Depression rate among Americans may have tripled amid coronavirus, people with low savings most impacted: Study
'We would hope that these findings promote creating a society where a robust safety net exists, where people have fair wages, where equitable policies and practices exist'
The coronavirus pandemic has taken a toll on people’s well-being. New research suggests that there is a high burden of depression symptoms in the US associated with the outbreak and that this burden falls disproportionately on individuals who are already at increased risk. Researchers found that the prevalence of depression symptoms in the US was more than three-fold higher during Covid-19 compared with before the pandemic.
An estimated 27.8% of US adults had depression symptoms as of mid-April, compared to 8.5% before the Covid-19 pandemic, reveals analysis by the Boston University School of Public Health (BUSPH). The authors also found that income and savings are the most dramatic predictors of depression symptoms in the time of Covid-19. Individuals with lower social resources, lower economic resources, and greater exposure to stressors (such as a job loss, death of someone close due to Covid-19, and having greater financial problems) reported a greater burden of depression symptoms.
“Mental health is sensitive to traumatic events and their social and economic consequences. Previous studies on disruptions to life owing to disasters, epidemics, or civil unrest suggest that exposure to large-scale traumatic events is associated with an increased burden of mental illness in the populations affected. In this nationally-representative study of US adults, we found that prevalence of depression symptoms was more than 3-fold higher during Covid-19 compared with the most recent population-based estimates of mental health in the US,” write authors in the report published in JAMA Network Open. They add, “This increase in depression symptom prevalence is higher than that recorded after previous mass traumatic events, likely reflecting the far more pervasive influence of Covid-19 and its social and economic consequences than other, previously studied mass traumatic events.”
The research team examined the change in depression prevalence before and during Covid-19 using the Patient Health Questionnaire-9 (PHQ 9), a leading self-administered depression screening tool. They used data from 5,065 respondents to the 2017-2018 National Health and Nutrition Examination Survey (NHANES), and 1,441 respondents from the Covid-19 Life Stressors Impact on Mental Health and Well-Being (CLIMB) study. The latter was conducted from March 31 to April 13, 2020, when 96% of the US population was under stay-at-home advisories or shelter-in-place policies. Both surveys used the PHQ 9 to assess depression symptoms and gathered the same demographic data, and the 2020 survey also gathered data on Covid-19-related stressors, including job loss, the death of a friend or loved one from coronavirus, and financial problems.
A total of 1,470 participants completed the CLIMB survey and of these, 1,441 were included in the final analysis. The report says that 619 participants were aged 18-39, 723 were men, and 933 were non-Hispanic White. Across the board, the researchers found an increase in depression symptoms among all demographic groups. Not surprisingly, experiencing more Covid-19-related stressors was a major predictor of depression symptoms, they add. A total of 458 participants (8.5%) had depression symptoms before Covid-19, and 382 participants (27.8%) had depression symptoms during Covid-19. Overall, the prevalence was 1.5-fold higher for mild depression symptoms, 2.6-fold higher for moderate depression symptoms, 3.7-fold higher for moderately severe depression symptoms, and 7.5-fold higher for severe depression symptoms categories during the pandemic compared with before Covid-19.
“Prevalence of depression symptoms in the US was higher in every category during Covid-19 compared with before. During Covid-19, most US residents (52.5%) had symptoms of mild depression or greater versus 24.7% before Covid-19. Mild depression symptoms prevalence was 16.2% before Covid-19 compared with 24.6% during Covid-19, while moderate depression symptoms prevalence was 5.7% before the pandemic compared with 14.8% during Covid-19. Moderately severe depression symptom prevalence was 2.1% before Covid-19 compared with 7.9% during Covid-19. Severe depression prevalence was 0.7% before the pandemic compared with 5.1% during Covid-19,” the findings state.
Commenting on the findings, Dr Ruth S Shim, Department of Psychiatry and Behavioral Sciences, University of California, says that while severe depression is not as common as moderate and mild depression, it is still a major contributor to the overall disability burden of depression and is associated with the increased suicide risk associated with depression. “While prevalence rates of depressive symptoms increased at all severity levels, the greatest increase was seen with those with severe depressive symptoms, the type of depression that requires intensive specialty treatment to effectively manage. These findings may help to explain why suicide rates increase with high levels of unemployment and during recessions and global pandemics. There is urgent need for greater examination of increased suicide risk associated with Covid-19,” she writes.
For race/ethnicity, non-Hispanic Asian individuals saw an 18.7-percentage point higher prevalence of depression symptoms during Covid-19 compared with before the pandemic. However, the biggest demographic difference came down to money. Lower-income groups were at greater risk of depression symptoms than higher-income groups. After adjusting for all other demographics, the team found that during Covid-19, someone with less than $5,000 in savings was 50% more likely to have depression symptoms than someone with more than $5,000. Additionally, they found that people with exposure to more stressors had greater odds (1.77 to 3.05) of depression symptoms.
“Persons who were already at risk before Covid-19, with fewer social and economic resources, were more likely to report probable depression, suggesting that inequity may increase during this time and that health gaps may widen,” says study lead author Catherine Ettman, a doctoral student at the Brown University School of Public Health and director of strategic development in the office of the dean at BUSPH.
What are the implications?
According to the investigators, while further data will be needed to assess the trajectory of depression in the US population and potential treatment for affected populations, it is important to recognize the potential for the mental health consequences of Covid-19 to be large in scale, to recognize that these effects can be longlasting, and to consider preventative action to help mitigate its effects. In particular, this burden is being borne by economically and socially marginalized groups, suggesting that individuals with low income and with fewer resources may benefit from particular policy attention in the coming months, they suggest.
“We would hope that these findings promote creating a society where a robust safety net exists, where people have fair wages, where equitable policies and practices exist, and where families can not only live on their income but can also save money towards the future,” emphasizes Ettman. The author recommends that there may be steps that policymakers can take now to help reduce the impact of Covid-19 stressors on depression, such as eviction moratoria, providing universal health insurance that is not tied to employment, and helping people return to work safely for those able to do so.
Shim emphasizes that the results highlighted are grim. She argues that just as US preparation for the pandemic was not ideal, there is little evidence that preparation for the mental health implications of Covid-19 is underway. According to the expert, steps taken so far to address the social determinants of mental health which could serve as an effective preventive tool, have not gone far enough, says the expert. “Capturing the mental health outcomes associated with Covid-19 among the US population is critically important. These findings serve to alert our attention to yet another impending public health crisis as a result of this pandemic — the increase in cases of major depression. To effectively prepare to face this public health crisis, healthcare practitioners and policymakers must commit to addressing the social determinants of health and mental health,” recommends Shim.