The Social Determinants of Mental Health Burden Two Years into the Pandemic: A Brief Report from a Longitudinal Survey

Objective: To examine two waves of longitudinal survey data, at 1- and 2-years into the COVID-19 pandemic, to determine sociodemographic and economic risk factors for prolonged mental health distress. Methods: A longitudinal study of adults (N=1,412) began in April of 2020 in a large health system in Texas. Follow-up surveys were sent at 1, 3, 6, 12, and 24 months. The survey data included demographics, self-report mental health history, and symptoms of depression (PHQ-8). Generalized linear regression models were utilized to determine factors associated with a change in PHQ-8 at 1-year and 2-years from baseline. Results: Significant increases in PHQ-8 scores at both 1- and 2-year follow-up were associated with lower income, lower education, unemployment, history of depression, and being a healthcare worker or essential worker. Conclusions: Lower income individuals, those unemployed at baseline, essential workers, healthcare providers, and people with a history of depression reported worsening depression symptoms from their baseline scores. Policy implications: Establishing mechanisms and pathways of causality in social determinants of health research is critical to inform public health policy and population health interventions.