Pandemic Only Modestly Increased Anxiety and Depression Among Americans, Study Finds

Clinically significant US adult anxiety and depression increased less in the first year of the COVID-19 pandemic than online surveys have suggested, according to a study published online in JAMA Network Open.

“Many empirical papers…investigated the association of the pandemic with mental health, and most concluded that the pandemic caused dramatic increases in anxiety and depression,” researchers explained in the study background. “However, such studies mostly compared online pandemic-era surveys with low or unreported response rates against pre-pandemic government benchmark probability surveys. These comparisons could be biased.”

Researchers noted that the modest increase could be masking more substantial increases in anxiety and depression in key population segments such as first responders.

Noting that government benchmark trend surveys tend to yield more accurate information, researchers analyzed data from the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System (BRFSS) survey, a monthly phone survey not disrupted by the pandemic. The study focused on responses to a screening question calibrated to a 4-item Patient Health Questionnaire score of 6 or greater among 1.4 million adults. Responses from March to December 2020 were compared with responses from the same months in 2017 to 2019.

The estimated 30-day prevalence of clinically significant anxiety and depression was 12.4% from March to December 2020, according to the study, compared with 12.1% from March to December 2017 to 2019.

The prevalence of anxiety and depression increased only among people who were students or employed, the study found. Among workers, anxiety and depression increases were positively associated with the state-month COVID-19 death rates.

In respondents who were unemployed for a short term or unable to work, the prevalence of anxiety and depression decreased, researchers reported. Meanwhile, it remained mostly unchanged in long-term unemployed, homemakers, or retired respondents.

“One plausible interpretation of this specification is that anxiety and depression were associated with risk of infection when going to work, which increased as the COVID-19 death rate increased,” researchers wrote.

“Early psychological resilience during other infectious disease outbreaks and natural disasters has sometimes given way to subsequent increases in psychopathology as the crises become more protracted,” the authors wrote. “Such a pattern is typical, for example, for suicide rates in the early and later phases of long-lasting mass traumas. The same might have occurred in the second year of the COVID-19 pandemic.”

—Jolynn Tumolo


 Kessler RC, Ruhm CJ, Puac-Polanco V, et al. Estimated prevalence of and factors associated with clinically significant anxiety and depression among US adults during the first year of the COVID-19 pandemic. JAMA Netw Open. Published online June 15, 2022. doi: 10.1001/jamanetworkopen.2022.17223