Trajectories of Mental Distress Among U.S. Adults During the COVID-19 Pandemic

• Published in: Annals of behavioral medicine Vol. 55; no. 2; pp. 93 - 102
• Main Authors: Riehm, Kira E, Holingue, Calliope, Smail, Emily J, Kapteyn, Arie, Bennett, Daniel, Thrul, Johannes, Kreuter, Frauke, McGinty, Emma E, Kalb, Luther G, Veldhuis, Cindy B, Johnson, Renee M, Fallin, M Daniele, Stuart, Elizabeth A
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 16-03-2021
• Subjects: Adult; Adults; Aged; Coronaviruses; COVID-19; COVID-19 - psychology; Cross-Sectional Studies; Editor's Choice; Female; Health behavior; Health psychology; Humans; Male; Mental disorders; Mental health; Mental Health - trends; Middle Aged; Pandemics; Patient Health Questionnaire; Psychological Distress; Regular; Self Report; Sociodemographics; Socioeconomic Factors; United States; Young Adult; United States; United States > US; COVID-19; Sociodemographic disparities; Psychiatric epidemiology; Mental health
• ISSN: 0883-6612; 1532-4796; 1532-4796
• DOI: 10.1093/abm/kaaa126

Abstract
Background
Cross-sectional studies have found that the coronavirus disease 2019 (COVID-19) pandemic has negatively affected population-level mental health. Longitudinal studies are necessary to examine trajectories of change in mental health over time and identify sociodemographic groups at risk for persistent distress.
Purpose
To examine the trajectories of mental distress between March 10 and August 4, 2020, a key period during the COVID-19 pandemic.
Methods
Participants included 6,901 adults from the nationally representative Understanding America Study, surveyed at baseline between March 10 and 31, 2020, with nine follow-up assessments between April 1 and August 4, 2020. Mixed-effects logistic regression was used to examine the association between date and self-reported mental distress (measured with the four-item Patient Health Questionnaire) among U.S. adults overall and among sociodemographic subgroups defined by sex, age, race/ethnicity, household structure, federal poverty line, and census region.
Results
Compared to March 11, the odds of mental distress among U.S. adults overall were 1.84 (95% confidence interval [CI] = 1.65–2.07) times higher on April 1 and 1.92 (95% CI = 1.62–2.28) times higher on May 1; by August 1, the odds of mental distress had returned to levels comparable to March 11 (odds ratio [OR] = 0.80, 95% CI = 0.66–0.96). Females experienced a sharper increase in mental distress between March and May compared to males (females: OR = 2.29, 95% CI = 1.85–2.82; males: OR = 1.53, 95% CI = 1.15–2.02).
Conclusions
These findings highlight the trajectory of mental health symptoms during an unprecedented pandemic, including the identification of populations at risk for sustained mental distress.
The prevalence of mental distress among U.S. adults fluctuated between March and August 2020, with a peak observed in mid-April; women experienced a proportionally larger increase in prevalence of mental distress compared to men.