The percentage of U.S. adults reporting symptoms of depression has not stopped rising since the pandemic began, according to survey data published Monday in The Lancet Regional Health – Americas. Those most likely to report elevated depressive symptoms tended to have less income and a greater number of COVID-related stressors, including the death of someone close to COVID-19, loss of employment, and/or challenges securing childcare.
“Typically, we would expect depression to peak following the traumatic event and then lower over time,” senior author Sandro Galea M.D., M.P.H., Dr.P.H., of Boston University School of Public Health said in a news release. “Instead, we found that 12 months into the pandemic, levels of depression remained high.”
Lead author Catherine Ettman, a doctoral candidate at Brown University, Galea, and colleagues analyzed data from two waves of the COVID-19 and Life Stressors Impact on Mental Health and Well-being study. The first survey included 1,441 respondents (aged 18 and older) and was conducted from March 31 to April 13, 2020, when much of the United States was under stay-at-home advisories. The second survey was conducted with the same group one year later, from March 23 to April 19, 2021, and included 1,161 respondents.
At both time points, the participants filled out the Patient Health Questionnaire-9 (PHQ-9) and answered questions about their stressful experiences. The authors defined elevated depressive symptoms as a PHQ-9 score of ≥10 and high stressor counts as the presence of 4 or more of 13 COVID-related stressors (including death of a loved one to COVID-19, job loss, financial problems, and more).
Although fewer respondents reported high stressor counts in 2021 compared with 2020 (37.1% vs 47.5%, respectively), the association between stress and depressive symptoms grew stronger, the authors reported. In 2020, people who experienced four or more stressors were about twice as likely to have elevated depressive symptoms as those who experienced one COVID-related stressor or less; in 2021 people who experienced four or more stressors were 5.4 times as likely to have elevated depressive symptoms. Similarly, adults with $19,999 or less in household income in 2020 were 2.3 times as likely to have elevated depressive symptoms as those with $75,000 income or more; by 2021, low-income adults were 7 times as likely to have elevated depressive symptoms.
Overall, the percentage of participants reporting elevated depressive symptoms rose from 27.8% in 2020 to 32.8% in 2021, the authors reported.
“The sustained and increasing prevalence of elevated depressive symptoms suggests that the burden of the pandemic on mental health has been ongoing—and that it has been unequal,” Ettman said in the news release. “Addressing stressors such as job loss, challenges accessing childcare, and difficulties paying rent will help to improve population mental health and reduce inequities that have deepened during the pandemic.”
For related information, see the Psychiatric News article “Why We Must Address Poverty,” by APA President Vivian B. Pender, M.D.
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