Changes in Prevalence of Mental Illness Among US Adults During Compared with Before the COVID-19 Pandemic

Abstract

The authors review trend and cohort surveys and administrative data comparing prevalence of mental disorders during, versus, and before the COVID-19 pandemic and changes in mental health disparities. Best evidence suggests clinically significant anxiety-depression point prevalence increased by relative-risk (RR) = 1.3 to 1.5 during the pandemic compared with before. This level of increase is much less than the implausibly high RR = 5.0 to 8.0 estimates reported in trend studies early in the pandemic based on less-appropriate comparisons. Changes in prevalence also occurred during the pandemic, but relative prevalence appears not to have changed substantially over this time.

Keywords: COVID-19; Cohort study; Health disparities; Mental disorders; Trend study.

Fig. 1

Comparing trends in anxiety and depression during the pandemic across studies: HPS, CSP, UAS. ^aThere were 2,745,185 observations in the HPS from April 2020 to July 2021. In this figure, the authors excluded any observations that were missing values for questions on anxiety or depression from the PHQ-4 for a total sample size of 2,373,044 observations. In instances when multiple waves of the survey were carried out in a single month, equal weight was given to the surveys as a function of number of days in the month covered rather than comparative sample size. In instances when a single wave was carried out across 2 months, the overall prevalence in that wave to both months was attributed based on number of days covered. For example, if a single wave was carried out in the last 5 days of 1 month and the first 2 days of the next month, the prevalence in the survey was counted as applying to 5 days in the first month and 2 days in the second month. If one additional wave was carried out over in the first month for a total of 14 days, for example, the prevalence in the overlapping wave would contribute 5/19 to the estimated prevalence in the month (and the first wave would contribute 14/19 to the estimated prevalence). ^bThere were 173,823 observations in the UAS. In this figure, the authors excluded 3261 observations that were missing values for questions on anxiety or depression from the PHQ-4 or who had an incomplete survey date for a total sample size of 170,562 observations. It is noteworthy in this regard that HPS and CSP are both trend surveys in which only a tiny proportion of respondents participate in more than one wave, whereas the UAS is a rolling panel trend survey in which the n = 9500 UAS panel members are surveyed repeatedly over time. This might have led to panel fatigue, which could account for why prevalence estimates are substantially lower in UAS than the other 2 surveys even though all 3 surveys were weighted to be nationally representative on the cross-classification of demographic-geographic characteristics.