Change in Health-Related Socioeconomic Risk Factors and Mental Health During the Early Phase of the COVID-19 Pandemic: A National Survey of U.S. Women

Abstract

Background: During a pandemic, women may be especially vulnerable to secondary health problems driven by its social and economic effects. We examined the relationship between changes in health-related socioeconomic risks (HRSRs) and mental health. Materials and Methods: A cross-sectional survey of 3,200 women aged 18-90 years was conducted in April 2020 using a quota-based sample from a national panel (88% cooperation rate). Patterns of change in HRSRs (food insecurity, housing instability, interpersonal violence, and difficulties with utilities and transportation) were described. Weighted, multivariate logistic regression was used to model the odds of depression, anxiety, and traumatic stress symptoms among those with and without incident or worsening HRSRs. Results: More than 40% of women had one or more prepandemic HRSRs. In the early pandemic phase, 49% of all women, including 29% with no prepandemic HRSRs, had experienced incident or worsening HRSRs. By April 2020, the rates of depression and anxiety were twice that of prepandemic benchmarks (29%); 17% of women had symptoms of traumatic stress. The odds of depression, anxiety, and posttraumatic stress symptoms were two to three times higher among women who reported at least one incident or worsening HRSR; this finding was similar for women with and without prepandemic HRSRs. Conclusions: Increased health-related socioeconomic vulnerability among U.S. women early in the coronavirus disease 2019 (COVID-19) pandemic was prevalent and associated with alarmingly high rates of mental health problems. Pandemic-related mental health needs are likely to be much greater than currently available resources, especially for vulnerable women.

Keywords: COVID-19; disparities; health behaviors; mental health; social determinants of health.

FIG. 1.

Frequencies of incident, persistent, or worsening health-related socioeconomic risks (HRSRs) during the early phase of the pandemic stratified by prepandemic HRSR status (no or one or more HRSR) (N = 3,124). HRSRs, health-related socioeconomic risks.

FIG. 2.

Anxiety, depression, and posttraumatic health symptoms by prepandemic health-related socioeconomic risks compared to national or best available prepandemic benchmarks (N = 3,176).

FIG. 3.

Adjusted odds of depression, anxiety, and traumatic stress symptoms (A) among those with at least one incident or worsening health-related socioeconomic risk (HRSR) and (B) for each additional incident or worsening HRSR during the early phase of the pandemic (N = 3,124). Models adjusted for age, race/ethnicity, marital status, income, education, number of people in household, number of children in household, self-reported health and comorbidities.