An increasing proportion of US adults have reported symptoms of anxiety and depression amid the COVID-19 pandemic, a trend most pronounced among younger adults and those without a high school education, according to a new study published by the Centers for Disease Control and Prevention (CDC).
The study examined responses collected from August 19, 2020, to February 1, 2021, from nearly 800 000 US adults who completed online surveys about their mental health, answering questions about symptoms of anxiety or depression and whether they sought mental health services. The researchers found that the trends in anxiety or depression symptoms were consistent with trends in the number of COVID-19 cases reported weekly, noting that “it has been theorized that increases in these mental health indicators correspond with pandemic trends.”
The findings are based on the ongoing Household Pulse Survey, a “rapid-response” online survey developed by the CDC’s National Center for Health Statistics, the US Census Bureau, and other federal agencies. The researchers invited adults associated with email addresses and mobile telephone numbers linked with randomly selected housing units to respond to questions designed to assess the social and economic effects of the COVID-19 pandemic.
The researchers used a validated 4-item tool, the Patient Health Questionnaire for depression and anxiety. Questions included how often during the preceding 7 days respondents had felt they were anxious or on edge, were not able to stop or control worrying, had little interest or pleasure in activities, or felt depressed or hopeless.
The survey also asked respondents about use of mental health care services, including whether they had, during the past 4 weeks, taken prescription medication for their mental health, received counseling from a mental health professional, or needed counseling but had not received it.
More than 2 in 5 adults (42%) reported symptoms of either an anxiety or depressive disorder during a period in December (December 9-21, 2020), increasing from 36% in August (August 19-31, 2020). During the same 2 periods, self-reported symptoms of an anxiety disorder increased from approximately 31% to 37%, and self-reported symptoms of a depressive disorder increased from approximately 25% to 30%.
Similarly, the percentage of adults who reported taking prescription medicine or receiving counseling for their mental health increased during the pandemic, from 22% during August 19 to 31 to 25% during November 25 to December 7. The percentage who said they needed but hadn’t received counseling in the past 4 weeks also rose, from 9% (during August 19-31) to 12% (during December 9-21).
Estimates assessed through January 2021 of mental health symptoms, receiving treatment, or unmet mental health needs (not receiving needed mental health counseling) were similar to those measured in December.
Nearly all adult age groups (except adults aged 80 years or older) had significant increases in symptoms; younger adults and respondents with less than a high school diploma experienced the largest increases. By February 1, nearly 3 in 5 (57%) individuals aged 18 to 29 years and half of people who did not finish high school reported having symptoms of anxiety or depression in the preceding 7 days.
Similarly, younger adults experienced the largest increases in unmet mental health needs (from nearly 16% in August to nearly 23% by February 1), as did those lacking a high school diploma (from 7% to 11%).
The authors noted that the study findings are subject to limitations. For example, although their estimates are intended to represent all US adults aged 18 years or older, “representativeness might be limited by the indirect exclusion of persons without internet access and by low response rates,” the latter ranging from nearly 7% to more than 9% during the phases studied.
Despite the limitations, the survey’s strengths include its timeliness and relevance, the authors said.
“Continued near real-time monitoring of mental health trends by demographic characteristics is critical during the COVID-19 pandemic,” they wrote. “These trends might be used to evaluate the impact of strategies that address mental health status and care of adults during the pandemic and to guide interventions for groups that are disproportionately affected.”
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Stephenson J. JAMA Health Forum.
Corresponding Author: Joan Stephenson, PhD, Consulting Editor, JAMA Health Forum (Joan.Stephenson@jamanetwork.org).
Conflict of Interest Disclosures: None reported.
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Stephenson J. CDC Study Finds Worsening Anxiety and Depression, Especially in Young Adults, During COVID-19 Pandemic. JAMA Health Forum. 2021;2(4):e210724. doi:10.1001/jamahealthforum.2021.0724