Mental Health Outcomes and Associations During the COVID-19 Pandemic: A Cross-Sectional Population-Based Study in the United States

  1. Bella Nichole Kantor
  2. Jonathan Kantor

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Abstract

Pandemic coronavirus disease 2019 (COVID-19) may lead to significant mental health stresses, potentially with modifiable risk factors. We performed an internet-based cross-sectional survey of an age-, sex-, and race-stratified representative sample from the US general population. Degrees of anxiety, depression, and loneliness were assessed using the 7-item Generalized Anxiety Disorder-7 scale (GAD-7), the 9-item Patient Health Questionnaire, and the 8-item UCLA Loneliness Scale, respectively. Unadjusted and multivariable logistic regression analyses were performed to determine associations with baseline demographic characteristics. A total of 1,005 finished surveys were returned of the 1,020 started, yielding a completion rate of 98.5% in the survey panel. The mean (standard deviation) age of the respondents was 45 (16) years, and 494 (48.8%) were male. Overall, 264 subjects (26.8%) met the criteria for an anxiety disorder based on a GAD-7 cutoff of 10; a cutoff of 7 yielded 416 subjects (41.4%), meeting the clinical criteria for anxiety. On multivariable analysis, male sex (odds ratio [OR] = 0.65, 95% confidence interval [CI] [0.49, 0.87]), identification as Black (OR = 0.49, 95% CI [0.31, 0.77]), and living in a larger home (OR = 0.46, 95% CI [0.24, 0.88]) were associated with a decreased odds of meeting the anxiety criteria. Rural location (OR 1.39, 95% CI [1.03, 1.89]), loneliness (OR 4.92, 95% CI [3.18, 7.62]), and history of hospitalization (OR = 2.04, 95% CI [1.38, 3.03]) were associated with increased odds of meeting the anxiety criteria. Two hundred thirty-two subjects (23.6%) met the criteria for clinical depression. On multivariable analysis, male sex (OR = 0.71, 95% CI [0.53, 0.95]), identifying as Black (OR = 0.62, 95% CI [0.40, 0.97]), increased time outdoors (OR = 0.51, 95% CI [0.29, 0.92]), and living in a larger home (OR = 0.35, 95% CI [0.18, 0.69]) were associated with decreased odds of meeting depression criteria. Having lost a job (OR = 1.64, 95% CI [1.05, 2.54]), loneliness (OR = 10.42, 95% CI [6.26, 17.36]), and history of hospitalization (OR = 2.42, 95% CI [1.62, 3.62]) were associated with an increased odds of meeting depression criteria. Income, media consumption, and religiosity were not associated with mental health outcomes. Anxiety and depression are common in the US general population in the context of the COVID-19 pandemic and are associated with potentially modifiable factors.

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  1. Version published to 10.3389/fpsyt.2020.569083
  2. ScreenIT

    SciScore for 10.1101/2020.05.26.20114140: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study was deemed exempt by the Ascension Health institutional review board.
    Consent: Participants provided consent and were permitted to terminate the survey at any time.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysis682 subjects (341 per group) would be adequate to detect a 10% change in GAD-7 with 80% power and with an alpha of 0.05, assuming a baseline GAD-7 mean of 11.6 with a standard deviation of 5.4 and assuming equal group sizes.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: This study has several limitations. First, as with any survey-based research, its generalizability may be limited. We used Prolific Academic for survey distribution in order to maximize our generalizability to the general US population by using an age-, sex-, and race-stratified survey panel design. As with any survey data, however, the sample willing to participate may not fully reflect the population of interest. Second, our study took place during the early phase of the COVID-19 pandemic, when shelter in place and stay at home orders were only just beginning. If anything, however, this underestimates the prevalence of anxiety and depression as these outcomes would only be expected to increase as restrictions persist, and highlights that even the anticipation of such restrictions may present a stressor. Third, as with any survey study, response bias and social desirability bias may play a role, though the anonymous survey design may help mitigate these concerns. Fourth, while our study relied on validated scales wherever possible, some survey questions were the product of pilot testing alone, and therefore their methodology—while consistent with the survey development literature—has not been fully vetted. Finally, and importantly, this cross-sectional study that lacks a comparator group cannot establish causation; therefore, we do not know whether the associations we describe are truly clinical risk factors.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.05.26.20114140v1 on medRxiv