Mental health consequences of COVID-19: a nationally representative cross-sectional study of pandemic-related stressors and anxiety disorders in the USA

Abstract

ObjectiveTo document the prevalence of anxiety disorders in the USA during the COVID-19 pandemic.DesignA cross-sectional analysis.SettingA nationally representative sample in the USA between 31 March and 13 April 2020.Participants1450 English-speaking adult participants in the AmeriSpeak Panel. AmeriSpeak is a probability-based panel designed to be representative of households in the USA.Main outcome measuresPrevalence of probable generalised anxiety disorder (GAD) using the GAD-7 and post-traumatic stress symptoms (PTSS) using the four-item PTSD (post-traumatic stress disorder) checklist. Both outcomes were stratified by demographics and COVID-19-related stressors.ResultsThe majority of participants were female (51.8%), non-Hispanic white (62.9%) and reported a household saving of $5000 or more. Those between 18 and 29 years old were the largest age group (38.1%) compared with 40–59 years (32.0%) and 60 years or more (29.9%). The prevalence of probable GAD was 10.9% (95% CI 9.1% to 13.2%) and the prevalence of PTSS was 21.7% (95% CI 19.1% to 24.6%). Among participants reporting five or more COVID-19-related stressors, the prevalence of probable GAD was 20.5% (95% CI 16.1% to 25.8%) and the prevalence of PTSS was 35.7% (95% CI 30.2% to 41.6%). Experiencing five or more COVID-19-related stressors was a predictor of both probable GAD (OR=4.5, 95% CI 2.3 to 8.8) and PTSS (OR=3.3, 95% CI 2.1 to 5.1).ConclusionsThe prevalence of probable anxiety disorders in the USA, as the COVID-19 pandemic and policies implemented to tackle it unfolded, is higher than estimates reported prior to the pandemic and estimates reported following other mass traumatic events. Exposure to COVID-19-related stressors is associated with higher prevalence of both probable GAD and PTSS, highlighting the role these stressors play in increasing the risk of developing anxiety disorders in the USA. Mitigation and recovery policies should take into account the mental health toll the pandemic had on the USA population.

Research on Posttraumatic Stress Disorder in the Context of the COVID-19 Pandemic: A Review of Methods and Implications in General Population Samples

“…A recent study examining the number of COVID-19-related stressors in relation to posttraumatic stress symptoms and confirmed the usefulness of this approach in general population samples. 90 Other major, as well as less severe life stressors, could be assessed as those that either pre-existed the pandemic or judged by a study participant as not directly related to the pandemic (e.g., divorce or separation). This type of approach would allow a more exhaustive picture of individual exposure to various stressors and take the latter into account when measuring associated symptoms.…”

Young Adult Adaptability to the Social Challenges of the COVID-19 Pandemic: The Protective Role of Friendships

“…Hence, lockdowns and physical distancing restrictions during the COVID-19 pandemic likely contributed to elevated emotional distress and feelings of loneliness. Indeed, surveys of adults conducted across the globe reveal increased emotional problems during the strictest lockdowns and physical distancing mandates (Abdalla et al, 2021 , Dawel et al, 2020 , O’Connor et al, 2021 ), and loneliness has been labeled the signature mental health problem of the COVID-19 pandemic (Killgore et al, 2020 ). Cross-sectional surveys of adults also reveal a robust age difference: compared to older individuals, young adults report higher rates of anxiety, depression, and loneliness during the pandemic (e.g., Groarke et al, 2020 , Keeter, 2021 ).…”

Relationship between Psychological Status and Health Behaviors during the Coronavirus Disease Pandemic in Japanese Community-Dwelling Older Adults

“…First, the stress status was assessed by the number of items that corresponded to nine typical stress items, such as infection, inability to engage in hobbies, discord in the family, relations with neighbors, difficulty in interacting with friends, difficulty with household chores, financial problems, and unemployment [14]. Second, the stressed group was defined as those with three or more items indicating the presence of a moderate or more significant stress factor based on the previous research [9] and average items and one standard deviation (SD). Based on these evaluation results, the participants were divided into four groups: no anxiety/stress group, mild anxiety/stress group, moderate anxiety/stress group, and severe anxiety/stress group (Table 1).…”

“…The psychological burden in older individuals may include stress caused by external factors and anxiety, which are psychological factors resulting from stress [8]. Several studies have reported on the factors that contribute to the psychological burden on older adults in the context of the COVID-19 pandemic [9,10]. Findings [9] have reported that the prevalence of anxiety disorders during the COVID-19 pandemic occurred in the United States was significantly higher than the prevalence reported after other significant traumatic events.…”

“…Several studies have reported on the factors that contribute to the psychological burden on older adults in the context of the COVID-19 pandemic [9,10]. Findings [9] have reported that the prevalence of anxiety disorders during the COVID-19 pandemic occurred in the United States was significantly higher than the prevalence reported after other significant traumatic events. Moreover, people who experience social and emotional stressors, especially stress due to economic problems and loneliness, are more likely to have post-traumatic stress disorder (PTSD) and anxiety disorders.…”