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Cited by 1,157COVID-19 and Mental HealthMaternal Mental Health During Pregnancy and PostpartumAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Factors associated with depression, anxiety, and PTSD symptomatology during the COVID-19 pandemic: clinical implications for U.S. young adult mental health

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Liu, Cindy H., Zhang, Emily, Wong, Ga Tin Fifi, Hyun, Sunah, Hahm, Hyeouk “Chris”·2020·Psychiatry Research
DOI 10.1016/j.psychres.2020.113172PMC PMC7263263
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Abstract

This study sought to identify factors associated with depression, anxiety, and PTSD symptomatology in U.S. young adults (18-30 years) during the COVID-19 pandemic. This cross-sectional online study assessed 898 participants from April 13, 2020 to May 19, 2020, approximately one month after the U.S. declared a state of emergency due to COVID-19 and prior to the initial lifting of restrictions across 50 U.S. states. Respondents reported high levels of depression (43.3%, PHQ-8 scores ≥ 10), high anxiety scores (45.4%, GAD-7 scores ≥ 10), and high levels of PTSD symptoms (31.8%, PCL-C scores ≥ 45). High levels of loneliness, high levels of COVID-19-specific worry, and low distress tolerance were significantly associated with clinical levels of depression, anxiety, and PTSD symptoms. Resilience was associated with low levels of depression and anxiety symptoms but not PTSD. Most respondents had high levels of social support; social support from family, but not from partner or peers, was associated with low levels of depression and PTSD. Compared to Whites, Asian Americans were less likely to report high levels across mental health symptoms, and Hispanic/Latinos were less likely to report high levels of anxiety. These factors provide initial guidance regarding the clinical management for COVID-19-related mental health problems.

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  • Exposure to nature may regulate stress, thus enhancing tolerance to negative emotions, which may further reduce the risk of depression and anxiety.

    “On the other hand, exposure to nature may regulate stress, thus enhancing tolerance to negative emotions (34, 35), which may further reduce the risk of depression and anxiety (36, 37).”

    From Can Viewing Nature Through Windows Improve Isolated Living? A Pathway Analysis on Chinese Male Prisoners During the COVID-19 Epidemic (2021) · cites this paper as [36]

    The Results and Discussion report that greater distress tolerance was associated with fewer depression and anxiety symptoms among U.S. young adults during the COVID-19 pandemic. The paper does not show that exposure to nature increases distress tolerance or that this pathway reduces the risk of depression or anxiety; its findings are associations, not a causal test. (LLM, conf=0.86)

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  • Socially restrictive measures, quarantines and lockdowns have been associated with reduced social interaction and increased loneliness that may lead to a rise in mental health problems such as symptoms of depression and anxiety.

    “Socially restrictive measures, quarantines and lockdowns have been associated with reduced social interaction and increased loneliness that may lead to a rise in mental health problems such as symptoms of depression and anxiety.”

    From A Longitudinal Study of Loneliness Before the End of the COVID-19 Pandemic: Trajectories, Predictors, and Impact on Chinese Adolescent Mental Health (2024) · cites this paper as [6]

  • The prevalence of depressive and anxiety symptoms in this sample is lower than that reported in early pandemic studies on young adult populations.

    “this is a lower prevalence when compared to those reported by research carried out on young adult populations at the early stages of the pandemic when social isolation was imposed to limit the spread of the virus (Faisal et al., 2022; Liu et al., 2020; Varma et al., 2021).”

    From Social connections combat loneliness and promote wellbeing among college students coming out of the COVID-19 pandemic (2025) · cites this paper as Liu et al., 2020

    Experimental — accuracy not yet measured

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Authors
Liu, C. H., Zhang, E., Wong, G. T. F., Hyun, S., & Hahm, H. “.
Affiliations
Boston University (US)
Corresponding author
Liu, Cindy H.
ORCID
Venue
Psychiatry Research
Publisher
Elsevier BV
Published
2020-08
Volume
290
Pages
113172
ISSN
0165-1781 (ISSN-L)
DOI
10.1016/j.psychres.2020.113172
PMC
PMC7263263
OpenAlex
W3030361728
Cited by
1,157
References
48
Citations by year
2026: 27 · 2025: 92 · 2024: 130 · 2023: 226 · 2022: 316 · 2021: 300 · 2020: 64
FWCI
90.67
Type
journal article
Language
en
Open access
Licence
Locations
  • Psychiatry Research (acceptedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health
  • National Science Foundation
Topics
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
COVID-19 pandemic, depression, anxiety, post-traumatic stress disorder, young adults, loneliness, distress tolerance, resilience, social support, family social support, racial and ethnic differences, mental health
MeSH terms
Patient Health Questionnaire, Betacoronavirus, COVID-19, SARS-CoV-2, Adolescent, Adult, Anxiety, Cross-Sectional Studies, Depression, Female, Humans, Loneliness, Male, Pneumonia, Viral, Quarantine, Social Support, Stress Disorders, Post-Traumatic, United States, Coronavirus Infections, Young Adult, Pandemics

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