Depression Rates Tripled and Symptoms Intensified During First Year of COVID-19 Pandemic

People with lower incomes and who have experienced multiple COVID-related stressors were more likely to feel the toll of the pandemic as socioeconomic inequalities in mental health continue to widen.

According to a new study from the Boston University School of Public Health (BUSPH), depression among American adults persisted — and worsened — through the first year of the COVID-19 pandemic.

The first study of its kind, published in the journal The Lancet Regional Health – Americas, found that 32.8% of U.S. adults experienced increased depressive symptoms in 2021, compared with 27.8% of adults in the first few months of the year. the pandemic in 2020, and 8.5% before the pandemic.

The main predictors of depressive symptoms during the pandemic were low family income, not being married, and the experience of multiple pandemic stressors. The findings underscore the inextricable link between the pandemic and its short- and long-term effects on the mental health of the population.

“The continued high prevalence of depression does not follow patterns of past traumatic events such as Hurricane Ike and the Ebola outbreak,” said lead researcher Dr. Sandro Galea, Dean and Robert A. Knox Professor at BUSPH. “Normally, we would expect depression to peak after the traumatic event and decrease over time. Instead, we found that levels of depression remained high 12 months after the pandemic.”

The study is the first nationally representative study in the US to examine change in the prevalence of depression before and during COVID, using the Patient Health Questionnaire-9 (PHQ 9), the leading self-administered depression screening tool.

The researchers used data from 5,065 respondents to the National Health and Nutrition Examination Survey (NHANES) 2017-2018, as well as from respondents to two COVID-19 Life Stressors Impact on Mental Health and Well-Being (CLIMB) surveys. The first survey included 1,441 respondents and was conducted from March 31 to April 13, 2020, when the majority of the U.S. population was advised to stay at home. The second survey was conducted with the same group a year later, from March 23 to April 19, 2021, and included 1,161 respondents.

Both surveys used the PHQ 9 to assess depression symptoms and collected the same demographic data, and the CLIMB surveys also collected data on COVID-related stressors such as job loss, the death of a loved one due to COVID, financial difficulties, feeling alone, and a lack of childcare.

Survey responses suggested that the burden of depression increased over the course of the pandemic, disproportionately impacting lower-income adults. When adjusting for other demographics, people earning less than $20,000 in the spring of 2020 were 2.3 times more likely to have increased depressive symptoms, compared with people earning $75,000 or more; in the spring of 2021, low-income adults were more than 7 times more likely to experience these symptoms.

While population-level stressors generally decreased during the first year of the pandemic, people who experienced four or more stressors were more likely to also experience increased depressive symptoms — and least likely to overcome those stressors.

“The ongoing and increasing prevalence of increased depressive symptoms suggests that the burden of the pandemic on mental health continues — and has been uneven,” said lead researcher Catherine Ettman, a doctoral student at Brown University School of Public Health and chief of staff and director. of strategic initiatives in the Office of the Dean at BUSPH. She notes that economic relief and the development of COVID-19 vaccines may have prevented even worse depression outcomes.

“Low-income populations have been disproportionately affected by the pandemic and future efforts should keep this population in mind,” Ettman said. “Addressing stressors such as job loss, difficulties accessing childcare and difficulty paying rent will help improve the mental health of the population and reduce the inequality that has increased during the pandemic.”

Reference: “Persistent depressive symptoms during COVID-19: a national, population-representative, longitudinal study of US adults” Oct 4, 2021, The Lancet Regional Health – Americas.
DOI: 10.1016/j.lana.2021.100091