ResearchPDF Available

Mental Health Impact of COVID-19

Authors:
  • Maryland Food Bank

Abstract

Comprehensive literature review on the mental health impacts of COVID-19. This research backgrounder summarizes findings of 45 research reports, surveys, and practitioner resources.
1 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
Mental Health Impacts of COVID-19
Research Backgrounder
Prepared by Daniel Sturm, Director of Research and Impact Analysis, M.A.
Nov. 24, 2020
2 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
EXECUTIVE SUMMARY
1. COVID-19’s Impact on Mental Health
Depression Levels Increased During Pandemic
Researchers surveyed mental health and well-being of 1,470 participants to assess depression
symptoms before and during the pandemic. Depression symptom prevalence was higher in
every category during COVID-19 compared with before the pandemic, as follows:
mild: 24.6% vs 16.2% (before pandemic)
moderate: 14.8% vs 5.7% (before pandemic)
moderately severe: 7.9% vs 2.1% (before pandemic)
severe: 5.1% vs 0.7% (before pandemic)
[Ettman, 2020]
Skyrocketing of Anxiety Screens
Mental Health America notes that the number of people looking for help with anxiety and
depression had skyrocketed since the onset of COVID-19. From January to September
2020, 315,220 people took the anxiety screen, a 93 percent increase over the 2019 total
number of anxiety screens. The 2020 report includes mental health prevalence rankings
by state. [Reinert, 2020].
COVID-19 to Increase Depression, Anxiety, Stress
The medical journal, The Lancet, theorizes about mental health needs as a result of the
pandemic. Most surveys showed increased symptoms of depression, anxiety, and stress
related to COVID-19, as a result of psychosocial stressors such as life disruption, fear of
illness, or fear of negative economic effects. Young people are particularly at risk,
according to study results. [Moreno, 2020]
Suicidal Ideation
Since the COVID-19 pandemic began to spread rapidly in March 2020, over 178,000
people have reported frequent suicidal ideation. 37% of people reported having thoughts
of suicide more than half or nearly every day in September 2020. [Reinert, 2020].
Five Times More Suicide Calls in Baltimore: Calls to the Here2Help Hotline have surged
amid the pandemic. Behavioral Health System Baltimore reported a spike in June in
calls directly attributed to COVID-19. Since the pandemic hit, the number of callers
threatening suicide soared, from about 75 to 380. [Wenger, 2020]
The Baltimore-based Pro Bono Counseling Project reports a doubling of people
indicating suicidal ideation/suicidal ideation with intention/plan (since same period last
year). Pandemic triggering past trauma/grief. [United Way correspondence PBCP]
53% of Adults Experience Stress Caused by COVID-19
For the first time since KFF began tracking this question in March, a majority of adults
(53%) now say that stress and worry related to the pandemic has had a negative impact
on their mental health. [Kaiser Family Foundation, 2020]
Disrupted Sleep Over COVID-19
Marylanders are incurring 24.5 hours of “sleep debt”—described by the National Sleep
Foundation as “the difference between the amount of sleep that you need and the
amount that you’re actually getting”—per week. [Maryland Matters, 2020]
3 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
New Oxford Study: Nearly 1 in 5 COVID Patients Later Diagnosed With Mental Illness
Nearly one in five people who have had Covid-19 are diagnosed with a psychiatric
disorder such as anxiety, depression or insomnia within three months of testing positive
for the virus, according to a study that suggests action is needed to mitigate the mental
health toll of the pandemic.
The analysis – conducted by researchers from the University of Oxford and NIHR Oxford
Health Biomedical Research Centre – also found that people with a pre-existing mental
health diagnosis were 65% more likely to be diagnosed with Covid-19 than those
without, even accounting for known risk factors such as age, sex, race, and underlying
physical conditions.
The calculations were made on the basis of roughly 70 million US health records,
including more than 62,000 cases of Covid-19 that did not require a hospital stay or an
emergency department visit. The incidence of any diagnosis of mental ill-health in the 14
to 90 days after a Covid-19 diagnosis was 18.1%, including 5.8% that were a first
diagnosis. (University of Oxford, November 2020)
Sharp Increase in Drug Overdoses and Deaths
The National EMS Information System (NEMSIS): March-July of 2020 compared to the
same period for 2019 and 2018, there was a sharp increase in calls activated by drug
overdoses and deaths, mental and behavioral issues, and the need for naloxone, and in
refusals to go to the hospitals by overdose victims.
EMS calls for opioid-related activities, for example, increased from roughly 2,000 per
week in February and March 2019 to almost 5,000 per week in the same time period for
2020. Calls for mental and behavioral problems increased from just under 35,000 per
week in the same time period for 2019 to almost 45,000 per week in 2020.
Other kinds of EMS calls—such as for traffic and other accidents decreased in 2020—
due to the lower volume of activity during lockdown.
(Brookings Institute, November 2020)
4 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
2. Demographic Groups Most Impacted
Women at Higher Risk to Experience Adverse Mental Health Impacts
All major studies show that women (and women with small children, migrants) have a higher risk
to experience adverse mental health impacts. All human service interventions should be aware
of this statistical reality and design program interventions accordingly.
Kaiser Family Foundation: Women (58%) are more likely than men (46%), to say stress
and worry related to coronavirus has had a negative impact on their mental health.
Shanhan: Females were at higher risk of each of the three emotional distress indicators.
Having a migrant background was associated with more perceived stress.
Pierce: (…) increases were greatest (…) women, and people living with young children.
NORC: Women are more likely than men to say that since the start of the pandemic they
have cried (53% vs. 21%) and felt more tired than usual (54% vs. 39%).
Young Adults at Higher Risk to Experience Adverse Mental Health Effects
All major surveys & studies show that youth and young adults have a higher risk to experience
adverse mental health impacts. All human service interventions should be aware of this
statistical reality and design program interventions accordingly.
Kaiser Family Foundation: Younger adults (60% ages 18-49) are more likely than older
adults (…) to say stress and worry related to coronavirus has had a negative impact on
their mental health.
Pierce. […]. increases were greatest in 18–24-year-olds, 25–34-year-olds,
NORC. 25% of young adults rate their mental health as fair or poor, compared with 13%
of older adults.
Reinert: Rates of suicidal ideation are highest among youth, especially LGBTQ+ youth.
Black Adults
Kaiser Family Foundation. About seven in ten Blacks adults (68%) and those who have
had difficulty paying household bills in the past three months due to the financial impact
of the coronavirus outbreak (71%) say that stress and worry related to the pandemic has
had a negative impact on their mental health.
Low-Income Americans
Ettman. Depression symptoms were higher for low-income Americans., 2020]
5 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
1. How has the pandemic affected the instances of people seeking
mental health services, primarily adults?
2. How do these stats compare to pre-pandemic?
Depression Levels Increased During Pandemic
Researchers surveyed mental health and well-being of 1,470 participants to assess depression
symptoms before and during the pandemic. Depression symptom prevalence was higher in
every category during COVID-19 compared with before the pandemic, as follows:
mild: 24.6% vs 16.2% (before pandemic)
moderate: 14.8% vs 5.7% (before pandemic)
moderately severe: 7.9% vs 2.1% (before pandemic)
severe: 5.1% vs 0.7% (before pandemic)
Higher risk of depression symptoms during COVID-19 was associated with having lower
income, having less than $5,000 in savings, and exposure to more stressors
Source: Catherine Ettman et al. “Prevalence of Depression Symptoms in US Adults
Before and During the COVID-19 Pandemic.” JAMA Network Open. 2020;3(9):
e2019686. Sept. 2, 2020.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770146
Adults More Likely to Develop Mood Disorders
Researchers compared prevalence rates of anxiety disorder and depressive disorder in U.S.
Census Bureau data samples before and during the pandemic (n=336,525). They found that
adults are considerably more likely to screen positive for mood disorders than pre-pandemic.
Compared to U.S. adults in 2019, U.S. adults in April and May 2020 were more than
three times as likely to screen positive for depressive disorders, anxiety disorders, or
one or both, with more than one out of three screening positive for one or both.
The prevalence of anxiety decreased slightly between the April 23–May 4, 2020 and the
May 21–26, 2020 administrations, while the prevalence of depression increased slightly.
Source: Jean Twenge and Thomas Joiner. “U.S. Census Bureauassessed prevalence
of anxiety and depressive symptoms in 2019 and during the 2020 COVID19 pandemic.”
July 15, 2020. In: Depress Anxiety. 2020;37:954–956.
https://onlinelibrary.wiley.com/doi/full/10.1002/da.23077
6 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
Skyrocketing of Anxiety Screens
Mental Health America notes that the number of people looking for help with anxiety and
depression had skyrocketed since the onset of COVID-19. From January to September 2020,
315,220 people took the anxiety screen, a 93 percent increase over the 2019 total number of
anxiety screens. The 2020 report includes mental health prevalence rankings by state.
From January to September 2020, 315,220 people took the anxiety screen, a 93 percent
increase over the 2019 total number of anxiety screens. 534,784 people took the
depression screen, a 62 percent increase over the 2019 total number of depression
screens.
In September 2020, the rate of moderate to severe anxiety peaked, with over 8 in 10
people who took an anxiety screen scoring with moderate to severe symptoms.
Since the COVID-19 pandemic began to spread rapidly in March 2020, over 178,000
people have reported frequent suicidal ideation. 37 percent of people reported having
thoughts of suicide more than half or nearly every day in September 2020.
The proportion of youth ages 11-17 who accessed screening was 9 percent higher than
the average in 2019. Not only are the number of youth searching for help with their
mental health increasing, but throughout the COVID-19 pandemic youth ages 11-17
have been more likely than any other age group to score for moderate to severe
symptoms of anxiety and depression.
Rates of suicidal ideation are highest among youth, especially LGBTQ+ youth. In
September 2020, over half of 11-17-year-olds reported having thoughts of suicide or
self-harm more than half or nearly every day of the previous two weeks. From January to
September 2020, 77,470 youth reported experiencing frequent suicidal ideation,
including 27,980 LGBTQ+ youth.
Source: Maddy Reinert et al. “The State of Mental Health in America. 2020.” Mental
Health America (MHA).
https://mhanational.org/sites/default/files/State%20of%20Mental%20Health%20in%20A
merica%20-%202020_0.pdf
Depression Worse for Vulnerable Adults
Researchers in this study surveyed mental health symptoms of 10,368 adults. They found
elevated symptoms of depression among study participants, particularly among socially
vulnerable populations (women, Hispanic, unmarried, not working).
One in three respondents had CESD scores higher than 25 on the Center for
Epidemiological Studies Depression Scale (CES-D).
Multiple regression results show elevated levels of depressive symptomatology among
the socially vulnerable (women, Hispanic, unmarried, not working).
Those persons expressing heightened COVID19 fear and moderate to high levels of
food insecurity report more depressive symptoms than persons with less fear and low or
no food insecurity.
All three of the resource variables (mastery of fate, strength of ties, and optimism) are
significant and in the negative direction.
Kevin M. Fitzpatrick et al. Living in the midst of fear: Depressive symptomatology among
US adults during the COVID19 pandemic.” July 15, 2020.
https://onlinelibrary.wiley.com/doi/full/10.1002/da.23080
7 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
40.9% of Adults Report Mental Health Impacts
This national study conducted representative panel surveys among adults older than 18 years
during June 2020. It found that 40.9% reported at least one adverse mental health condition.
Overall, 40.9% of respondents reported at least one adverse mental or behavioral health
condition, including symptoms of anxiety disorder or depressive disorder (30.9%),
symptoms of a trauma- and stressor-related disorder (TSRD) related to the
pandemichttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440121/ - FN2 (26.3%), and
having started or increased substance use to cope with stress or emotions related to
COVID-19 (13.3%).
The percentage of respondents who reported having seriously considered suicide in the
30 days before completing the survey (10.7%) was significantly higher among
respondents aged 18–24 years (25.5%), minority racial/ethnic groups (Hispanic
respondents [18.6%], non-Hispanic black [black] respondents [15.1%]), self-reported
unpaid caregivers for adults (30.7%), and essential workers (21.7%).
Mark Czeisler et al. “Mental Health, Substance Use, and Suicidal Ideation During the
COVID-19 Pandemic - United States, June 24-30, 2020. MMWR. Morbidity and mortality
weekly report vol. 69,32 1049-57. Aug. 14, 2020.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440121
Deaths of Despair to Rise
One study predicts the nation’s economic and emotional pain and suffering could result
in as many as 75,000 excess deaths of despair – lives lost as a result of substance
misuse and suicide – over the next decade in the US.
Across nine different scenarios, additional deaths of despair range from 27,644 (quick
recovery, smallest impact of unemployment on deaths of despair) to 154,037 (slow
recovery, greatest impact of unemployment on deaths of despair), with somewhere in
the middle being around 68,000.
Source: Steve Petterson et al. “Projected Deaths of Despair During the Coronavirus
Recession,” Well Being Trust.” May 8, 2020. https://wellbeingtrust.org/areas-of-
focus/policy-and-advocacy/reports/projected-deaths-of-despair-during-covid-19/
Anxiety Worse for People with COVID-19 Fear
This study reports a connection between COVID-19 fear and depression in regions with higher
COVID-19 incident rates (Maryland included). More than 25% of the study sample reported
moderate to severe anxiety symptoms.
[…] there are higher concentrations of COVID-19 fear in the Northeast New England
region, Northeast Mid-Atlantic region, South-South Atlantic Region, and West Pacific.
Not surprising, these regions and the major cities located within those regions also
reported some of the highest densities in terms of confirmed COVID-19 cases
Fear appears to be concentrated in regions with the highest reported COVID-19 cases.
Additionally, significant bivariate relationships were found between socially vulnerable
respondents (female, Asians, Hispanic, foreign-born, families with children) and fear, as
well as with mental health consequences (anxiety and depressive symptoms).
Depressive symptoms, on average, were high (16+ on the Center for Epidemiologic
Studies Depression scale), and more than 25% of the sample reported moderate to
severe anxiety symptoms.
Source: Kevin Fitzpatrick et al. “Fear of COVID-19 and the Mental Health Consequences
in America.” In: Psychological Trauma: Theory, Research, Practice, and Policy. Vol. 12,
No. S1, S17–S21, 2020. https://psycnet.apa.org/fulltext/2020-38568-001.pdf
8 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
15% of Adults with No Prior History Affected
The analytic sample consisted of 9,687 individuals with no prior history of a mental health
condition who completed the survey between March 19–24, 2020. Fifteen percent experiences
mental health symptoms.
15% of the sample experienced two psychological distress symptoms for at least three
days over the past week; 13% had three or more symptoms.
Risk factors for higher distress included searching online or using social media to post
about coronavirus, reporting that the outbreak caused major changes to personal life,
and perception that the virus was a threat to the US economy, the individual's personal
health or finances.
Source: Calliope Holinguea et al. “Mental distress during the COVID-19 pandemic
among US adults without a pre-existing mental health condition: Findings from American
trend panel survey.” In: Preventive Medicine 139 (2020).
https://www.sciencedirect.com/science/article/pii/S0091743520302553
More than 50% Americans Experience Pandemic Stress
Since March 2020, the Kaiser Family Foundation Health Tracking Poll has been observing a
steady increase of adults expressing concerns and worries about mental health issues.
July 2020: For the first time since KFF began tracking this question in March, a majority
of adults (53%) now say that stress and worry related to the pandemic has had a
negative impact on their mental health.
This is up 14 percentage points since May, and up 8 percentage points since the
previous high of 45% in early April. About one in four (26%) say worry and stress related
to coronavirus has had a “major impact” on their mental health, while a similar share
(28%) say it has had a “minor impact.”
Kaiser Family Foundation: https://www.kff.org/coronavirus-covid-19/report/kff-health-
tracking-poll-july-2020/ (July 2020 Poll).
68% of Black Adults Experience Pandemic Stress
About seven in ten Blacks adults (68%) and those who have had difficulty paying
household bills in the past three months due to the financial impact of the coronavirus
outbreak (71%) say that stress and worry related to the pandemic has had a negative
impact on their mental health.
Kaiser Family Foundation: https://www.kff.org/coronavirus-covid-19/report/kff-health-
tracking-poll-july-2020/ (July 2020 Poll).
9 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
New Oxford Study: Nearly 1 in 5 COVID Patients Later Diagnosed With Mental Illness
Nearly one in five people who have had Covid-19 are diagnosed with a psychiatric
disorder such as anxiety, depression or insomnia within three months of testing positive
for the virus, according to a study that suggests action is needed to mitigate the mental
health toll of the pandemic.
The analysis – conducted by researchers from the University of Oxford and NIHR Oxford
Health Biomedical Research Centre – also found that people with a pre-existing mental
health diagnosis were 65% more likely to be diagnosed with Covid-19 than those
without, even accounting for known risk factors such as age, sex, race, and underlying
physical conditions.
The calculations were made on the basis of roughly 70 million US health records,
including more than 62,000 cases of Covid-19 that did not require a hospital stay or an
emergency department visit. The incidence of any diagnosis of mental ill-health in the 14
to 90 days after a Covid-19 diagnosis was 18.1%, including 5.8% that were a first
diagnosis. (University of Oxford, November 2020)
36% of Adults Report Problems with Sleep
Since March 2020, the Kaiser Family Foundation Health Tracking Poll observes a steady
increase of adults expressing concerns and worries about mental health issues.
About a third say coronavirus-related worry or stress has led to problems with their sleep
(36%) or has led to a poor appetite or overeating (32%).
About one in five say worry or stress related to the pandemic has caused them to
experience frequent headaches or stomachaches (18%) or difficulty controlling their
temper (18%), while 12% each say it has led to increased alcohol or drug use or
worsening chronic health conditions.
Kaiser Family Foundation: https://www.kff.org/coronavirus-covid-19/report/kff-health-
tracking-poll-july-2020/ (July 2020 Poll)
Help Lines Report 30-40% Call Volume Increases
Many crisis centers are reporting 30% to 40% increases in the number of people seeking
help. The helpline at Provident is experiencing a tenfold increase compared with this
time last year when no national disaster was occurring. (...) Already, more than 4 in 10
Americans say that stress related to the pandemic has had a negative impact on their
mental health, according to an April poll by the Kaiser Family Foundation.
Christine Vestal, “Fear, Isolation, Depression: The Mental Health Fallout of a Worldwide
Pandemic.” In: State Line/Pew Research. May 12, 2020. https://tinyurl.com/y6veauy4
10 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
Philadelphia Survey Finds High Level of Depression Post-Pandemic
49% of Philadelphia residents surveyed say they or someone in their household has been
seriously depressed or anxiety-ridden since March 1.
In Philadelphia, 20% said they had trouble accessing therapy or mental health services
In Philadelphia, 44% of residents also say they’ve had to delay medical treatment for a
condition other than COVID-19.
49% of Philadelphia residents surveyed say they or someone in their household has
been seriously depressed or anxious since March 1.
Pew Research, “How COVID-19 Has Undercut Philadelphians’ Physical and Financial
Well-Being. Pew poll also reveals less positive views of police and public safety.” Oct. 7,
2020. https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2020/10/how-
covid-19-has-undercut-philadelphians-physical-and-financial-well-
being?utm_campaign=2020-10-14+Rundown&utm_medium=email&utm_source=Pew
Disrupted Sleep Over COVID-19
Marylanders are incurring 24.5 hours of “sleep debt”—described by the National Sleep
Foundation as “the difference between the amount of sleep that you need and the
amount that you’re actually getting”—per week
That’s more than three hours a night, and significantly more sleep than the national
average of 21.4 hours. A quarter of the Marylanders surveyed by Ocere.com said their
sleep routines have changed since the start of the COVID-19 outbreak. And 37% of
people said worrying about the pandemic itself is the main issue keeping them up at
night.
Source: Maryland Matters, “Marylanders Racking Up Almost 25 Hours of ‘Sleep Debt’
Per Week During Pandemic.” Aug. 20, 2020. https://tinyurl.com/y354wt7x
Five Times More Suicide Calls in Baltimore
Calls to the Here2Help Hotline have surged amid the pandemic. Behavioral Health System
Baltimore reported a spike in June in calls directly attributed to COVID-19, especially for
supportive counseling. Suicide calls have spiked since the outbreak (500% increase)
General counseling calls to the Behavioral Health System Baltimore’s crisis hotline have
doubled from 2,772 in February 2020 to 5,685 in July 2020.
Since the pandemic hit, the number of callers threatening suicide soared, from
about 75 to 380.
Mental health practitioners and suicide experts fear is that COVID-19 will exacerbate the
suicide epidemic—and the worst could be yet to come.
Source: Yvonne Wenger. “As coronavirus rolls on in Maryland, mental health toll surges,
with experts fearing spike in suicides.” The Baltimore Sun. Sept. 29, 2020.
https://www.baltimoresun.com/features/bs-hs-mental-health-covid-20200929-
yzjfdfc2ijb4vab7o3v4g7q25a-story.html
Source: Behavioral Health System Baltimore, https://www.bhsbaltimore.org/find-help/in-
crisis; https://www.healthcareaccessmaryland.org/programs-services/behavioral-
health-services/the-behavioral-health-information-and-referral-line-2/
11 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
Mental Health Impacts Vary by Ethnicity
African Americans also report better mental health than whites, with the most significant
disparities occurring between low-income blacks and low-income whites. Hispanics also
score higher on life satisfaction and optimism and have slightly better mental health than
whites, but the gaps are not as large as those between African Americans and whites.
Authors argue that this may be due to “more experience with and adaptation to job
insecurity among African Americans, or it may simply reflect general levels of higher
resilience.”
Source: Carol Graham et al. “Resilience in the face of a pandemic: COVID weighs
unevenly across racial lines.” Brookings Institute, June 24, 2020.
https://www.brookings.edu/blog/how-we-rise/2020/06/24/resilience-in-the-face-of-a-
pandemic-covid-weighs-unevenly-across-racial-lines/?utm_campaign=brookings-
comm&utm_medium=email&utm_content=90319579&utm_source=hs_email
Mental Health Number-2 Need in Central Maryland
In late May of 2020, United Way of Central Maryland asked more than 145 community
partner organizations to identify the top five client needs, in light of organizations’
emergency response to the pandemic.
60.2% of participants identified Paying Basic Needs Bills as a top client priority. Mental
Health/Coping Support came in as a close second with 56.4%, followed by Accessing
Food with 52.6%, Finding Employment (41.4%), and Digital Access (38.3%).
Source: United Way of Central Maryland, “Effects of COVID-19 on Maryland Nonprofits
and the Communities They Serve.” Survey Analysis & Internal Report. June 2020.
Adults: 57% of Maryland Adults Feel More Stressed
The Goucher College Poll surveyed 1,002 Maryland adults from September 30 to October 4,
2020, and it finds that 57% of Maryland adults are feeling stressed more often.
58 percent say they felt frustrated more often.
57 percent say they felt stressed more often.
33 percent say they felt angry more often.
33 percent say they felt sad more often.
26 percent say they felt lonely more often
The Goucher College Poll, https://www.goucher.edu/hughes-
center/documents/Goucher-College-Poll-Oct-2020-Part-3.pdf
Sheppard Pratt Reports Increased Demands for Mental Health Services
The hospital launched a new telemedicine clinic in response to pandemic.
To help meet the need, the institution created a virtual walk-in clinic for people
experiencing an urgent mental health problem. Between April and August, the tele-
medicine clinic resulted in 1,000 crisis evaluations and 2,000 follow-up appointments.
Source: Yvonne Wenger. “As coronavirus rolls on in Maryland, mental health toll surges,
with experts fearing spike in suicides.” The Baltimore Sun. Sept. 29, 2020.
https://www.baltimoresun.com/features/bs-hs-mental-health-covid-20200929-
yzjfdfc2ijb4vab7o3v4g7q25a-story.html
Source: Sheppard Pratt, Virtual Crisis Walk-In Clinic,
https://www.sheppardpratt.org/care-finder/virtual-crisis-walk-in-clinic/
12 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
Baltimore City: Counseling Calls First Decreased, Then Spiked
The Baltimore-based Pro Bono Counseling Project—a partner agency of the United Way of
Central Maryland— reports a range of mental health impacts due to the pandemic, as follows:
Early on in the pandemic we saw a marked decrease in new requests for counseling.
(This is very common during a crisis—people are most concerned with physical needs
like food/housing/childcare). The numbers of new requests have gradually rebounded,
and raw numbers of new callers now meet or exceed similar periods last year (starting
from end of August onward).
Increases in people indicating suicidal ideation/suicidal ideation with intention/plan (more
than doubling since same period last year). Pandemic triggering past trauma/grief.
Source: United Way of Central Maryland correspondence with Amy Greensfelder,
Executive Director, Pro Bono Counseling Project (Baltimore, MD).
https://probonocounseling.org
13 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
3. What are the reasons people are seeking mental health services?
Depression, suicide, coping, etc. by age groups?
4. How do these stats compare to pre-pandemic?
Mental Health Prevalence by Age Group (Pre-Pandemic)
19.1% of U.S. adults experienced mental illness in 2018 (47.6 million people). This
represents 1 in 5 adults.
4.6% of U.S. adults experienced serious mental illness in 2018 (11.4 million people).
This represents 1 in 25 adults.
16.5% of U.S. youth aged 6-17 experienced a mental health disorder in 2016 (7.7 mill.)
3.7% of U.S. adults experienced a co-occurring substance use disorder and mental
illness in 2018 (9.2 million people)
Mental Health Prevalence Among US Adults by Demographic Group (Pre-Pandemic)
Non-Hispanic Asian: 14.7%
Non-Hispanic white: 20.4%
Non-Hispanic black or African-American: 16.2%
Non-Hispanic American Indian or Alaska Native: 22.1%
Non-Hispanic mixed/multiracial: 26.8%
Hispanic or Latino: 16.9%
Lesbian, Gay or Bisexual: 37.4%
Mental Health Prevalence Among US Adults by Condition (Pre-Pandemic)
Major Depressive Episode: 7.2% (17.7 million people)
Schizophrenia: <1% (estimated 1.5 million people)
Bipolar Disorder: 2.8% (estimated 7 million people)
Anxiety Disorders: 19.1% (estimated 48 million people)
Posttraumatic Stress Disorder: 3.6% (estimated 9 million people)
Obsessive Compulsive Disorder: 1.2% (estimated 3 million people)
Borderline Personality Disorder: 1.4% (estimated 3.5 million people)
Mental Health Treatment by Type of Population (Pre-Pandemic)
43.3% of U.S. adults with mental illness received treatment in 2018
64.1% of U.S. adults with serious mental illness received treatment in 2018
50.6% of U.S. youth aged 6-17 with a MH disorder received treatment in 2016
Annual treatment rates among U.S. adults with any mental illness by demographic group:
Male: 34.9%
Female: 48.6%
Lesbian, Gay or Bisexual: 48.5%
Non-Hispanic Asian: 24.9%
Non-Hispanic white: 49.1%
Non-Hispanic black or African-American: 30.6%
Non-Hispanic mixed/multiracial: 31.8%
Hispanic or Latino: 32.9%
11.3% of U.S. adults with mental illness had no insurance coverage in 2018
13.4% of U.S. adults with serious mental illness had no insurance coverage in 2018
60% of U.S. counties do not have a single practicing psychiatrist
Source: National Alliance on Mental Illness (NAMI). Mental Health by the Numbers.
https://www.nami.org/mhstats
14 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
Skyrocketing of Anxiety Screens
Mental Health America notes that the number of people looking for help with anxiety and
depression had skyrocketed since the onset of COVID-19. From January to September 2020,
315,220 people took the anxiety screen, a 93 percent increase over the 2019 total number of
anxiety screens. 534,784 people took the depression screen, a 62 percent increase over the
2019 total number of depression screens. The 2020 report includes mental health prevalence
rankings by state.
Key Findings:
Youth mental health is worsening. 9.7% of youth in the U.S. have severe major
depression, compared to 9.2% in last year’s dataset. This rate was highest among youth
who identify as more than one race, at 12.4%.
Even before COVID-19, the prevalence of mental illness among adults was increasing.
In 2017-2018, 19% of adults experienced a mental illness, an increase of 1.5 million
people over last year’s dataset.
Suicidal ideation among adults is increasing. The percentage of adults in the U.S. who
are experiencing serious thoughts of suicide increased 0.15% from 2016-2017 to 2017-
2018 – an additional 460,000 people from last year’s dataset.
There is still unmet need for mental health treatment among youth and adults. 60% of
youth with major depression did not receive any mental health treatment in 2017-2018.
Even in states with the greatest access, over 38% are not receiving the mental health
services they need. Among youth with severe depression, only 27.3% received
consistent treatment. 23.6% of adults with a mental illness reported an unmet need for
treatment in 2017-2018. This number has not declined since 2011.
The percentage of adults with a mental illness who are uninsured increased for the first
time since the passage of the Affordable Care Act (ACA). Nationally, 10.8% are
uninsured, totaling 5.1 million adults. This figure differs dramatically across states – in
New Jersey (ranked #1) 2.5% of adults with AMI are uninsured, compared to 23% in
Wyoming (ranked #51).
This year’s report includes a spotlight on the impact of COVID-19 on mental health, using the
over 1.5 million people who have taken a screen on MHA Screening from January to September
2020. From these screens we have found:
The number of people looking for help with anxiety and depression has skyrocketed.
From January to September 2020, 315,220 people took the anxiety screen, a 93 percent
increase over the 2019 total number of anxiety screens. 534,784 people took the
depression screen, a 62 percent increase over the 2019 total number of depression
screens.
The number of people screening with moderate to severe symptoms of depression and
anxiety has continued to increase throughout 2020 and remains higher than rates prior
to COVID-19. In September 2020, the rate of moderate to severe anxiety peaked, with
over 8 in 10 people who took an anxiety screen scoring with moderate to severe
symptoms. Over 8 in 10 people who took a depression screen have scored with
symptoms of moderate to severe depression consistently since the beginning of the
pandemic in March 2020.
More people are reporting frequent thoughts of suicide and self-harm than have ever
been recorded in the MHA Screening program since its launch in 2014. Since the
COVID-19 pandemic began to spread rapidly in March 2020, over 178,000 people have
15 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
reported frequent suicidal ideation. 37 percent of people reported having thoughts of
suicide more than half or nearly every day in September 2020.
Young people are struggling most with their mental health. The proportion of youth ages
11-17 who accessed screening was 9 percent higher than the average in 2019. Not only
are the number of youth searching for help with their mental health increasing, but
throughout the COVID-19 pandemic youth ages 11-17 have been more likely than any
other age group to score for moderate to severe symptoms of anxiety and depression.
Rates of suicidal ideation are highest among youth, especially LGBTQ+ youth. In
September 2020, over half of 11-17-year-olds reported having thoughts of suicide or
self-harm more than half or nearly every day of the previous two weeks. From January to
September 2020, 77,470 youth reported experiencing frequent suicidal ideation,
including 27,980 LGBTQ+ youth.
People screening at risk for mental health conditions are struggling most with loneliness
or isolation. From April to September 2020, among people who screened with moderate
to severe symptoms of anxiety or depression, 70 percent reported that one of the top
three things contributing to their mental health concerns was loneliness or isolation.
People who identify as Asian or Pacific Islander are searching for mental health
resources more in 2020 than ever before. The proportion of screeners identifying as
Asian or Pacific Islander increased 7 percent, from 9 percent of screeners in 2019 to 16
percent in 2020.
While rates of anxiety, depression, and suicidal ideation are increasing for people of all
races and ethnicities, there are notable differences in those changes over time. Black or
African American screeners have had the highest average percent change over time for
anxiety and depression, while Native American or American Indian screeners have had
the highest average percent change over time for suicidal ideation.
Source: Maddy Reinert et al. “The State of Mental Health in America. 2020.” Mental
Health America (MHA).
https://mhanational.org/sites/default/files/State%20of%20Mental%20Health%20in%20A
merica%20-%202020_0.pdf
COVID-19 to Increase Depression, Anxiety, Stress—Young People Particularly at Risk
The medical journal, The Lancet, theorizes about mental health needs as a result of the
pandemic. Most surveys showed increased symptoms of depression, anxiety, and stress related
to COVID-19, as a result of psychosocial stressors such as life disruption, fear of illness, or fear
of negative economic effects. Young people are particularly at risk, according to study results.
Phobic anxiety, panic buying, and binge-watching television (which has been associated
with mood disturbances, sleep disturbances, fatiguability and impairment in self-
regulation) have been reported, and social media exposure has been associated with
increased odds of anxiety and combined depression with anxiety.
Quarantine can also contribute to stress, anger, and an increase in risky behaviours
such as online gambling.
Young people might be at particular risk. In previous pandemics, quarantined children
were more likely to develop acute stress disorder, adjustment disorders, and grief than
were those who had not been quarantined. An increase in young people making calls to
helplines with symptoms of anxiety has been reported.
Increased alcohol sales and alcohol use in the home have also been recorded, which
could potentially increase alcohol use disorders and domestic violence (both in young
people and in adults).
16 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
Although published data are few, individuals, including children, could be at increased
risk of physical and sexual abuse at home during the pandemic. The pandemic could
also exacerbate mental health conditions—and further limit scarce access to mental
health services—in people living in humanitarian and conflict settings.
Some positive benefits might also accrue from reductions in social pressure and
exposure to chronic psychosocial stressors (e.g., commuting, office workplaces, bullying
Source: Carmen Moreno et al. “How mental health care should change as a
consequence of the COVID-19 pandemic.” Lancet Psychiatry. Position Paper. Volume 7,
Issue 9. September 1, 2020.
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30307-2/fulltext
PTSD on the Rise?
Researchers point to the possible rise of post-traumatic stress disorders as a common after-
shock of disasters. And even if mental health conditions may not meet the scientific definition for
PTSD, but depressive and anxiety disorders may increase significantly.
After disasters, most people are resilient and do not succumb to psychopathology.
Indeed, some people find new strengths. Nevertheless, in “conventional” natural
disasters, technological accidents, and intentional acts of mass destruction, a primary
concern is post-traumatic stress disorder (PTSD) arising from exposure to trauma.
Medical conditions from natural causes such as life-threatening viral infection do not
meet the current criteria for trauma required for a diagnosis of PTSD, but other
psychopathology, such as depressive and anxiety disorders, may ensue.
Betty Pfefferbaum and Carol North. “Mental Health and the Covid-19 Pandemic.” The
New England Journal of Medicine. 383:510-512. Aug. 6, 2020.
https://www.nejm.org/doi/full/10.1056/NEJMp2008017
Pre-COVID Emotional Stress Predicts Pandemic Stress
On average, participants showed increased levels of perceived stress and anger (but not
internalizing symptoms) during the pandemic compared to before.
Pre-COVID-19 emotional distress was the strongest predictor of during-pandemic
emotional distress, followed by during-pandemic economic and psychosocial stressors
(e.g. lifestyle and economic disruptions) and hopelessness, and pre-pandemic social
stressors (e.g. bullying victimization and stressful life events).
Females were at higher risk of each of the three emotional distress indicators. Having a
migrant background was associated with more perceived stress.
Pre-pandemic social stressors, stressful life events, low generalized trust, poor self-rated
health, and concurrent pandemic-related stressors (i.e. during-pandemic lifestyle and
economic disruptions, loss of occupation/education) and other risks (e.g. hopelessness
and low trust in responses) were associated with during-pandemic distress.
Frequent news-seeking was associated with perceived stress and anger.
Source: Lilly Shanahan et al. “Emotional distress in young adults during the COVID-19
pandemic: evidence of risk and resilience from a longitudinal cohort study.” In:
Psychological Medicine 1–10. June 23, 2020.
https://www.cambridge.org/core/journals/psychological-medicine/article/emotional-
distress-in-young-adults-during-the-covid19-pandemic-evidence-of-risk-and-resilience-
from-a-longitudinal-cohort-study/BD42C8C4EDFEEC6255554B195EA4ADED
17 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
200% Increase of Suicide Calls & Race-Based Trauma Calls
The Baltimore-based Pro Bono Counseling Project reports a range of mental health impacts due
to the pandemic, as follows:
Increases in people indicating suicidal ideation/suicidal ideation with intention/plan (more
than doubling since same period last year)
Pandemic triggering past trauma/grief and grief in general
Race-based trauma has been a huge theme; Black, Indigenous, and People of Color
callers requesting to be matched with a therapist of same racial/ethnic background
(we’ve always presented this as an option when we talk about what the client is looking
for in therapy, but clients are affirmatively requesting this more
White clients requesting to talk with therapists about issues related to the racial justice
movements
Source: United Way of Central Maryland correspondence with Amy Greensfelder,
Executive Director, Pro Bono Counseling Project. https://probonocounseling.org
Educators Concerned About Mental Health of Youth
The Maryland State Education Association conducted a survey of 650 registered voters and 800
Maryland educators and MSEA members statewide, asking about challenges of distance
learning and inequities exacerbated by the pandemic.
More than 80% of educators are seriously concerned about student motivation,
participation, internet access, and mental health.
Majorities of educators strongly support reduced class sizes, PPE for educators and
students, and additional mental health staff as pre-requisites to reopening schools.
Maryland State Education Association,
https://www.marylandeducators.org/sites/default/files/msea_distance_learning_memo_0
60420_final.pdf
25% of Young Adults Rate Mental Health as Poor
U.S. poll that finds adults under 35 especially likely to report negative feelings or experience
physical or emotional symptoms associated with stress and anxiety.
A majority of Americans ages 18 through 34 (56%) say they have at least sometimes felt
isolated in the past month, compared with about 4 in 10 older Americans,
25% of young adults rate their mental health as fair or poor, compared with 13% of older
adults, while 56% of older adults say their mental health is excellent or very good,
compared with just 39% of young adults.
NORC at the University of Chicago. COVID Response Tracking Study (Three Survey
Waves from May-July-September 2020).
https://www.norc.org/Research/Projects/Pages/covid-response-tracking-study.aspx
Mental Health Impacts Worse for Adults with Lower Education
Americans with a high school degree or less are more likely than those with some
college education and those with a college degree to have felt dizzy (29% vs. 21% vs.
17%) and had clammy hands (15% vs. 11% vs. 8%).
NORC at the University of Chicago. COVID Response Tracking Study.
https://www.norc.org/Research/Projects/Pages/covid-response-tracking-study.aspx
18 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
Depression Worse for Low-Income Americans
Researchers surveyed mental health and well-being of 1,470 participants to assess depression
symptoms before/during the pandemic. Depression symptoms were higher for low-income
Americans.
Higher risk of depression symptoms during COVID-19 was associated with having lower
income, having less than $5,000 in savings, and exposure to more stressors.
Source: Catherine Ettman et al. “Prevalence of Depression Symptoms in US Adults
Before and During the COVID-19 Pandemic.” JAMA Network Open. 2020;3(9):
e2019686. Sept. 2, 2020.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770146
Mental Health Impacts Worse for Women
Women are more likely than men to say that since the start of the pandemic they have
cried (53% vs. 21%) and felt more tired than usual (54% vs. 39%).
NORC at the University of Chicago. COVID Response Tracking Study.
https://www.norc.org/Research/Projects/Pages/covid-response-tracking-study.aspx
Pandemic Sleep Disruption Worse for Younger Americans
The frequency of experiencing symptoms diminishes with age. For example, among
those age 18-34, 35-49, 50-64, and 65 and older, troubles with falling asleep during the
pandemic are reported by 62%, 58%, 51%, and 35% of respondents, respectively.
NORC at the University of Chicago. COVID Response Tracking Study.
https://www.norc.org/Research/Projects/Pages/covid-response-tracking-study.aspx
Women at Higher Risk to Experience Mental Health Impacts
Women (58%) are more likely than men (46%), to say stress and worry related to
coronavirus has had a negative impact on their mental health.
Kaiser Family Foundation: https://www.kff.org/coronavirus-covid-19/report/kff-health-
tracking-poll-july-2020/ (July 2020 Poll)
Younger Adults at Higher Risk
Younger adults (60% ages 18-49) are more likely than older adults (48% ages 50-64;
37% ages 65 and older) to say stress and worry related to coronavirus has had a
negative impact on their mental health.
Kaiser Family Foundation: https://www.kff.org/coronavirus-covid-19/report/kff-health-
tracking-poll-july-2020/ (July 2020 Poll).
African Americans Less Likely to Lose Temper
Black Americans are less likely than white and Hispanic Americans to report that they
lost their temper more than usual (21% vs. 31% and 38%), felt dazed and numb (11%
vs. 22% and 23%), and kept forgetting things (17% vs. 32% and 37%) since the start of
the pandemic.
NORC at the University of Chicago. COVID Response Tracking Study.
https://www.norc.org/Research/Projects/Pages/covid-response-tracking-study.aspx
19 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
Women and Migrants at Higher Risk (Pre-COVID vs. During-Pandemic Stress)
Females were at higher risk of each of the three emotional distress indicators. Having a
migrant background was associated with more perceived stress.
Source: Lilly Shanahan et al. “Emotional distress in young adults during the COVID-19
pandemic: evidence of risk and resilience from a longitudinal cohort study.” In:
Psychological Medicine 1–10. June 23, 2020.
https://www.cambridge.org/core/journals/psychological-medicine/article/emotional-
distress-in-young-adults-during-the-covid19-pandemic-evidence-of-risk-and-resilience-
from-a-longitudinal-cohort-study/BD42C8C4EDFEEC6255554B195EA4ADED
UK Study Finds Mental Health Deterioration
By late April, 2020, mental health in the UK had deteriorated compared with pre-COVID-19
trends. Policies highlighting the needs of women, young people, and those with preschool aged
children are likely to play an important part in preventing future mental illness.
Population prevalence of clinically significant levels of mental distress rose from 18.9%
in 2018–19 to 27.3% in April, 2020, one month into UK lockdown.
Mean General Health Questionnaire (GHQ)-12 score also increased over this time, from
11.5 in 2018–19, to 12.6 in April, 2020. This was 0.48 points higher than expected when
accounting for previous upward trends between 2014 and 2018.
Comparing GHQ-12 scores within individuals, adjusting for time trends and significant
predictors of change, increases were greatest in 18–24-year-olds, 25–34-year-olds,
women, and people living with young children. People employed before the pandemic
also averaged a notable increase in GHQ-12 score.
Matthias Pierce et al.Mental health before and during the COVID-19 pandemic: a
longitudinal probability sample survey of the UK population. Lancet Psychiatry 2020;
Volume 7, Issue 10: 883–92. October 2020.
https://www.sciencedirect.com/science/article/pii/S2215036620303084
People with Schizophrenia Unaffected
This study looked at mental health impacts on 148 individuals with schizophrenia spectrum
illnesses. Contrary to expectations, there were no significant changes in mood experiences.
Contrary to expectations, there were no significant changes in mood experiences or
psychotic symptoms over time, and sleep duration was also unaffected.
Participants did report a small but significant increase in the number of substances used,
and somewhat surprisingly, participants also reported a significant increase in
well-being post-pandemic onset.
Amy Pinkham et al. “A Longitudinal Investigation of the Effects of the COVID-19
Pandemic on the Mental Health of Individuals with Pre-existing Severe Mental Illnesses.”
In: Psychiatry Research. Volume 294, December 2020.
https://www.sciencedirect.com/science/article/pii/S0165178120331541
20 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
5. What Mental Health trends do we typically see during the holidays
(depression, etc.)?
6. What might we expect to see this holiday season during the
pandemic?
Mental Health Effects Worsened by SAD and Winter Blues
Experts quoted in this news article theorize that mental health impacts may be worse in the
winter of 2020-21, considering that seasonal affective disorder and “winter blues” will be added
factors.
This winter, seasonal affective disorder (SAD), a form of clinical depression affecting at
least 5% of American adults, will strike after a summer of unprecedented losses and
turmoil, and amid mounting fears of further health, economic and political chaos.
“Being outside has felt like a safe place to be,” said Vaile Wright, the American
Psychological Association’s senior director of healthcare innovation. But winter is
coming, and uncertainty is growing – a worrisome combination for mental health, warn
experts.
“People are really suffering and struggling as a result of the grief and losses from Covid,
and now comes winter with shorter, darker days, it’s a double whammy and we expect
the general sense of unhappiness to be amplified by SAD and the winter blues. It’s going
to be a big problem,” said [Norman] Rosenthal, professor of psychiatry at Georgetown
University School of Medicine.
Daylight walks, artificial lights, healthy eating, regular sleep and maintaining virtual or
distanced social connections will help stave off the sadness, according to mental health
experts. But the holidays could be tough. Thanksgiving, Hanukkah, and Christmas will
look very different for many families this year because of ongoing concerns about the
virus, travel restrictions and financial woes.
Source. Nina Lakhani, “Many Americans face bleak winter as Covid takes toll on mental
health.” The Guardian. Sept. 6, 2020. https://www.theguardian.com/us-
news/2020/sep/06/seasonal-affective-disorder-sad-coronavirus-americans
Depression and Anxiety Might Spike
The Boston Globe echoes this research perspective and summarizes practitioner responses to
the likely scenario of increased adverse mental health impacts. The stay-at-home orders will
contribute to a worsening of overall mental health conditions, considering the adverse impact of
mobility restriction on overall well-being and mental health.
“When you’re treating depression, one of the biggest things you can do is
behavioral action, and that means basically getting people to do stuff,” said
Karestan Koenen, professor of psychiatric epidemiology at Harvard T.H. Chan School of
Public Health, in the Boston Globe article. “Telling someone to stay home is exactly the
opposite of that. The weather changing will compound that. We’ll be robbed of some of
the ways we’ve been able to cope.”
The article also quotes Steven Taylor, a clinical psychologist and author of The
Psychology of Pandemics. “Uncertainty has always played a role in pandemics, and the
coronavirus is no different. People have a lot of difficulties tolerating uncertainty. When
you take away the things that people derive a sense of pleasure or security from
21 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
and combine that with the mishandling of the pandemic, it is a recipe to depress
and demoralize people.
To stave off feelings of confinement and isolation, experts recommend that people take
daylight walks, use artificial lights, eat a healthy diet, get regular sleep, and maintain
virtual or distanced social connections.
Hanna Krueger. “Struggles with mental health could get worse as winter looms.” The
Boston Globe. Sept. 16, 2020.
https://www.bostonglobe.com/2020/09/16/nation/struggles-with-mental-health-could-get-
worse-winter-looms/
Calls to Baltimore Crisis Line Double
Calls to the Here2Help Hotline have surged amid the pandemic. Behavioral Health System
Baltimore reported a spike in June in calls directly attributed to COVID-19, especially for supportive
counseling.
Calls doubled from 2,772 in February 2020 to 5,685 in July 2020.
Source: Yvonne Wenger. “As coronavirus rolls on in Maryland, mental health toll surges,
with experts fearing spike in suicides.” The Baltimore Sun. Sept. 29, 2020.
https://www.baltimoresun.com/features/bs-hs-mental-health-covid-20200929-
yzjfdfc2ijb4vab7o3v4g7q25a-story.html
Source: Behavioral Health System Baltimore, https://www.bhsbaltimore.org/find-help/in-
crisis; https://www.healthcareaccessmaryland.org/programs-services/behavioral-
health-services/the-behavioral-health-information-and-referral-line-2/
One in three Marylanders Feeling Anxious or Depressed
30.6% of Marylanders say the pandemic has left them feeling anxiety or depression,
according to a survey by the Centers for Disease Control and Prevention conducted
from Aug. 19 to Aug. 31.
Source: National Center for Health Statistics (NCHS). “Anxiety and Depression.
Household Pulse Survey.” State Estimate (Rankings).
https://www.cdc.gov/nchs/covid19/pulse/mental-health.htm
22 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
7. What are the unique considerations for different age groups: young
children, school aged children, college, and Gen X?
Special MH Supports Needed for Youth of Color
Researchers argues that students of color are at heightened risk for long-term, adverse mental
health outcomes, and schools will need to be equipped to serve students with mental health
needs.
Given the relationship between trauma exposure and toxic stress and risk for pervasive
mental health consequences into adulthood, a focused response to COVID-19 is needed
for youth of color already facing heightened risks.
Unfortunately, most schools and communities are generally unprepared to fully address
mental health needs, and schools serving lower income communities are particularly
under-resourced. Although many are dedicated mission-driven schools, filled with
compassionate teachers who seek to best serve students, the cultivation of solutions
requires a societal investment.
Source: Lisa R. Fortuna et al. “Inequity and the Disproportionate Impact of COVID-19 on
Communities of Color in the United States: The Need for a Trauma-Informed Social
Justice Response.” In: Psychological Trauma: Theory, Research, Practice, and Policy.
2020, Vol. 12, No. 5, 443–445. https://psycnet.apa.org/fulltext/2020-37320-001.pdf
Adding Mental Health Staff to Schools
Maryland State Education Association analysis finds that educators support the idea of adding
mental health staff to schools, considering adverse mental health impacts on students.
Voters would like safety measures to be implemented before reopening schools. Voters
and educators overwhelmingly support reducing classes sizes to help with social
distancing, requiring protective equipment like masks and gloves, and adding mental
health staff. Educators, in particular, place strong emphasize on reduced class sizes.
Source: Maryland State Education Association, “Poll Analysis: Maryland Voters and
Educators on Distance Learning.” May 29, 2020.
https://www.marylandeducators.org/sites/default/files/msea_distance_learning_memo_0
60420_final.pdf
Women at Higher Risk to Experience Adverse Mental Health Impacts
All major studies show that women (and women with small children, migrants) have a higher risk
to experience adverse mental health impacts. All human service interventions should be aware
of this statistical reality and design program interventions accordingly.
Kaiser Family Foundation: Women (58%) are more likely than men (46%), to say stress
and worry related to coronavirus has had a negative impact on their mental health.
Shanhan, 2020: Females were at higher risk of each of the three emotional distress
indicators. Having a migrant background was associated with more perceived stress.
Pierce, 2020: (…) increases were greatest (…) women, and people living with young
children.
NORC, 2020: Women are more likely than men to say that since the start of the
pandemic they have cried (53% vs. 21%) and felt more tired than usual (54% vs. 39%).
23 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
Young Adults at Higher Risk to Experience Adverse Mental Health Effects
All major surveys & studies show that youth and young adults have a higher risk to experience
adverse mental health impacts. All human service interventions should be aware of this
statistical reality and design program interventions accordingly.
Kaiser Family Foundation: Younger adults (60% ages 18-49) are more likely than older
adults (48% ages 50-64; 37% ages 65 and older) to say stress and worry related to
coronavirus has had a negative impact on their mental health.
Pierce, 2020: […]. increases were greatest in 18–24-year-olds, 25–34-year-olds,
NORC, 2020: 25% of young adults rate their mental health as fair or poor, compared
with 13% of older adults. (…) The frequency of experiencing symptoms diminishes with
age. For example, among those age 18-34, 35-49, 50-64, and 65 and older, troubles
with falling asleep during the pandemic are reported by 62%, 58%, 51%, and 35% of
respondents, respectively.
Food-Insecurity Contributes to Depression Symptoms
Researchers in this study surveyed mental health symptoms of 10,368 adults. In their survey
analysis, food insecurity emerged as a critical depressive symptom stressor during the
pandemic. “Hoarding and panic buying became the norm early in the pandemic, particularly
among persons who were more likely to have the additional resources to make the purchases.”
All human service interventions should be aware of the linkage between food insecurity and
mental health, and design programs accordingly.
Those persons expressing heightened COVID19 fear and moderate to high levels of
food insecurity report more depressive symptoms than persons with less fear and low or
no food insecurity.
Kevin M. Fitzpatrick et al. Living in the midst of fear: Depressive symptomatology among
US adults during the COVID19 pandemic.” July 15, 2020.
https://onlinelibrary.wiley.com/doi/full/10.1002/da.23080
24 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
8. Other than 211, what are some resources the audience can have
access to, should they themselves or know of anyone who might
need helps?
Encloses is a selective list of mental health providers that offer resources for Central
Marylanders in crisis. The 2-1-1 Maryland United Way Helpline (Provider Search) offers a
more comprehensive list of resources at https://211md.org/211provider-md-search
United Way of Central Maryland—2-1-1 Maryland United Way Helpline
2-1-1 is a number people can call when they are in crisis and aren’t sure where to turn for help.
It is an easy-to-remember three-digit number that provides callers with information and referrals
for food, shelter, healthcare, childcare and other critical services. 2-1-1 uses callers zip codes
to find services available to them in their community. It is available 23/7 in 150 languages.
The 2-1-1 Maryland United Way Helpline receives over 100,000 calls each year from
Central Maryland residents in need. Nearly half of the calls to 2-1-1 each year come
from Baltimore City.
Locations: Baltimore City, Baltimore County, Anne Arundel County, Howard County,
Harford County, Carroll County
Source: The 2-1-1 Maryland United Way Helpline (Provider Search)
https://211md.org/211provider-md-search
United Way of Central Maryland Partnership with the Pro Bono Counseling Project
People in need can call 211 and be seamlessly transferred to Pro Bono for free mental health
support. We’re paying for this out of our COVID Fund and a grant from the state.
In June 2020, a grant from UWCM created our temporary Warmline program which
created a position that was directly able to provide emotional support to people directly
transferred from 211 (and people could call the Warmline directly).
Source: Pro Bono Counseling Project. https://probonocounseling.org
Maryland Crisis Connect (Maryland Department of Health)
Offers crisis intervention & linkage with local community resources, information and
referral and telephone support for anyone experiencing a crisis. Assistance is available
by phone, text, and chat. Chat services can be reached at
http://www.mdcrisisconnect.org/chat-with-us/.
Provides trained crisis counselors to assist individuals struggling with suicide, physical
and sexual abuse, depression, stress, pregnancy, homicide concerns. Assists with
concerns of eating disorders, sexual identity concerns, running away, relationship
problems, divorce, sexually transmitted disease, and school issues. Callers with
substance abuse concerns can contact the following Regional Crisis Centers.
Frederick County Hotline, Frederick, MD
Grassroots Crisis Intervention Center, Columbia, MD
Life Crisis Center, Salisbury, MD
Montgomery County Hotline, Rockville, MD
Community Crisis Services, Lanham, MD
Baltimore Crisis Response Inc. Baltimore, MD
Contact: 211; Text zip code for assistance: 898-211; Alternate: 800-422-0009;
https://www.mdcrisisconnect.org
25 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
Baltimore Crisis Response, Mobile Crisis Team
MOBILE CRISIS TEAM: Responds to emergency mental health crisis calls. The team of
a mental health professional and a nurse goes to the caller's home, workplace, or
community location to assess the person's needs and initiate the least restrictive
intervention. Must be within Baltimore City.
Contact Toll-Free: 800-273-8255 (National Suicide Prevention Lifeline)
Hot-Line: 410-433-5175
Here2Help Hotline
Baltimore City’s Here2Help Hotline is a collaborative effort with Baltimore City Crisis
Response (BCRI), Baltimore Child & Adolescent Response System (BCARS), Behavioral
Health Baltimore (BHSB) and HealthCare Access Maryland (HCAM). One number, 410-
433-5175, connects Baltimore City residents with crisis services, which include the
following:
General information regarding many behavioral health related concerns.
Screen callers for mental health and substance use disorders
Call providers and make appointments to directly link individuals to treatment.
In FY17, Here2Help connected 1,160 Baltimore City residents to mental health and
substance use treatment appointments.
Source: Behavioral Health System Baltimore, https://www.bhsbaltimore.org/find-help/in-
crisis; https://www.healthcareaccessmaryland.org/programs-services/behavioral-
health-services/the-behavioral-health-information-and-referral-line-2/
Sheppard Pratt Offers New Telemedicine Clinic
Between April and August, a new telemedicine clinic resulted in 1,000 crisis evaluations and
more than 2,000 follow-up appointments.
To help meet the need, the institution created a virtual walk-in clinic for people
experiencing an urgent mental health problem. Between April and August, the innovative
telemedicine clinic resulted in 1,000 crisis evaluations and more than 2,000 follow-up
appointments.
Source: Yvonne Wenger. “As coronavirus rolls on in Maryland, mental health toll surges,
with experts fearing spike in suicides.” The Baltimore Sun. Sept. 29, 2020.
https://www.baltimoresun.com/features/bs-hs-mental-health-covid-20200929-
yzjfdfc2ijb4vab7o3v4g7q25a-story.html
Source: Sheppard Pratt, Virtual Crisis Walk-In Clinic,
https://www.sheppardpratt.org/care-finder/virtual-crisis-walk-in-clinic/
Maryland Mind Health Texting Initiative
Maryland has expanded the availability of telemedicine. Maryland also launched a texting
initiative called “MD Mind Health” to combat social isolation by reaching people on their phones
to connect and offer wellness tips.
Maryland Mind Health. If you or someone you know is in crisis, contact Maryland’s crisis
hotline by calling 2-1-1 and pressing option 1 or texting 898-211.
Source: Yvonne Wenger. “As coronavirus rolls on in Maryland, mental health toll surges,
with experts fearing spike in suicides.” The Baltimore Sun. Sept. 29, 2020.
https://www.baltimoresun.com/features/bs-hs-mental-health-covid-20200929-
yzjfdfc2ijb4vab7o3v4g7q25a-story.html;
Maryland Mind Health.
https://health.maryland.gov/suicideprevention/MHP/Pages/Home.aspx
26 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
Baltimore Region May See New Comprehensive Mental Health Crisis Care
Behavioral Health System Baltimore, the Horizon Foundation and other providers have
proposed a model for the Maryland Health Services Cost Review
Commission’s Regional Partnership Catalyst Grant Program that would create one
centralized crisis care system across Baltimore City and Howard, Carroll and Baltimore
counties.(…) If approved, participating hospitals would receive money from a $45 million
grant funded by the state’s rate-setting system over the course of five years to provide
cohesive care for behavioral health and substance abuse services.
Maryland Matters, https://www.marylandmatters.org/2020/11/10/baltimore-region-may-
see-new-comprehensive-mental-health-crisis-care/)
Mental Health Support for Baltimore City Youth Offenders
The Maryland Department of Juvenile Services announced Tuesday that it has received over
$100,000 in grant funding to connect at-risk kids and young adults in Baltimore City to
Multisystemic Therapy diversion services.
The $130,000 in funding was given by the Governor’s Office of Crime Control and
Prevention, Youth, and Victim Services to support the agency’s partnership with the
University of Maryland School of Social Work’s Institute for Innovation and
Implementation aimed at connecting youth offenders aged 12 to 20 with mental health
and family support services.
Multisystemic Therapy is a trauma-responsive approach that addresses behavior
change through the lens of mental health services, school and work intervention and
family participation, among other avenues. Therapists will be available to families 24
hours a day to arm them with necessary skills to cope with negative influences in
juvenile offenders’ communities, improve their interpersonal relationships and school
performance and build a peer support network to maintain positive behavior change.
Maryland Matters, https://www.marylandmatters.org/blog/state-providing-funds-to-
connect-at-risk-teens-with-mental-health-services/
CDC
The CDC has also shared information and recommendations regarding stress and
coping in its online COVID-19 resources.
Source: CDC. “Coping with Stress.” July 2020 (Updated)
https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-
anxiety.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F201
9-ncov%2Fprepare%2Fmanaging-stress-anxiety.html
Get immediate help in a crisis
Call 911
Disaster Distress Helpline: 1-800-985-5990 (press 2 for Spanish), or text TalkWithUs for
English or Hablanos for Spanish to 66746. Spanish speakers from Puerto Rico can text
Hablanos to 1-787-339-2663.
National Suicide Prevention Lifeline: 1-800-273-TALK (8255) for English, 1-888-628-9454
for Spanish, or Lifeline Crisis Chat.
National Domestic Violence Hotline: 1-800-799-7233 or text LOVEIS to 22522
National Child Abuse Hotline: 1-800-4AChild (1-800-422-4453) or text 1-800-422-4453
National Sexual Assault Hotline: 1-800-656-HOPE (4673) or Online Chat
The Eldercare Locator: 1-800-677-1116 TTY Instructions
Veteran’s Crisis Line: 1-800-273-TALK (8255) or Crisis Chat or text: 8388255
27 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
Find a health care provider or treatment for substance use disorder and mental health
SAMHSA’s National Helpline: 1-800-662-HELP (4357) and TTY 1-800-487-4889
Treatment Services Locator Website
Interactive Map of Selected Federally Qualified Health Centers
National Institute on Drug Abuse
Additionally, the National Institute on Drug Abuse has noted that while little is known
about COVID-19 in relation to substance use, there are potential associations between
severe COVID-19 and substance use disorder.
Source: National Institute on Drug Abuse. “COVID-19: Potential Implications for
Individuals with Substance Use Disorders.” April 6, 2020.
https://www.drugabuse.gov/about-nida/noras-blog/2020/04/covid-19-potential-
implications-individuals-substance-use-disorders
The Substance Abuse and Mental Health Services Administration
SAMHSA has also provided resources and recommendations to address mental health
and substance use disorders during the pandemic.
Source: SAMHSA. https://www.samhsa.gov/coronavirus
World Health Organization – COVID-19 Resources
In recognition of the mental health implications of the COVID-19 pandemic, the World
Health Organization released a list of considerations to address the mental well-being of
the general population and specific, high-risk groups,
Source: WHO. Mental health and psychosocial considerations during the COVID-19
outbreak. https://www.who.int/docs/default-source/coronaviruse/mental-health-
considerations.pdf
The United Nations – COVID-19 Resources
The United Nations put forth recommendations for addressing and minimizing poor
mental health outcomes, including incorporating mental health in national COVID-19
responses and increasing access to mental health care through telemedicine.
UN. “Policy Brief: COVID-19 and the Need for Action on Mental Health.” May 13, 2020.
https://www.un.org/sites/un2.un.org/files/un_policy_brief-
covid_and_mental_health_final.pdf
What is helping people’s mental health and wellbeing during the pandemic?
This UK-based study comes to similar analytical findings regarding the pandemic’s impact on
mental health—the study features a useful description of useful coping strategies on pp. 30-34,
as follows:
Staying connected
Keeping busy
Physical activity
Staying calm
Information intake
Maintaining routine
Source: Cowan, K. “Survey results: Understanding people’s concerns about the mental
health impacts of the COVID-19 pandemic.” London, United Kingdom: Academy of
Medical Sciences. 2020. https://acmedsci.ac.uk/file-download/99436893
28 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
Literature
Katherine Cowan. “Survey results: Understanding people’s concerns about the mental health
impacts of the COVID-19 pandemic.” London, United Kingdom: Academy of Medical Sciences.
2020. https://acmedsci.ac.uk/file-download/99436893
Mark Czeisler et al. “Mental Health, Substance Use, and Suicidal Ideation During the COVID-
19 Pandemic - United States, June 24-30, 2020. MMWR. Morbidity and mortality weekly report vol.
69,32 1049-57. Aug. 14, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440121
Catherine Ettman et al. “Prevalence of Depression Symptoms in US Adults Before and During
the COVID-19 Pandemic.” JAMA Network Open. 2020;3(9): e2019686. Sept. 2, 2020.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770146
Kevin Fitzpatrick et al. “Fear of COVID-19 and the Mental Health Consequences in America.”
In: Psychological Trauma: Theory, Research, Practice, and Policy. Vol. 12, No. S1, S17–S21, 2020.
https://psycnet.apa.org/fulltext/2020-38568-001.pdf
Kevin M. Fitzpatrick et al. Living in the midst of fear: Depressive symptomatology among US
adults during the COVID19 pandemic.” July 15, 2020.
https://onlinelibrary.wiley.com/doi/full/10.1002/da.23080
Lisa Fortuna et al. “Inequity and the Disproportionate Impact of COVID-19 on Communities of
Color in the United States: The Need for a Trauma-Informed Social Justice Response.” In:
Psychological Trauma: Theory, Research, Practice, and Policy. 2020, Vol. 12, No. 5, 443–445.
https://psycnet.apa.org/fulltext/2020-37320-001.pdf
Goucher College Poll, https://www.goucher.edu/hughes-center/documents/Goucher-College-
Poll-Oct-2020-Part-3.pdf
Carol Graham et al. “Resilience in the face of a pandemic: COVID weighs unevenly across racial
lines.” Brookings Institute, June 24, 2020. https://www.brookings.edu/blog/how-we-
rise/2020/06/24/resilience-in-the-face-of-a-pandemic-covid-weighs-unevenly-across-racial-
lines/?utm_campaign=brookings-
comm&utm_medium=email&utm_content=90319579&utm_source=hs_email
Calliope Holinguea et al. “Mental distress during the COVID-19 pandemic among US adults
without a pre-existing mental health condition: Findings from American trend panel survey.” In:
Preventive Medicine 139 (2020).
https://www.sciencedirect.com/science/article/pii/S0091743520302553
Kaiser Family Foundation: https://www.kff.org/coronavirus-covid-19/report/kff-health-tracking-
poll-july-2020/ (July 2020 Poll). https://www.kff.org/health-reform/report/kff-health-tracking-poll-early-
april-2020 (April 2020 Poll)
Hanna Krueger. “Struggles with mental health could get worse as winter looms.” The Boston
Globe. Sept. 16, 2020. https://www.bostonglobe.com/2020/09/16/nation/struggles-with-mental-
health-could-get-worse-winter-looms/
Nina Lakhani, “Many Americans face bleak winter as Covid takes toll on mental health.” The
Guardian. Sept. 6, 2020. https://www.theguardian.com/us-news/2020/sep/06/seasonal-affective-
disorder-sad-coronavirus-americans
Maryland Matters, “Marylanders Racking Up Almost 25 Hours of ‘Sleep Debt’ Per Week During
Pandemic.” Aug. 20, 2020. https://tinyurl.com/y354wt7x
Maryland State Education Association, “Poll Analysis: Maryland Voters and Educators on
Distance Learning.” May 29, 2020.
https://www.marylandeducators.org/sites/default/files/msea_distance_learning_memo_060420_final.
pdf Carmen Moreno et al. “How mental health care should change as a consequence of the
COVID-19 pandemic.” Lancet Psychiatry. Position Paper. Volume 7, Issue 9. September 1, 2020.
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30307-2/fulltext
29 COVID-19 Mental Health Impact (Research Backgrounder) – Daniel Sturm, Director for Research and Impact Analysis
National Alliance on Mental Illness (NAMI). Mental Health by the Numbers.
https://www.nami.org/mhstats
NORC at the University of Chicago. COVID Response Tracking Study (Three Survey Waves
from May-July-September 2020). https://www.norc.org/Research/Projects/Pages/covid-response-
tracking-study.aspx
Steve Petterson et al. “Projected Deaths of Despair During the Coronavirus Recession,” Well
Being Trust.” May 8, 2020. https://wellbeingtrust.org/areas-of-focus/policy-and-
advocacy/reports/projected-deaths-of-despair-during-covid-19/
Pew Research, “How COVID-19 Has Undercut Philadelphians’ Physical and Financial Well-
Being. Pew poll also reveals less positive views of police and public safety.” Oct. 7, 2020.
https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2020/10/how-covid-19-has-
undercut-philadelphians-physical-and-financial-well-being?utm_campaign=2020-10-
14+Rundown&utm_medium=email&utm_source=Pew
Betty Pfefferbaum and Carol North. “Mental Health and the Covid-19 Pandemic.” The New
England Journal of Medicine. 383:510-512. Aug. 6, 2020.
https://www.nejm.org/doi/full/10.1056/NEJMp2008017
Matthias Pierce et al.Mental health before and during the COVID-19 pandemic: a longitudinal
probability sample survey of the UK population. Lancet Psychiatry 2020; Volume 7, Issue 10: 883–
92. October 2020. https://www.sciencedirect.com/science/article/pii/S2215036620303084
Amy Pinkham et al. “A Longitudinal Investigation of the Effects of the COVID-19 Pandemic on
the Mental Health of Individuals with Pre-existing Severe Mental Illnesses.” In: Psychiatry Research.
Volume 294, December 2020.
https://www.sciencedirect.com/science/article/pii/S0165178120331541
Maddy Reinert et al. “The State of Mental Health in America. 2020.” Mental Health America.
https://mhanational.org/sites/default/files/State%20of%20Mental%20Health%20in%20America%20-
%202020_0.pdf
Lilly Shanahan et al. “Emotional distress in young adults during the COVID-19 pandemic:
evidence of risk and resilience from a longitudinal cohort study.” In: Psychological Medicine 1–10.
June 23, 2020. https://www.cambridge.org/core/journals/psychological-medicine/article/emotional-
distress-in-young-adults-during-the-covid19-pandemic-evidence-of-risk-and-resilience-from-a-
longitudinal-cohort-study/BD42C8C4EDFEEC6255554B195EA4ADED
Jean Twenge and Thomas Joiner. “U.S. Census Bureauassessed prevalence of anxiety and
depressive symptoms in 2019 and during the 2020 COVID19 pandemic.” In: Depress Anxiety.
2020;37:954–956. July 15, 2020. https://onlinelibrary.wiley.com/doi/full/10.1002/da.23077
United Way of Central Maryland, “Effects of COVID-19 on Maryland Nonprofits and the
Communities They Serve,” June 2020 (Report Available Upon Request)
Christine Vestal, “Fear, Isolation, Depression: The Mental Health Fallout of a Worldwide
Pandemic.” State Line/Pew Research. May 12, 2020. https://tinyurl.com/y6veauy4
Yvonne Wenger. “As coronavirus rolls on in Maryland, mental health toll surges, with experts
fearing spike in suicides.” The Baltimore Sun. Sept. 29, 2020.
https://www.baltimoresun.com/features/bs-hs-mental-health-covid-20200929-
yzjfdfc2ijb4vab7o3v4g7q25a-story.html
ResearchGate has not been able to resolve any citations for this publication.
Article
Full-text available
Importance: The coronavirus disease 2019 (COVID-19) pandemic and the policies to contain it have been a near ubiquitous exposure in the US with unknown effects on depression symptoms. Objective: To estimate the prevalence of and risk factors associated with depression symptoms among US adults during vs before the COVID-19 pandemic. Design, setting, and participants: This nationally representative survey study used 2 population-based surveys of US adults aged 18 or older. During COVID-19, estimates were derived from the COVID-19 and Life Stressors Impact on Mental Health and Well-being study, conducted from March 31, 2020, to April 13, 2020. Before COVID-19 estimates were derived from the National Health and Nutrition Examination Survey, conducted from 2017 to 2018. Data were analyzed from April 15 to 20, 2020. Exposures: The COVID-19 pandemic and outcomes associated with the measures to mitigate it. Main outcomes and measures: Depression symptoms, defined using the Patient Health Questionnaire-9 cutoff of 10 or higher. Categories of depression symptoms were defined as none (score, 0-4), mild (score, 5-9), moderate (score, 10-14), moderately severe (score, 15-19), and severe (score, ≥20). Results: A total of 1470 participants completed the COVID-19 and Life Stressors Impact on Mental Health and Well-being survey (completion rate, 64.3%), and after removing those with missing data, the final during-COVID-19 sample included 1441 participants (619 participants [43.0%] aged 18-39 years; 723 [50.2%] men; 933 [64.7%] non-Hispanic White). The pre-COVID-19 sample included 5065 participants (1704 participants [37.8%] aged 18-39 years; 2588 [51.4%] women; 1790 [62.9%] non-Hispanic White). Depression symptom prevalence was higher in every category during COVID-19 compared with before (mild: 24.6% [95% CI, 21.8%-27.7%] vs 16.2% [95% CI, 15.1%-17.4%]; moderate: 14.8% [95% CI, 12.6%-17.4%] vs 5.7% [95% CI, 4.8%-6.9%]; moderately severe: 7.9% [95% CI, 6.3%-9.8%] vs 2.1% [95% CI, 1.6%-2.8%]; severe: 5.1% [95% CI, 3.8%-6.9%] vs 0.7% [95% CI, 0.5%-0.9%]). Higher risk of depression symptoms during COVID-19 was associated with having lower income (odds ratio, 2.37 [95% CI, 1.26-4.43]), having less than $5000 in savings (odds ratio, 1.52 [95% CI, 1.02-2.26]), and exposure to more stressors (odds ratio, 3.05 [95% CI, 1.95-4.77]). Conclusions and relevance: These findings suggest that prevalence of depression symptoms in the US was more than 3-fold higher during COVID-19 compared with before the COVID-19 pandemic. Individuals with lower social resources, lower economic resources, and greater exposure to stressors (eg, job loss) reported a greater burden of depression symptoms. Post-COVID-19 plans should account for the probable increase in mental illness to come, particularly among at-risk populations.
Article
Full-text available
COVID-19 has had disproportionate contagion and fatality in Black, Latino, and Native American communities and among the poor in the United States. Toxic stress resulting from racial and social inequities have been magnified during the pandemic, with implications for poor physical and mental health and socioeconomic outcomes. It is imperative that our country focus and invest in addressing health inequities and work across sectors to build self-efficacy and long-term capacity within communities and systems of care serving the most disenfranchised, now and in the aftermath of the COVID-19 epidemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Article
Full-text available
The intent of this work was to examine the intersection of COVID-19 fear with social vulnerabilities and mental health consequences among adults living in the United States. Data are from a nationally representative sample (n = 10,368) of U.S. adults surveyed online during demographic subgroups (gender, age, income, race and ethnicity, geography). The sample week of March 23, 2020. The sample was poststratification weighted to ensure a balanced representation across social and demographic subgroups (gender, age, income, race or ethnicity, geography). The sample comprised 51% female; 23% non-White; 18% Hispanic; 25% of households with children under 18 years of age; 55% unmarried; and nearly 20% unemployed, laid off, or furloughed at the time of the interview. Respondents were fearful, averaging a score of nearly 7 on a scale of 10 when asked how fearful they were of COVID-19. Preliminary analysis suggests clear spatial diffusion of COVID-19 fear. Fear appears to be concentrated in regions with the highest reported COVID-19 cases. Significant differences across several U.S. census regions are noted (p < .01). Additionally, significant bivariate relationships were found between socially vulnerable respondents (female, Asians, Hispanic, foreign-born, families with children) and fear, as well as with mental health consequences (anxiety and depressive symptoms). Depressive symptoms, on average, were high (16+ on the Center for Epidemiologic Studies Depression scale), and more than 25% of the sample reported moderate to severe anxiety symptoms. More in-depth psychosocial research is needed using nationally representative samples that can help to inform potential mental health risks, as well as by targeting specific mental health interventions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Article
Objective Individuals with severe mental illnesses (SMI), including schizophrenia spectrum illnesses and affective disorders, may be at increased risk for negative mental health outcomes related to the COVID-19 pandemic. This study compared the severity of pre-pandemic symptoms and affective experiences to current symptoms to evaluate this possibility. Methods 148 individuals with SMI (92 with schizophrenia spectrum illnesses and 56 with affective disorders) were recruited from ongoing ecological momentary assessment studies that sampled day-to-day experiences and symptom severity prior to the pandemic. Participants completed a one-time phone survey that queried these same experiences/symptoms between April and June of 2020. Results Severity of affective experiences and psychotic symptoms remained stable across time, as did sleep duration. Well-being and the number of substances used increased during the early months of the pandemic. Increases in well-being were associated with being female and spending less time alone pre-pandemic. Patterns of stability/change did not differ according to diagnostic category. Conclusions At this relatively early stage, individuals with SMI are not reporting a worsening of symptoms or affective experiences and instead appear to be resilient in the face of the pandemic. Continued assessment is needed to determine whether this resilience will persist as the pandemic progresses.
Article
The coronavirus disease 2019 (COVID-19) pandemic has been associated with mental health challenges related to the morbidity and mortality caused by the disease and to mitigation activities, including the impact of physical distancing and stay-at-home orders.* Symptoms of anxiety disorder and depressive disorder increased considerably in the United States during April-June of 2020, compared with the same period in 2019 (1,2). To assess mental health, substance use, and suicidal ideation during the pandemic, representative panel surveys were conducted among adults aged ≥18 years across the United States during June 24-30, 2020. Overall, 40.9% of respondents reported at least one adverse mental or behavioral health condition, including symptoms of anxiety disorder or depressive disorder (30.9%), symptoms of a trauma- and stressor-related disorder (TSRD) related to the pandemic† (26.3%), and having started or increased substance use to cope with stress or emotions related to COVID-19 (13.3%). The percentage of respondents who reported having seriously considered suicide in the 30 days before completing the survey (10.7%) was significantly higher among respondents aged 18-24 years (25.5%), minority racial/ethnic groups (Hispanic respondents [18.6%], non-Hispanic black [black] respondents [15.1%]), self-reported unpaid caregivers for adults§ (30.7%), and essential workers¶ (21.7%). Community-level intervention and prevention efforts, including health communication strategies, designed to reach these groups could help address various mental health conditions associated with the COVID-19 pandemic.
Article
Most individuals in the United States have no history of a mental health condition yet are at risk for psychological distress due to the COVID-19 pandemic. The objective of this study was to assess the frequency and risk and protective factors of psychological distress, during the beginning of the COVID-19 pandemic, in this group. Data comes from the Pew Research Center’s American Trends Panel (ATP), a probability-based online survey panel representative of the US adult population. The analytic sample consisted of 9,687 individuals with no prior history of a mental health condition who completed the survey between March 19-24, 2020. Explanatory variables included sociodemographic factors and items related to behavior, perceptions, and experiences surrounding the pandemic. The outcome was psychological distress, measured by five items on symptoms of anxiety, depression, loneliness, sleep difficulties, and hyperarousal. A multivariable linear regression model was used to identify risk and protective factors for psychological distress. Fifteen percent of the sample experienced 2 psychological distress symptoms for at least 3 days over the past week; 13% had three or more symptoms. Risk factors for higher distress included searching online or using social media to post about coronavirus, reporting that the outbreak caused major changes to personal life, and perception that the virus was a threat to the US economy, the individual’s personal health or finances. This has important implications for mental health service delivery.
Article
Background The potential impact of the COVID-19 pandemic on population mental health is of increasing global concern. We examine changes in adult mental health in the UK population before and during the lockdown. Methods In this secondary analysis of a national, longitudinal cohort study, households that took part in Waves 8 or 9 of the UK Household Longitudinal Study (UKHLS) panel, including all members aged 16 or older in April, 2020, were invited to complete the COVID-19 web survey on April 23–30, 2020. Participants who were unable to make an informed decision as a result of incapacity, or who had unknown postal addresses or addresses abroad were excluded. Mental health was assessed using the 12-item General Health Questionnaire (GHQ-12). Repeated cross-sectional analyses were done to examine temporal trends. Fixed-effects regression models were fitted to identify within-person change compared with preceding trends. Findings Waves 6–9 of the UKHLS had 53 351 participants. Eligible participants for the COVID-19 web survey were from households that took part in Waves 8 or 9, and 17 452 (41·2%) of 42 330 eligible people participated in the web survey. Population prevalence of clinically significant levels of mental distress rose from 18·9% (95% CI 17·8–20·0) in 2018–19 to 27·3% (26·3–28·2) in April, 2020, one month into UK lockdown. Mean GHQ-12 score also increased over this time, from 11·5 (95% CI 11·3–11·6) in 2018–19, to 12·6 (12·5–12·8) in April, 2020. This was 0·48 (95% CI 0·07–0·90) points higher than expected when accounting for previous upward trends between 2014 and 2018. Comparing GHQ-12 scores within individuals, adjusting for time trends and significant predictors of change, increases were greatest in 18–24-year-olds (2·69 points, 95% CI 1·89–3·48), 25–34-year-olds (1·57, 0·96–2·18), women (0·92, 0·50–1·35), and people living with young children (1·45, 0·79–2·12). People employed before the pandemic also averaged a notable increase in GHQ-12 score (0·63, 95% CI 0·20–1·06). Interpretation By late April, 2020, mental health in the UK had deteriorated compared with pre-COVID-19 trends. Policies emphasising the needs of women, young people, and those with preschool aged children are likely to play an important part in preventing future mental illness. Funding None.
Survey results: Understanding people's concerns about the mental health impacts of the COVID-19 pandemic
  • Katherine Cowan
Katherine Cowan. "Survey results: Understanding people's concerns about the mental health impacts of the COVID-19 pandemic." London, United Kingdom: Academy of Medical Sciences. 2020. https://acmedsci.ac.uk/file-download/99436893
Living in the midst of fear: Depressive symptomatology among US adults during the COVID-19 pandemic
  • Kevin M Fitzpatrick
Kevin M. Fitzpatrick et al. Living in the midst of fear: Depressive symptomatology among US adults during the COVID-19 pandemic." July 15, 2020. https://onlinelibrary.wiley.com/doi/full/10.1002/da.23080
Marylanders Racking Up Almost 25 Hours of 'Sleep Debt' Per Week During Pandemic
  • Hanna Krueger
Hanna Krueger. "Struggles with mental health could get worse as winter looms." The Boston Globe. Sept. 16, 2020. https://www.bostonglobe.com/2020/09/16/nation/struggles-with-mentalhealth-could-get-worse-winter-looms/ Nina Lakhani, "Many Americans face bleak winter as Covid takes toll on mental health." The Guardian. Sept. 6, 2020. https://www.theguardian.com/us-news/2020/sep/06/seasonal-affectivedisorder-sad-coronavirus-americans Maryland Matters, "Marylanders Racking Up Almost 25 Hours of 'Sleep Debt' Per Week During Pandemic." Aug. 20, 2020. https://tinyurl.com/y354wt7x