COVID-19 pandemic has placed heavy mental health burden on those at risk for depression

The COVID-19 pandemic has been linked to a high burden of depression symptoms in the U.S., according to study results published in JAMA Network Open.

Individuals who were already at increased risk for depression, especially because of economic reasons, appeared disproportionately affected by the pandemic.

“We know that depression increases after traumatic events, but we did not know the magnitude and scope of depression during the COVID-19 pandemic,” Catherine K. Ettman, BA, of Boston University School of Public Health, told Healio Psychiatry. “This study aimed to measure the prevalence of depression in a nationally representative sample of the U.S. adult population during the COVID-19 pandemic.”

Prior studies of mental health related to the COVID-19 pandemic were primarily conducted in China and focused on specific subpopulations. Studies published in the U.S. have been in purposive samples, with findings of one that included 9,009 completed surveys suggesting that 67.3% of participants felt very or extremely concerned about COVID-19 and 48.8% of participants self-isolated most of the time to avoid the virus. However, to Ettman and colleagues’ knowledge, studies have not documented the mental health of the broader U.S. population during the pandemic.

In the current nationally representative survey study, the investigators analyzed data of 1,441 individuals who completed the COVID-19 and Life Stressors Impact on Mental Health and Well-being study during the pandemic, as well as of 5,065 individuals who completed the National Health and Nutrition Examination Survey, which was conducted between 2017 and 2018. Depression symptoms defined according to the Patient Health Questionnaire-9 cutoff of 10 or higher served as the main outcome. The researchers analyzed data for both surveys of individuals aged 18 to 39. They defined depression symptom categories as none (score of zero to four), mild (score of five to nine, moderate (score of 10 to 14), moderately severe (score of 15 to 19) and severe (score of 20).

Results showed higher depression symptom prevalence in every category during the COVID-19 pandemic vs. before it. Prevalence rates for during vs. before, respectively, were as follows:

• mild = 24.6% vs. 16.2%;

• moderate = 14.8% vs. 5.7%;

• moderately severe = 7.9% vs. 2.1%; and

• severe = 5.1% vs. 0.7%.

Those with higher risk for depression symptoms during the pandemic were more likely to have lower income (OR = 2.37; 95% CI, 1.26-4.43), have less than $5,000 in savings (OR = 1.52; 95% CI, 1.02-2.26) and be exposed to more stressors (OR = 3.05; 95% CI, 1.95-4.77).

“These rates were higher than what we have seen in the general population after other large-scale traumas, such as September 11th, Hurricane Katrina and the Hong Kong unrest,” Ettman told Healio Psychiatry. “The reason for that is probably that this is not one event. This is both COVID-19 and the fear and anxiety associated with it, as well as the dramatic economic consequences. Evidence for that comes in particular from the disproportionate burden of depression on people with fewer resources.

“Given the disproportionate burden on people with fewer resources, societal efforts to support people with fewer resources will be essential to mitigate the mental health burden of this pandemic,” Ettman added. “This calls for a redoubling in our societal investment in supporting people through difficult economic times.”

In a related editorial, Ruth S. Shim, MD, MPH, of the department of psychiatry and behavioral sciences at the University of California, Davis, emphasized the critical importance of addressing the COVID-19-related mental health outcomes among the U.S. population.

“To effectively prepare to face this public health crisis, health care practitioners and policy makers must commit to addressing the social determinants of health and mental health,” Shim wrote. “Convincing data support investments in public health and social welfare benefits (e.g., food, housing, unemployment benefits) over investments in health care services (e.g., Medicaid, Medicare) to achieve better health outcomes. By documenting the increased risk [for] depression that is waiting on the horizon after new cases of COVID-19 subside, the study by Ettman [and colleagues] might remind us of the importance of investing (both during and after the COVID-19 pandemic) in stable housing, unemployment benefits, access to healthy food and policies that end discrimination and exclusion to effectively manage a highly disabling, common mental health condition that will likely only increase in prevalence as the pandemic rages on.”