Psychological distress in the face of a pandemic: An observational study characterizing the impact of COVID-19 on immigrant outpatient mental health

Abstract

Undocumented immigrants have disproportionately suffered during the novel coronavirus disease 2019 (COVID-19) pandemic due to factors including limited medical access and financial insecurity, which can exacerbate pandemic-associated distress. Psychological outcomes for immigrant outpatients were assessed after transition to telepsychiatry in March 2020. Mental health was assessed with Patient Health Questionnaire (PHQ-2) and Generalized Anxiety Disorder (GAD-2) inventories, a novel coronavirus-specific survey, and the Kessler Psychological Distress Scale (K10+). Feedback on telepsychiatry sessions and access to non-clinical resources were also gathered, after which multivariable linear regression modeling identified psychosocial factors underlying changes in distress levels. 48.57% and 45.71% of participants reported worsened anxiety and depression levels due to the pandemic, respectively. From March to April, PHQ-2 and GAD-2 scores significantly increased by 0.81 and 0.63 points, respectively. The average total psychological distress score was 23.8, with 60% of scores reflecting serious mental illness. Factors that most influenced K10+ scores included a pre-existing depressive disorder, food insecurity, and comfort during telepsychiatry visits. 93.75% of participants believed access to remote psychiatry helped their mental health during COVID-19. The negative impact of COVID-19 on mental health in vulnerable populations stems from medical and psychosocial factors such as pre-existing psychiatric conditions and unmet essential needs.

Keywords: Anxiety; COVID-19; Depression; Distress; Mental health; Telepsychiatry; Vulnerable populations.

Figure 1.

Change in PHQ-2 and GAD-2 Scores During the Early Months of the COVID-19 Pandemic. N=28 and N=30 participants completed the PHQ-2 and GAD-2, respectively, in both March and April. Comparison of PHQ-2 and GAD-2 raw scores (PHQ-2 95% CI: 0.057–1.05, t=7.01, df=27, p<0.0001; GAD-2 95% CI: 0.40–0.85, df=29, t=5.79, p<0.0001) and positive test thresholds between March and April (PHQ-2 McNemar with continuity correction, χ2=8.5, p=0.004; GAD-2 χ2=3.78, p=0.05).

Figure 2.

Summary of Key Psychological Distress Survey Findings. N=35 participants completed the K10+ survey. A) The median psychological distress score was a 22.0, with individual scores ranging from 10–43. B) Participant response tranches were as follows: 14 (40%) participants were considered “Low Risk” (score<20); 5 (14.29%) “Mild” (score=20–24); 3 (8.57%) “Moderate” (score=25–29); 13 (37.14%) “Severe” (score>29). C) Correlation between responses to Q3 and K10+ psychological distress scores (r2 = 0.71, p<0.0001). D) Comparison between K10+ psychological distress scores and frequency of distress (one-way ANOVA (F(2,28)=15.99, p<0.0001) (*p<0.05, ****p<0.0001).

Figure 3.

Inter-inventory Comparisons of Participant Mental Health Outcomes. A) Correlation between psychological distress scores and GAD-2 scores (r2 = 0.61; p = 0.001). B) Correlation between K10+ psychological distress scores and PHQ-2 scores (r2 = 0.51; p = 0.01). For A and B, color of individual data point corresponds to magnitude of psychological distress score. C) Comparison between K10+ psychological distress scores and COVID-19 Mental Health Survey Q1 (Anxiety) and Q2 (Depression) (Q1 one-way ANOVA F(4,27)=5.146, p=0.003; Q2 F(4,27)=4.545, p=0.006) (*p<0.05, **p<0.001).