As the COVID-19 pandemic continues to sicken millions and claim the lives of thousands of people in the US, as millions lose their jobs, as parents and teachers worry about kids going back to school, as renters face eviction and homeowners face foreclosures… it may not come as a surprise that mental health in the general population is far from good right now.
But a first-of-its-kind School of Public Health study finds that this unprecedented time has more than tripled the prevalence of depression symptoms in the US, from 8.5 percent of adults before the pandemic to 27.8 percent as of mid-April.
The findings are published in the journal JAMA Network Open.
“Depression in the general population after prior large scale traumatic events has been observed to, at most, double,” says study senior author Sandro Galea, Dean and Robert A. Knox Professor, citing examples such as September 11, the Ebola outbreak, and civil unrest in Hong Kong.
“We were surprised to see these results at first, but other studies since conducted suggest similar-scale mental health consequences,” Galea says. These studies have mainly been conducted in Asia and focused on specific populations such as healthcare workers and college students (one such study found depression symptoms among half of Chinese healthcare workers who had treated COVID patients).
But the new SPH study is the first nationally-representative study in the US to assess the change in depression prevalence 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 2017-2018 National Health and Nutrition Examination Survey (NHANES), and 1,441 respondents from the COVID-19 Life Stressors Impact on Mental Health and Well-Being (CLIMB) study, which was conducted from March 31 to April 13, 2020, when 96 percent of the US population was under stay-at-home advisories or shelter-in-place policies.
Both surveys used the PHQ 9 to assess depression symptoms and gathered the same demographic data, and the 2020 survey also gathered data on COVID-related stressors including job loss, the death of a friend or loved one from COVID, and financial problems.
Not surprisingly, experiencing more COVID-related stressors was also a major predictor of depression symptoms.
Across the board, the researchers found an increase in depression symptoms among all demographic groups. However, the biggest demographic difference came down to money. After adjusting for all other demographics, the researchers found that, during COVID, someone with less than $5,000 in savings was 50 percent more likely to have depression symptoms than someone with more than $5,000.
“Persons who were already at risk before COVID-19, with fewer social and economic resources, were more likely to report probable depression, suggesting that inequity may increase during this time and that health gaps may widen,” says study lead author Catherine Ettman, a doctoral student at the Brown University School of Public Health and director of strategic development in the Office of the Dean here at SPH.
“We would hope that these findings promote creating a society where a robust safety net exists, where people have fair wages, where equitable policies and practices exist, and where families can not only live on their income but can also save money towards the future,” she says.
As COVID continues to grip the country, Ettman says, “There may be steps that policymakers can take now to help reduce the impact of COVID-19 stressors on depression, such as eviction moratoria, providing universal health insurance that is not tied to employment, and helping people return to work safely for those able to do so.”
At the same time, Ettman says she and her colleagues hope the study findings will also help those who are experiencing depression in this incredibly difficult time see that they are not alone: On the contrary, one in four US adults is probably going through the same thing.
The study was co-authored by research fellow Salma Abdalla (SPH’16); Gregory Cohen, statistical analyst in the Department of Epidemiology; alum Laura Sampson (SPH’20), who was a doctoral candidate at SPH while working on the study; and Patrick M. Vivier of the Brown University School of Public Health.