Emotional adaptation during a crisis: decline in anxiety and depression after the initial weeks of COVID-19 in the United States

Abstract

Crises such as the COVID-19 pandemic are known to exacerbate depression and anxiety, though their temporal trajectories remain under-investigated. The present study aims to investigate fluctuations in depression and anxiety using the COVID-19 pandemic as a model crisis. A total of 1512 adults living in the United States enrolled in this online study beginning April 2, 2020 and were assessed weekly for 10 weeks (until June 4, 2020). We measured depression and anxiety using the Zung Self-Rating Depression scale and State-Trait Anxiety Inventory (state subscale), respectively, along with demographic and COVID-related surveys. Linear mixed-effects models were used to examine factors contributing to longitudinal changes in depression and anxiety. We found that depression and anxiety levels were high in early April, but declined over time. Being female, younger age, lower-income, and previous psychiatric diagnosis correlated with higher overall levels of anxiety and depression; being married additionally correlated with lower overall levels of depression, but not anxiety. Importantly, worsening of COVID-related economic impact and increase in projected pandemic duration exacerbated both depression and anxiety over time. Finally, increasing levels of informedness correlated with decreasing levels of depression, while increased COVID-19 severity (i.e., 7-day change in cases) and social media use were positively associated with anxiety over time. These findings not only provide evidence for overall emotional adaptation during the initial weeks of the pandemic, but also provide insight into overlapping, yet distinct, factors contributing to depression and anxiety throughout the first wave of the pandemic.

Fig. 1. Data collection timeline, with participant exclusion, and depression and anxiety scores.

Longitudinal data were collected through weekly surveys for a 10-week period. A Drop-outs are presented alongside numbers of exclusions based on duplicate responses and failed attention checks. B Depression and anxiety trends in different subsets of participants. The blue line depicts depression (top panel) and anxiety (bottom panel) scores from participants with valid observations from the first week of data collection (n = 1456). The yellow line depicts scores from participants who successfully completed all 10 weeks of data collection (n = 743). All other lines depict intermediate subsets of participants. The shaded area represents the standard error of the mean. C Depression and D state anxiety scores were measured weekly. Error bars indicate the standard error of the mean.

Fig. 2. Dynamic variables in the study.

A COVID-19 severity was measured as a 7-day running average of the number of daily new cases (per 10 K), and a weekly change in said average between timepoints. B Self-reported economic impact, social media frequency use, and subjective projection of pandemic’s duration during data collection. Statistics were calculated on participants with complete data (n = 743), but plots reflect every valid observation per time-point. The economic impact is overall negative but improves with time [B1]. Individuals reported using social media less frequently with time [B2]. Individuals’ projected duration for the pandemic increased with time [B3]. Error bars represent standard errors.

Fig. 3. Factors influencing depression and anxiety during the COVID-19 pandemic in the United States.

A The coefficients of a mixed-effects linear regression of depression (blue) and anxiety (red). Error bars represent confidence intervals. * p < 0.05, **p < 0.01, ***p < 0.001. B Illustration of significant demographic variables related to depression and anxiety. Numbers in parentheses represent the number of participants at the first time point, and plots are of all valid observations at each time point. C Example participants depicting significant behavioral and attitude variables related to depression and anxiety. Colored lines represent the example participant’s depression (blue) and anxiety (red). Dotted lines represent the same participant’s behavioral/attitude variable.