Evolution of Depression and Anxiety During the COVID-19 Pandemic and Across Demographic Groups in a Large Sample of U.S. Adults

Psychological Well-Being of US Educators Remains a Post-Pandemic Concern: Findings From a Cross-Sectional Study

BACKGROUND

Educator mental health plays an important role in schools, yet the long-term impacts of the COVID-19 pandemic remain unknown. We sought to estimate the prevalence of school employee stress, anxiety, and depression in the 2022-2023 school year within two school districts in the Northeastern United States.

METHODS

An electronic survey was distributed to school employees. Stress was assessed with the 10-item Perceived Stress Scale with scores 0-13, 14-26, and 27-40 representing low, moderate, and high stress. The Generalized Anxiety Disorder 7-item scale and the Center for Epidemiologic Studies Depression 10-item scale were used to assess clinically significant anxiety and depressive symptoms, with a cut-point of 10 applied to the total summed score of each scale. We used log-binomial regression models to estimate prevalence ratios (PR) and 95% confidence intervals (CI).

RESULTS

The majority (76.0%) of the 725 school employees surveyed reported moderate to severe stress with 31.2% and 49.5% reporting clinically significant anxiety or depressive symptoms, respectively. A significantly higher prevalence of anxiety was reported among females (PR = 1.15 (CI: 1.02, 1.30)), instructional staff (PR = 1.15 (CI: 1.02, 1.30)), and employees reporting financial insecurity (PR = 1.18 (CI: 1.10, 1.27)). Likewise, a significantly higher prevalence of depression was reported was reported among women (PR = 1.24; CI (1.00-1.52)), instructional staff (PR = 1.31; CI (1.06-1.62)), and employees reporting financial insecurity (PR = 1.38; CI (1.19-1.60)). Stress, anxiety, and depression were each associated with employees' intention to quit.

CONCLUSIONS

The residual effects of the pandemic remain prevalent among school employees. Improving school employees' mental health is crucial for the well-being and retention of educators.

Prevalence of Self-reported COVID-19 Infection in Persons With Complicated Mild to Severe Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study

OBJECTIVES

The aims of the study are to describe the incidence of self-reported COVID-19 history in a longitudinal cohort of individuals with complicated mild to severe traumatic brain injury and describe demographic, injury, and functional differences based on history of COVID-19 infection.

DESIGN

Individuals with complicated mild to severe traumatic brain injury aged 16 or older at time of injury who were enrolled in the Traumatic Brain Injury Model Systems longitudinal cohort study, completed a baseline or follow-up interview between October 1, 2021-March 31, 2023, and provided information about COVID-19 history and timing of COVID-19 infection was collected.

RESULTS

Of the 3627 individuals included in the analysis, 29.5% reported a history of COVID-19 infection. Those with reported COVID-19 history tended to be younger, not of a racial/ethnic minority background, and greater functional status at follow-up based on the Glasgow Outcome Scale-Extended Scale compared with those with no reported COVID-19 history ( P < 0.05). Among those with COVID-19 history, 61.8% did not receive medical care, 27.6% received medical care but no hospitalization, and 10.5% were hospitalized. Of those hospitalized, 21.4% required ventilator use.

CONCLUSIONS

Incidence of COVID-19 diagnosis and related hospitalization characteristics in persons with complicated mild to severe traumatic brain injury was similar to national incidence between March 2020-2023. Secondary effects of the COVID-19 pandemic on persons with traumatic brain injury require investigation.

Symptoms of Mental Health Conditions and Their Predictors Among U.S. Adults During the First Year of the COVID-19 Pandemic

Background/Objectives: This study examined the impact of the COVID-19 pandemic on mental health among U.S. adults during its first year, using monthly surveys from March to November 2020. Methods: The primary outcome was the Patient Health Questionnaire four-item (PHQ-4) measure of anxiety and depressive symptoms. Univarite and bivariate analyses were used to provide foundational understanding of key variables. Parametric and non-parametric correlation analyses were conducted to observe the relationship between COVID-19 impacts or risk factors and the frequency of anxiety/depressive symptoms. A series of regression models were fit to assess the impact of pandemic stressors on PHQ-4 scores. Results: There was a statistically significant increase in mean PHQ-4 scores and the proportion of respondents with moderate to severe symptoms (PHQ-4 = 6+) between March-June and July-November 2020. Factors such as fear of contracting the virus, health concerns, and lifestyle disruptions had statistically significant impacts on mental health outcomes; however, these effects were more modest than estimates reported elsewhere. Financial strain, particularly among lower-income households and those experiencing job loss, showed stronger associations with increased anxiety and depressive symptoms, but the overall impact on population-level mental health was limited due to the small proportion severely affected financially. Using regression models, we found that demographic factors and pandemic stressors collectively explained about 21% of the variance in anxiety and depressive symptoms. Conclusions: This study provides a nuanced understanding of the pandemic's mental health impact, suggesting that while certain subgroups were more affected, the overall population level increase in anxiety and depression was less pronounced than previously assumed.

Impact of pandemic-related worries on mental health in India from 2020 to 2022

This study examines how pandemic-related worries affected mental health in India's adults from 2020 to 2022. Using data from the Global COVID-19 Trends and Impact Survey (N = 2,576,174), it explores the associations between worry variables (financial stress, food insecurity, and COVID-19-related health worries) and self-reported symptoms of depression and anxiety. Our analysis, based on complete cases (N = 747,996), used survey-weighted models, adjusting for demographics and calendar time. The study finds significant associations between these worries and mental health outcomes, with financial stress being the most significant factor affecting both depression (adjusted odds ratio, aOR: 2.36; 95% confidence interval, CI: [2.27, 2.46]) and anxiety (aOR: 1.91; 95% CI: [1.81, 2.01])). Models with interaction terms revealed gender, residential status, and calendar time as effect modifiers. This study demonstrates that social media platforms like Facebook can effectively gather large-scale survey data to track mental health trends during public health crises.

Assets and depression in U.S. adults during the COVID-19 pandemic: a systematic review

PURPOSE

Mental health is shaped by social and economic contexts, which were altered during the COVID-19 pandemic. No study has systematically reviewed the literature on the relation between different assets and depression during the COVID-19 pandemic.

METHODS

We conducted a systematic review of the literature on financial (e.g. income/savings), physical (e.g., home ownership), and social (e.g., marital status, educational attainment) assets and depression in U.S. adults. For each asset type, we created binary comparisons to report on the direction of the relationship and described if each study reported insignificant, positive, negative, or mixed associations.

RESULTS

Among the 41 articles identified, we found that income was the most studied asset (n=34), followed by education (n=25), marital status (n=18), home ownership (n=5), and savings (n=4). 88%, 100%, and 100% of articles reported a significant association of higher income, home ownership, and higher savings, respectively, with less depression. The association between marital status and education with depression was more nuanced: 72% (13 of 18) studies showed that unmarried persons had greater risk of depression than married or cohabitating persons and 52% (13 of 25) of studies reported no significant difference in depression across educational groups.

CONCLUSION

This work adds to the literature a deeper understanding of how different assets relate to depression. In the context of largescale traumatic events, policies that maintain and protect access to social, physical, and financial assets may help to protect mental health.

Prevalence and associated factors of depression, anxiety and stress among clinical therapists in China in the context of early COVID-19 pandemic

Objectives

To study the socio-demographic characteristics and the prevalence of depression, anxiety, and stress among clinical therapists in China during the early Coronavirus disease 2019 (COVID-19) pandemic and to identify associated factors.

Method

This cross-sectional study was part of a multicenter, nationally representative survey conducted through WeChat from January 2021 to March 2021. Data, including socio-demographics, health-related behaviors, and information on whether they participated in the frontline work of treating COVID-19, were collected anonymously. Respondents also completed the Depression Anxiety Stress Scales-21 (DASS-21).

Results

In total, 396 clinical therapists in the selected hospitals completed the questionnaires, with a response rate of 89.0%. Respondents were predominantly female (77.3%). About 6.6% of the participants were current tobacco users, and 20.7% had participated in the frontline work of treating COVID-19. Overall, 22.0%, 17.9%, and 8.8% of participants were classified as having clinically meaningful depression, anxiety, and stress, respectively, based on DASS-21 scores. Multiple logistic regression in Model 1 and Model 2 showed that depression, anxiety, and stress were associated with regular physical activity and frequent insomnia (all, p < 0.05). In anxiety model 2, the associated factors for anxiety during the pandemic were identified as education (master's degree or more, OR=0.520; 95% CI=0.283-0.955), marital status (single, OR=2.064; 95% CI=1.022-4.168), tobacco use (OR=4.265; 95% CI=1.352-13.454), regular physical activity (OR=0.357; 95% CI=0.192-0.663), frequent insomnia (OR=6.298; 95% CI =2.522-15.729), and participation in the frontline work of treating COVID-19 (OR=3.179; 95% CI=1.697-5.954). The COVID-19 epidemic did not significantly increase the depression and stress levels among clinical therapists, but it did significantly increase anxiety levels.

Conclusion

During the COVID-19 pandemic, depression, anxiety and stress were relatively common among clinical therapists in China. Regular physical activity and good sleep were important protective factors against emotional problems. Therefore, encouraging regular physical activity and actively addressing clinical therapists' sleep problems is beneficial to improving the ability to cope with negative emotions. The COVID-19 epidemic significantly increased anxiety, and awareness and interventions should be recommended to reduce anxiety among clinical therapists during the COVID-19 pandemic.