Symptoms of Anxiety or Depressive Disorder and Use of Mental Health Care Among Adults During the COVID-19 Pandemic — United States, August 2020–February 2021

Vahratian, Anjel; Blumberg, Stephen J.; Terlizzi, Emily P; Schiller, Jeannine S.

doi:10.15585/mmwr.mm7013e2

Cited by 361 publications

(315 citation statements)

References 5 publications

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“…Furthermore, the infrequency of assessments of both parental and caregiving roles makes comparing these estimates difficult. ******* The prevalence and trajectories of anxiety and depression symptoms were consistent with results from the Household Pulse Survey ††††††† ( 10 ), and robust associations between parenting and caregiving roles and adverse mental health symptoms in the large, demographically diverse COPE Initiative sample merit additional research.…”

Section: Discussionsupporting

confidence: 68%

Mental Health Among Parents of Children Aged <18 Years and Unpaid Caregivers of Adults During the COVID-19 Pandemic — United States, December 2020 and February–⁠March 2021

Czeisler¹,

Rohan²,

Melillo³

et al. 2021

MMWR Morb. Mortal. Wkly. Rep.

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Early during the COVID-19 pandemic, nearly two thirds of unpaid caregivers of adults reported adverse mental or behavioral health symptoms, compared with approximately one third of noncaregivers † (1). In addition, 27% of parents of children aged <18 years reported that their mental health had worsened during the pandemic (2). To examine mental health during the COVID-19 pandemic among U.S. adults on the basis of their classification as having a parenting role (i.e., unpaid persons caring for children and adolescents aged <18 years, referred to as children in this report) or being an unpaid caregiver of adults (i.e., persons caring for adults aged ≥18 years), § CDC analyzed data from cross-sectional surveys that were administered during December 2020 and February-March 2021 for The COVID-19 Outbreak Public Evaluation (COPE) Initiative. ¶ Respondents were categorized as parents only, caregivers of adults only, parents-caregivers (persons in both roles), or nonparents/noncaregivers (persons in neither role). Adjusted odds ratios (aORs) for any adverse mental health symptoms, particularly suicidal ideation, were higher among all respondents who were parents, caregivers of adults, or both compared with respondents who were nonparents/ noncaregivers and were highest among persons in both roles

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Section: Discussionsupporting

confidence: 68%

Mental Health Among Parents of Children Aged <18 Years and Unpaid Caregivers of Adults During the COVID-19 Pandemic — United States, December 2020 and February–⁠March 2021

Czeisler¹,

Rohan²,

Melillo³

et al. 2021

MMWR Morb. Mortal. Wkly. Rep.

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“…Together, the lack of neurodevelopmental differences between in utero SARS-CoV-2 exposed and unexposed infants and the observed group differences between the historical and pandemic cohorts suggest COVID-19-related stress should be considered as a potential underlying mechanism. Reported stressors have included job loss, food insecurity, and loss of housing, 49 and the pandemic has resulted in significant increases in symptoms of anxiety and depression 50 . Consistent with our finding that infants born to women who were in the first trimester of pregnancy during the pandemic peak had the greatest reduction in personal-social scores, data from numerous cohort studies have demonstrated that prenatal perceived stress, loneliness, and objective stress, especially during early gestation, are associated with increased risk for adverse neurodevelopment in children 3,51-59 . Although consistent with prior studies of children born during natural disasters, interpretation of our results should take into account several limitations.…”

Section: Discussionmentioning

confidence: 99%

Birth during the COVID-19 pandemic, but not maternal SARS-CoV-2 infection during pregnancy, is associated with lower neurodevelopmental scores at 6-months

Shuffrey

Firestein

Kyle

et al. 2021

Preprint

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The intrauterine environment strongly influences development. Neurodevelopmental effects of in utero exposure to maternal SARS-CoV-2 infection are widely speculated but currently unknown. The COVID-19 Mother Baby Outcomes (COMBO) initiative was established at Columbia University Irving Medical Center (CUIMC) in New York City to prospectively study the health and wellbeing of infants with and without in utero exposure to maternal SARS-CoV-2 infection. We report findings on 6-month neurodevelopmental outcomes using the parental-report Ages & Stages Questionnaire, 3rd Edition (ASQ-3), from 107 in utero exposed and 131 unexposed full-term infants born between March and December, 2020. We compare these infants to a historical cohort comprised of 62 infants born at CUIMC at least two months prior to the onset of the pandemic. In utero exposure to maternal SARS-CoV-2 infection was not associated with differences on any ASQ-3 subdomain regardless of infection timing or severity, however, infants born during the pandemic had significantly lower scores on gross motor, fine motor, and personal-social subdomains when compared to the historical cohort. Infants born to women who were in the first trimester of pregnancy during the peak of the pandemic in NYC had the lowest personal-social scores. Birth during the pandemic, but not maternal SARS-CoV-2 infection, was associated with differences in neurodevelopmental outcomes at 6-months. These early findings suggest significantly higher public health impact for the generation born during the COVID-19 pandemic than previously anticipated.

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“…Analysis of longitudinal U.K. and U.S. survey data suggested that those increased prevalence may have been transient, with anxiety and depression symptoms declining among participants who completed several follow-up measures between March or April and August 2020 (Fancourt et al ., 2020 ; Riehm et al ., 2021 ). However, those longitudinal data from repeat-responders are not consistent with cross-sectional U.S. survey data, which indicate that levels of adverse mental health symptoms have remained persistently elevated (CDC, 2020 ; Vahratian et al ., 2021 ; Czeisler et al ., 2021 c ). As, for example, 38.5% of U.K. respondents were excluded from analysis because they did not complete multiple follow-up surveys, we analysed data from U.S. adults invited to complete surveys over a comparable time interval to determine if survivorship bias could account for the discrepancy between the published cross-sectional and longitudinal data from U.S. and U.K.…”

Section: Introductionmentioning

confidence: 99%

Uncovering survivorship bias in longitudinal mental health surveys during the COVID-19 pandemic

Czeisler

Wiley

Czeisler

et al. 2021

Epidemiol Psychiatr Sci

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Aims. Markedly elevated adverse mental health symptoms were widely observed early in the coronavirus disease-2019 (COVID-19) pandemic. Unlike the U.S., where cross-sectional data indicate anxiety and depression symptoms have remained elevated, such symptoms reportedly declined in the U.K., according to analysis of repeated measures from a large-scale longitudinal study. However, nearly 40% of U.K. respondents (those who did not complete multiple follow-up surveys) were excluded from analysis, suggesting that survivorship bias might partially explain this discrepancy. We therefore sought to assess survivorship bias among participants in our longitudinal survey study as part of The COVID-19 Outbreak Public Evaluation (COPE) Initiative. Methods. Survivorship bias was assessed in 4039 U.S. respondents who completed surveys including the assessment of mental health as part of The COPE Initiative in April 2020 and were invited to complete follow-up surveys. Participants completed validated screening instruments for symptoms of anxiety, depression and insomnia. Survivorship bias was assessed for (1) demographic differences in follow-up survey participation, (2) differences in initial adverse mental health symptom prevalence adjusted for demographic factors and (3) differences in follow-up survey participation based on mental health experiences adjusted for demographic factors. Results. Adjusting for demographics, individuals who completed only one or two out of four surveys had significantly higher prevalence of anxiety and depression symptoms in April 2020 (e.g. one-survey v. four-survey, anxiety symptoms, adjusted prevalence ratio [aPR]: 1.30, 95% confidence interval [CI]: 1.08-1.55, p = 0.0045; depression symptoms, aPR: 1.43, 95% CI: 1.17-1.75, p = 0.00052). Moreover, individuals who experienced incident anxiety or depression symptoms had significantly higher adjusted odds of not completing follow-up surveys (adjusted odds ratio [aOR]: 1.68, 95% CI: 1.22-2.31, p = 0.0015, aOR: 1.56, 95% CI: 1.15-2.12, p = 0.0046, respectively). Conclusions. Our findings reveal significant survivorship bias among longitudinal survey respondents, indicating that restricting analytic samples to only respondents who provide repeated assessments in longitudinal survey studies could lead to overly optimistic interpretations of mental health trends over time. Cross-sectional or planned missing data designs may provide more accurate estimates of population-level adverse mental health symptom prevalence than longitudinal surveys.

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Symptoms of Anxiety or Depressive Disorder and Use of Mental Health Care Among Adults During the COVID-19 Pandemic — United States, August 2020–February 2021

Cited by 361 publications

References 5 publications

Mental Health Among Parents of Children Aged <18 Years and Unpaid Caregivers of Adults During the COVID-19 Pandemic — United States, December 2020 and February–⁠March 2021

Mental Health Among Parents of Children Aged <18 Years and Unpaid Caregivers of Adults During the COVID-19 Pandemic — United States, December 2020 and February–⁠March 2021

Birth during the COVID-19 pandemic, but not maternal SARS-CoV-2 infection during pregnancy, is associated with lower neurodevelopmental scores at 6-months

Uncovering survivorship bias in longitudinal mental health surveys during the COVID-19 pandemic

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