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Factors associated with depression, anxiety, and PTSD symptomatology during the COVID-19 pandemic: Clinical implications for U.S. young adult mental health
Open accessAbstract
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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“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]
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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.”
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]
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“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
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“For example, Liu et al. (2020) found that emotional support from family was associated with low levels of depression and PTSD in young adults during COVID-19, a finding consistent with prior research (Lee et al., 2021).”
BackgroundResultInfluentialSherman, A. C., Williams, M. L., Amick, B. C., Hudson, T. J., & Messias, E. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113476 · Cited by 93
“…et al. 2020b; Forte et al., 2020; Gonzaelz-Sanguino et al., 2020; Huang and Zhao, 2020; Petzold et al., 2020; Ren et al. 2020; Rossi et al., 2020; Smith et al., 2020; Solomou and Constantinidou, 2020; Varshney et al, 2020; Wang et al., 2020), and in the US (Liu et al., 2020; Tull et al. 2020).”
BackgroundResultInfluentialTFOS Lifestyle: Impact of lifestyle challenges on the ocular surface
Galor, A., Britten‐Jones, A. C., Feng, Y., Ferrari, G., Goldblum, D., Gupta, P. K., Merayo-Llovés, J., Na, K., Naroo, S. A., Nichols, K. K., et al. (2023) · The Ocular Surface · doi:10.1016/j.jtos.2023.04.008 · Cited by 96
Stinson, E. A., Sullivan, R. M., Peteet, B. J., Tapert, S. F., Baker, F. C., Breslin, F. J., Dick, A. S., Gonzalez, M. R., Guillaumé, M., Marshall, A. T., et al. (2021) · Biological Psychiatry Global Open Science · doi:10.1016/j.bpsgos.2021.08.007 · Cited by 94
“However, few studies have examined the impact of ACEs on mental health during the COVID-19 pandemic in preadolescents and adolescents from minoritized racial-ethnic backgrounds in the United States.”
InfluentialReyes‐Portillo, J. A., Warner, C. M., Kline, E. A., Bixter, M. T., Chu, B. C., Miranda, R., Nadeem, E., Nickerson, A. B., Ortin‐Peralta, A., Reigada, L. C., et al. (2022) · Emerging Adulthood · doi:10.1177/21676968211066657 · Cited by 90
“While loneliness is a strong risk factor for depression and anxiety across the lifespan (Matthews et al., 2016; Okruszek et al., 2020), rates of loneliness are consistently found to be elevated among emerging adults relative to other developmental periods (Liu et al., 2020; Matthews et al., 2016).”
BackgroundInfluentialHawke, L. D., Sheikhan, N. Y., MacCon, K., & Henderson, J. L. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06321-7 · Cited by 84
“Indeed, youth are experiencing mental health challenges during the pandemic [7–12], including heighted symptoms of internalizing mental health challenges [7, 13], posttraumatic stress disorder [10, 13], and general stress and distress [10–12].”
BackgroundZhang, L., Pan, R., Cai, Y., & Pan, J. (2021) · Psychiatry Investigation · doi:10.30773/pi.2020.0458 · Cited by 87
Gabarrell‐Pascuet, A., García‐Mieres, H., Giné-Vázquez, I., Moneta, M. V., Koyanagi, A., Haro, J. M., & Domènech‐Abella, J. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20042765 · Cited by 97
Kobayashi, L. C., O’Shea, B. Q., Kler, J. S., Nishimura, R., Palavicino‐Maggio, C. B., Eastman, M. R., Vinson, Y. R., & Finlay, J. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-044965 · Cited by 82
The COVID-19 disaster and mental health—assessing, responding and recovering
Lindert, J., Jakubauskienė, M., & Bilsen, J. J. R. (2021) · European Journal of Public Health · doi:10.1093/eurpub/ckab153 · Cited by 89
Depression, anxiety, and academic performance in COVID-19: a cross-sectional study
Barbosa‐Camacho, F. J., Romero-Limón, O. M., Ibarrola‐Peña, J. C., Almanza-Mena, Y. L., Pintor‐Belmontes, K. J., Sánchez‐López, V. A., Chejfec‐Ciociano, J. M., Guzmán-Ramírez, B. G., Sapién-Fernández, J. H., Guzmán-Ruvalcaba, M. J., et al. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04062-3 · Cited by 85
Kogan, L. R., Currin-McCulloch, J., Bussolari, C., Packman, W., & Erdman, P. (2021) · Animals · doi:10.3390/ani11072084 · Cited by 79
Rösel, I., Bauer, L. L., Seiffer, B., Deinhart, C., Atrott, B., Sudeck, G., Hautzinger, M., & Wolf, S. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114559 · Cited by 84
“Our results are in accordance with research on mental health during COVID-19 from North and South America (Callow et al., 2020; Liu et al., 2020; Meyer et al., 2020; Schuch et al., 2020; Torales et al., 2020), Asia (Cao et al.”
Hahm, H. C., Hall, C. D. X., Garcia, K. T., Cavallino, A., Ha, Y., Cozier, Y. C., & Liu, C. H. (2021) · BMC Public Health · doi:10.1186/s12889-021-11559-1 · Cited by 80
“This study uses data from Wave I (April through September 2020) of the COVID-19-CARES [21], a longitudinal study examining the psychosocial experiences of individuals ages 18–30 years across three time points from 2020 to 2021.”
MethodSelf-citationGénéreux, M., Schlüter, P. J., Hung, K. K. C., Wong, C. S., Mok, C. P. Y., O’Sullivan, T. L., David, M. D., Carignan, M.-È., Blouin-Genest, G., Champagne-Poirier, O., et al. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17228390 · Cited by 80
Psychological risks to mother–infant bonding during the COVID-19 pandemic
Liu, C. H., Hyun, S., Mittal, L. P., & Erdei, C. (2021) · Pediatric Research · doi:10.1038/s41390-021-01751-9 · Cited by 82
“Reported grief experiences using this 6-item grief scale have been associated with mental health symptoms among perinatal women, college students (50), and young adults (51); it has also been associated with mental health diagnoses (52), and sleep problems (53).”
MethodSelf-citationDepression Detection in Speech Using Transformer and Parallel Convolutional Neural Networks
Yin, F., Du, J. K., Xu, X., & Li, Z. (2023) · Electronics · doi:10.3390/electronics12020328 · Cited by 79
Scherlinger, M., Felten, R., Gallais, F., Nazon, C., Chatelus, E., Pijnenburg, L., Mengin, A. C., Gras, A., Vidailhet, P., Arnould-Michel, R., et al. (2021) · Infectious Diseases and Therapy · doi:10.1007/s40121-021-00484-w · Cited by 82
Longitudinal effects of COVID‐19‐related stressors on young adults' mental health and wellbeing
Graupensperger, S. A., Calhoun, B. H., Patrick, M. E., & Lee, C. M. (2022) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.12344 · Cited by 74
“It also extends our understanding of the initial effects of COVID19-related stressors by examining a community sample of young adults, supporting hypotheses that social/relational stressors may be central to the widespread declines in mental health/well-being among young adults (Liu et al., 2020).”
BackgroundJaffe, A. E., Graupensperger, S. A., Blayney, J. A., Duckworth, J. C., & Stappenbeck, C. A. (2022) · Vaccine · doi:10.1016/j.vaccine.2022.01.038 · Cited by 75
Loneliness and COVID-19 preventive behaviours among Japanese adults
Stickley, A., Matsubayashi, T., & Ueda, M. (2020) · Journal of Public Health · doi:10.1093/pubmed/fdaa151 · Cited by 76
COVID-19 Lockdown and Mental Health in a Sample Population in Spain: The Role of Self-Compassion
Gutiérrez-Hernández, M. E., Fanjul, L. F., Díaz, A., Reyes-Hurtado, P., Herrera-Rodríguez, J. F., Enjuto-Castellanos, M. D. P., & Castro, W. P. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18042103 · Cited by 77
Scandurra, C., Bochicchio, V., Dolce, P., Valerio, P., Muzii, B., & Maldonato, M. N. (2021) · Current Psychology · doi:10.1007/s12144-021-02059-x · Cited by 77
“Since there are no certainties in relation to the end of the pandemic, feelings of uncontrollability may dramatically increase and this, in turn, may cause anxiety as a common response to a stressful situation (Giallonardo et al., 2020; Liu et al., 2020; Usher et al., 2020).”
BackgroundHawke, L. D., Szatmári, P., Cleverley, K., Courtney, D., Cheung, A., Voineskos, A. N., & Henderson, J. L. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-049209 · Cited by 71
Ueafuea, K., Boonnag, C., Sudhawiyangkul, T., Leelaarporn, P., Gulistan, A., Chen, W., Mukhopadhyay, S. C., Wilaiprasitporn, T., & Piyayotai, S. (2020) · IEEE Sensors Journal · doi:10.1109/jsen.2020.3046259 · Cited by 72
“general public, women [45], [47], those who did not receive support [39], those with suspected COVID-19 symptoms [40],”
BackgroundRisk Factors Underlying COVID-19 Lockdown-Induced Mental Distress
Novotný, J., Gonzalez-Rivas, J. P., Kunzová, Š., Skladaná, M., Pospíšilová, A., Polcrova, A. B., Medina‐Inojosa, J. R., López-Jiménez, F. A., Geda, Y. E., & Stokin, G. B. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.603014 · Cited by 68
Wellbeing and Resilience in Tourism: A Systematic Literature Review During COVID-19
Pocinho, M. M. F. D. D., Garcês, S. F., & de Jesús, S. N. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.748947 · Cited by 69
“As a personal trait, resilience may allow people to manage negative situations better (Liu et al., 2020).”
BackgroundAbdalla, S. M., Ettman, C. K., Cohen, G. H., & Galea, S. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-044125 · Cited by 68
Stevens, C., Zhang, E., Cherkerzian, S., Chen, J. A., & Liu, C. H. (2020) · Depression and Anxiety · doi:10.1002/da.23094 · Cited by 69
Self-citationVogel, M., Meigen, C., Sobek, C., Ober, P., Igel, U., Körner, A., Kieß, W., & Poulain, T. (2021) · JCPP Advances · doi:10.1111/jcv2.12004 · Cited by 73
“…and higher perceived stress (Mikkelsen et al., 2020), higher prevalence of depression (Goosby et al., 2013; C. H. Liu, Zhang et al., 2020), anxiety (C. H. Liu, Zhang et al., 2020), suicidality (Shovestul et al., 2020), and somatic symptoms (C. H. Liu, Zhang et al., 2020; S. Liu, Liu et al., 2020).”
BackgroundCox, R. C., Jessup, S. C., Luber, M. J., & Olatunji, B. O. (2020) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2020.102315 · Cited by 69
The psychological impact of the COVID-19 pandemic on pregnant women
Puertas‐Gonzalez, J. A., Mariño-Narváez, C., Peralta‐Ramírez, M. I., & Romero‐Gonzalez, B. (2021) · Psychiatry Research · doi:10.1016/j.psychres.2021.113978 · Cited by 77
“Moreover, several studies conducted in different countries (United States, China, Canada, Italy, Turkey and Greece) suggest that the prevalence of anxiety and depression symptoms may have increased in pregnant women during the pandemic (Hessami et al., 2020; Liu et al., 2020; Wu et al., 2020).”
Oliveira Carvalho, P., Hülsdünker, T., & Carson, F. (2021) · Behavioral Sciences · doi:10.3390/bs12010003 · Cited by 66
Jaworski, B. K., Taylor, K. L., Ramsey, K. M., Heinz, A. J., Steinmetz, S. E., Pagano, I., Moraja, G., & Owen, J. E. (2021) · Journal of Medical Internet Research · doi:10.2196/26559 · Cited by 66
“COVID-19 has also negatively impacted mental health and well-being globally [1-3].”
Background
Metadata
- Authors
- Liu, C. H., Zhang, E., Wong, G. T. F., Hyun, S., & Hahm, H. “.
- Affiliations
- Boston University (US)
- Corresponding author
- Liu, Cindy H.
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2020-08
- Volume
- 290
- Pages
- 113172
- ISSN
- 0165-1781 (ISSN-L)
- 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
- bronze
- doi.org
- 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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