The mental health burden of racial and ethnic minorities during the COVID-19 pandemic

Abstract

Racial/ethnic minorities have been disproportionately impacted by COVID-19. The effects of COVID-19 on the long-term mental health of minorities remains unclear. To evaluate differences in odds of screening positive for depression and anxiety among various racial and ethnic groups during the latter phase of the COVID-19 pandemic, we performed a cross-sectional analysis of 691,473 participants nested within the prospective smartphone-based COVID Symptom Study in the United States (U.S.) and United Kingdom (U.K). from February 23, 2021 to June 9, 2021. In the U.S. (n=57,187), compared to White participants, the multivariable odds ratios (ORs) for screening positive for depression were 1·16 (95% CI: 1·02 to 1·31) for Black, 1·23 (1·11 to 1·36) for Hispanic, and 1·15 (1·02 to 1·30) for Asian participants, and 1·34 (1·13 to 1·59) for participants reporting more than one race/other even after accounting for personal factors such as prior history of a mental health disorder, COVID-19 infection status, and surrounding lockdown stringency. Rates of screening positive for anxiety were comparable. In the U.K. (n=643,286), racial/ethnic minorities had similarly elevated rates of positive screening for depression and anxiety. These disparities were not fully explained by changes in leisure time activities. Racial/ethnic minorities bore a disproportionate mental health burden during the COVID-19 pandemic. These differences will need to be considered as health care systems transition from prioritizing infection control to mitigating long-term consequences.

Fig 1. Odds of screening positive for depression or anxiety according to population subgroup.

Stratified analyses for A. PHQ and B. GAD scores, respectively, each conditioned upon age, sex, and date of mental health questionnaire completion, and adjusted for personal history of mental health diagnosis, diabetes, heart disease, lung disease, kidney disease, current smoking status, body mass index, prior reported history of COVID-19 infection, HCW status, and community-level education, income, and lockdown stringency except in a given strata. Referent is White individuals of the same subgroup. Abbreviations: CI (confidence interval), OR (odds ratio), PHQ-2 (Patient Health Questionnaire-2), GAD-2 (Generalized Anxiety Disorder 2-item).

Fig 2. Changes in peri-pandemic behavior by race and ethnicity.

Proportions have been rescaled among individuals to whom a given question was deemed applicable (i.e., time spent with pets reported among pet owners). Stratified analyses conditioned upon age, sex, and date of mental health questionnaire completion, and adjusted for personal history of mental health diagnosis, diabetes, heart disease, lung disease, kidney disease, current smoking status, body mass index, prior reported history of COVID-19 infection, HCW status, and community-level education, income, and lockdown stringency except in a given strata. Referent is White individuals of the same subgroup.