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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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“Young people with a pre-existing mental illness have also reported significant levels of depression, anxiety and PTSD in the US (Liu et al., 2020).”
BackgroundCOVID-19 Pediatric Problems: A Narrative Review
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Carvalho, M. L. G., Matos, F. C., Trindade, A. C. S., & Bernardo, A. M. C. D. S. (2021) · doi:10.22533/at.ed.59321080712
Pang, N. T. P., Kassim, M. A. M., Shoesmith, W. D., & James, S. (2021) · Borneo Epidemiology Journal · doi:10.51200/bej.v2i1.3237
Schleihauf, E., & Bowes, M. (2021) · Promotion de la santé et prévention des maladies chroniques au Canada · doi:10.24095/hpcdp.42.2.02f
التوجه الدینی (الظاهری والجوهری) وعلاقته بالصحة النفسیة والأداء لدى المرشدین النفسیین العیادیین
محمد, ص. م. م. (2021) · التربية (الأزهر) مجلة علمية محکمة للبحوث التربوية والنفسية والاجتماعية) · doi:10.21608/jsrep.2021.205871
Shropshire, S. A. (2008) · Digital Commons - East Tennessee State University (East Tennessee State University)
Peña, G., & Luisa, M. (1981) · Narria: Estudios de artes y costumbres populares
Stephenson, R. B., Walsh, A., Chavanduka, T., Sallabank, G., Horvath, K. J., Castel, A. D., Hightow‐Weidman, L., Bauermesiter, J., & Sullivan, P. S. (2020) · doi:10.2196/preprints.24894
Editorial_Anxiety and the COVID-19 Pandemic
Sousa, A. D. (2021) · Indian Journal of Mental Health(IJMH) · doi:10.30877/ijmh.8.2.2021.123-127
عمران, ف. م. ع. (2022) · المجلة التربوية لکلية التربية بسوهاج · doi:10.21608/edusohag.2022.211550
Das, B., Das, B., Chatterjee, A., & Das, A. (2022) · Elsevier eBooks · doi:10.1016/b978-0-12-824557-6.00003-0
“Clinical researches are performed based on person-to-person questioner to a significant amount (Liu et al., 2020).”
Background(2022) · Presses universitaires du Septentrion eBooks · doi:10.4000/books.septentrion.127582
Pellegrina, U., Deligne, H., & Quaglino, V. (2022) · Psychologie Française · doi:10.1016/j.psfr.2022.02.003
Self-Reported and Behavioral Perseverance Associated with the Maintenance of Health Behaviors
Frazier, A. (2022) · doi:10.33915/etd.11204
“The majority of these research studies support the conclusion that as distress tolerance increases, well-being and mental health during the pandemic increases as well (Akbari et al., 2021; Hyun et al., 2021; Liu et al., 2020; Mohammadipour et al., 2021).”
ResultThe Relationship between Emotion Regulation and Substance Use Treatment Attrition
Roys, M. R. (2021) · Louisiana State University · doi:10.31390/gradschool_dissertations.5601
A longitudinal descriptive assessment of US college COVID-19 dashboards
Jones, K. A., Steyn, F. D., & Wallace, L. S. (2022) · Journal of American College Health · doi:10.1080/07448481.2022.2061861
Beigi, D. M. R., Pellegrino, G., Cadar, M., Bisconti, I., Ciommo, F. R. D., Stefanantoni, K., Conti, F., & Riccieri, V. (2022) · Open Access Rheumatology Research and Reviews · doi:10.2147/oarrr.s367424
“Such was associated primarily with young age, female gender, and previous psychiatric illness,(6) but also with loneliness, COVID-19-specific worry, and low distress tolerance.(7) Other studies on the Chinese population showed how the prevalence of acute stress symptoms gradually declined with the progression of the e…”
BackgroundStudents for others: Correlates of adherence to COVID-19 guidelines
Annunziato, R. A., Tutino, R. C., Campagna, B. R., Duncan, S. E., Dunphy, C., Flood, J. R., Riklin, E. I. K., Stevanović, K., & Mast, M. B. (2022) · Journal of American College Health · doi:10.1080/07448481.2022.2095514
Anxiety in Patients and Medical Providers during the Covid-19 Pandemic
al-Warith, H., Schneider, U., & Rohlfing, S. (2022) · Open Journal of Psychiatry · doi:10.4236/ojpsych.2022.123018
Subjective perception of anxiety as PSYCHOSOCIAL effect of COVID-19
Robak, M., & Jurkiewicz, B. (2022) · Journal of Education Health and Sport · doi:10.12775/jehs.2022.12.07.055
“economic and employment difficulties may put young adults at greater risk for mental health problems [17,18].”
BackgroundDodds, R. L., & Maurer, K. J. (2022) · Journal of Mental Health Research in Intellectual Disabilities · doi:10.1080/19315864.2022.2076960
“In general, adults reported increased levels of anxiety, depression, and loneliness at the beginning of the pandemic (Liu et al., 2020), but research points to disparities across income levels and social circumstances.”
BackgroundBae, S., & Cho, O. (2022) · Healthcare · doi:10.3390/healthcare10091758
Pandemic as a Trigger of Anxiety and Depressive Disorders
Кирпиченко, А. А. (2022) · Рецепт · doi:10.34883/pi.2022.25.4.007
Psychological Impacts of the COVID-19 Pandemic
Powell, S. K., Saali, A., Serafini, R. A., O’Shea, C. P., Frere, J. J., & Katz, C. L. (2022) · Springer eBooks · doi:10.1007/978-3-031-08045-6_10 · Cited by 2
Ertürk, D., Kuşçu, F., Şahin, M. T. K., İnal, A. S., Candevir, A., Kömür, S., Kurtaran, B., & Taşova, Y. (2022) · Flora the Journal of Infectious Diseases and Clinical Microbiology · doi:10.5578/flora.20229610
Котова, О. В., Tsareva, E. V., Medvedev, V. E., Belyaev, A. A., Gushanskaya, E. V., Фролова, В. И., & Kotelnikova, I. G. (2022) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro202212212139
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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