Anxiety and Depression Symptoms Have Risen Dramatically During the Pandemic
Many are suffering from symptoms of anxiety and depression during the COVID-19 pandemic. How prevalent are these symptoms? An article published in the Morbidity and Mortality Weekly Report (MMWR) from the Centers for Disease Control and Prevention (CDC) describes the results of a recent survey.
During one week in June 2020, 9,896 adults age 18 years and older were invited to participate in a web-based survey; 5412 (55%) responded. Standardized self-reported screening instruments were used to assess symptoms of anxiety, depressive disorders, and trauma- or stressor-related disorders (TSRD) as a result of the pandemic. Participants were also asked whether they had seriously considered suicide during the previous 30 days. Although self-reported symptoms do not mean that individuals would meet diagnostic criteria for anxiety disorders or major depression in clinician-administered diagnostic interviews, such self-reports do correlate with increased risks of fulfilling such diagnoses.
Overall, about 26% of participants demonstrated symptoms of anxiety, 24% symptoms of depression, and 26% symptoms of TSRD. About 41% had symptoms suggestive of at least one of these groups of symptoms. The authors estimate that these rates are three to four times higher than those reported in similar surveys one year earlier.
The authors found interesting trends related to age, race/ethnicity, income, type of employment, and employment status. Young adults were much more likely to report symptoms than older individuals: 75% of those 18-24 years of age reported symptoms of anxiety, depressive disorder, and/or TSRD. This decreased to 52% in those 25-44, 30% in those 45-64, and 15% in those 65 and older.
Non-Hispanic white and Black individuals reported rates of symptoms of 38% and 44%, respectively, whereas Non-Hispanic Asians had a lower rate of 32%. Hispanics reported a higher rate, 52%.
In terms of household income, the percent of respondents reporting symptoms ranged from 45% in those with a household income of less than $25,000 to 35% in those with a household income of $200,000 or higher. In terms of job status, those who considered themselves “essential workers” reported a rate of 54% compared to “non-essential” employees who reported a rate of 41%. Only about 20% of retired individuals reported symptoms of anxiety, depression, or TSRD.
Some of the categories in this study are correlated. For instance, being retired is much more common in older than younger individuals. The investigators did not report results using a statistical model that examined independent contributions of each of the demographic variables.
Suicidal thoughts are often associated with anxiety and depression: 11% of those surveyed indicated that they had seriously considered suicide in the 30 days preceding the survey. The prevalence of such thoughts varied substantially with age. About 26% of those 18-24 years of age reported serious thoughts of suicide, while 16% of those 25-44 noted such thoughts. This number decreased to 4% of those 45-64, and 2% of those 65 and older. This mirrors the decreasing prevalence of symptoms of anxiety or depressive disorder with age.
Participants were asked whether they had started or increased substance use to cope with stress or symptoms related to COVID-19. Substance use was defined as the use of “alcohol, legal or illegal drugs, or prescription drugs that are taken in a way not recommended by your doctor.” Thirteen percent of all respondents indicated that they had. Again, there was a difference among age groups, with more young adults indicating that they had started or increased substance use than older groups. The investigators acknowledge self-reported substance use might be subject to bias.
The data in this MMWR demonstrate that the mental health consequences of the COVID-19 pandemic are dramatic. Over 40% of individuals reported significant symptoms of anxiety, depression, or TSRD. Young adults appear to be particularly susceptible. About 75% of 18- to 24-year-olds reported such symptoms, and over 25% had seriously considered taking their own lives. The elderly appear more resilient with fewer than 15% reporting symptoms and 2% reporting seriously considering suicide.
The information in this report should alert all health care professionals to be sensitive to the mental health needs of their patients. Equally important, everyone should be aware of the impact this pandemic is having on the mental state of those around them, particularly young adults. Reasons for the elevated rates of symptoms including suicidal thoughts in young adults are not certain, but likely reflect multiple personal, economic, and societal factors. The importance of maintaining social ties cannot be overemphasized. Touching base with family, friends, and neighbors can make a difference. Such relationships are important during this acute phase of the pandemic and will remain important long after the virus is tamed by vaccines and better treatments. It is also important that health care systems, employers, and governments enhance access to psychiatric and other mental health services, particularly telehealth approaches. Stress from the pandemic continues unabated, and the impact of the accompanying psychiatric dysfunction is likely to be felt for years to come.
This post was written by Eugene Rubin, M.D., Ph.D., and Charles Zorumski, M.D.