and their associations with psychological distress, a variety of popular media polls and reports indicated the burden of the pandemic on the mental health of Americans. 5–9 For example, the Kaiser Family Foundation conducted two polls in March and July, where participants across the nation indicated that their mental health was negatively impacted due to worry and stress over the coronavirus (32% in March and 53% in July). 6 Similarly, an international survey of more than 8000 individuals conducted from March to May by the Commonwealth Fund found that a third of Americans reported experiencing stress, sadness and anxiety which were difficult to cope with (significantly higher than other countries included in the survey).…”

“… 8 While few other such polls and reports exist, there are certain limitations of these estimates. 5–10 First, the preponderance of the evidence on the mental health burden of the pandemic comes from the early stages of the pandemic (i.e. March–June) and countries other than the USA.…”

A behavioral economic risk aversion experiment in the context of the COVID-19 pandemic

“…More precisely, it was shown that the burden of measures designed to stem the pandemic are unevenly distributed across sociodemographic groups and, therefore, it is necessary to shed light on what behavior can be expected of different segments of the population during a pandemic given heterogeneity in the incentives, constraints and circumstances people face [ 33 ]. Moreover, as showed before, high expected probability of running out of money is positively associated with mental health score, while perceived risks of dying from Covid-19 and social are also strongly correlated with higher levels of depression/anxiety [ 49 ]. Therefore, as the number of cases continues to rise, public-health politics may consider not only sensitizing people regarding infection rates, but also by providing health information and services, financial incentives, or fiscal alternatives so that people can maintain their businesses in a sustainable way.…”