COVID-19-related mental health, substance use disparities differ by race, ethnicity

Combined prevalence estimates of depression, initiating or increasing substance use and suicidal thoughts/ideation among U.S. adults have been significant during the COVID-19 pandemic, researchers noted in MMWR.

Estimates varied by race/ethnicity.

“Selected mental health conditions and initiation of or increase in substance use to cope with stress or emotions during the COVID-19 pandemic were commonly reported by U.S. adults responding to an opt-in survey in April and May 2020,” Lela R. McKnight-Eily, PhD, of the CDC’s COVID-19 Social and Behavioral Health Team, and colleagues wrote. “The prevalence of current depression, suicidal thoughts/ideation and increased or newly initiated substance use was also higher for some racial and ethnic minority groups, especially Hispanic respondents. Hispanic adults reported higher levels of stress and worry about not having enough food or stable housing than did white adults.”

The researchers analyzed survey data of 1,004 participants who responded in April 2020 and May 2020, with questions regarding increases in or initiation of substance use during the COVID-19 pandemic, symptoms of current depression and suicidal thoughts/ideations, as well as questions regarding psychosocial stress, such as feeling isolated and alone, stigma or discrimination, such as being blamed for spreading COVID-19, and social determinants of health, such as food instability.

Results showed prevalence estimates of 28.6% for current depression, 8.4% for suicidal thoughts/ideation and 18.2% for initiation of or increase in substance use. A total of 40.3% of Hispanic adults reported symptoms of current depression vs. 25.3% among non-Hispanic white individuals. Hispanic individuals had estimates of self-reported suicidal thoughts/ideation that were four times higher than those of non-Hispanic Black individuals and white individuals and approximately two times higher than those multiracial and non-Hispanic individuals of other races/ethnicities. A total of 36.9% of Hispanic participants reported increased or newly initiated substance use vs. 14.3% to 15.6% among all other participants.

Participants reported several sources of psychosocial stress, including family health (36.3%), feelings of isolation or loneliness (28.6%), worry about getting ill from COVID-19 or infecting others (25.7%), worry about the death of a loved one or persons dying (15.2%), workplace COVID-19 exposure (13.5%) and stigma or discriminations for being blamed for spreading COVID-19 (4.1%), McKnight-Eily and colleagues noted. A total of 39.3% of white participants reported stress and worry about the health of family member and loved ones vs. 24.5% for Black adults, and 12.9% of multiracial and non-Hispanic individuals of other races/ethnicities reported stress and worry about stigma or discriminations linked to being blamed for spreading COVID-19 vs. 2.4% of white and 3.7% of Hispanic individuals. Further, regarding estimates of stress and worry about social determinants, 27.1% reported possible job loss, 18.4% reported ability to obtain needed health care, 14.4% report not having enough food and 11.8% reported housing instability. A total of 22.7% and 20.7% of Hispanic participants reported stress related to not having enough food or stable housing, respectively, vs. 11.9% and 9.2% for white adults, respectively.

“Addressing barriers or disruptions to access to and delivery of mental health and substance use services during the COVID-19 pandemic, including considerations for health care systems, practices and providers using telehealth coverage; consideration of parity in insurance coverage for mental health and substance use services; and use of virtual mental health treatment and substance use recovery groups, is important,” McKnight-Eily and colleagues wrote. “Policies and structural programs can be adapted or developed to reduce preexisting racial and ethnic group disparities in social determinants of health (eg, housing, food, access to health care and income security) while also addressing psychosocial stressors unique to communities with large racial and ethnic minority populations. The mental health and psychosocial needs of U.S. adults, including persons in racial and ethnic minority groups, are an important consideration when promoting community resilience and preserving access to and provision of services during the COVID-19 pandemic.”