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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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“social interaction and cognitive performance (Albus, 2010; Liu et al., 2020; Sepúlveda-Loyola et al., 2020; Smith et al., 2020; Cauberghe et al., 2021; Fruehwirth et al., 2021; Morrissette, 2021).”
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van den Berg, Y. H. M., Burk, W. J., Cillessen, A. H. N., & Roelofs, K. (2021) · Emerging Adulthood · doi:10.1177/21676968211039979 · Cited by 51
“large samples of emerging adults suggested high or even clinically elevated levels of mental health problems (Liu et al., 2020; Shanahan et al., 2020; Sun et al., 2020).”
BackgroundInfluentialAshby, J. S., Rice, K. G., Kira, I. A., & Davari, J. (2021) · Journal of Community Psychology · doi:10.1002/jcop.22762 · Cited by 39
“These findings are consistent with previous research suggesting that the relationship between race/ethnicity, COVID‐19 stress and trauma, and mental distress is complicated and may go beyond the simplistic categorization to include other factors (e.g., Liu et al., 2020).”
BackgroundResultPredicting stress in first-year college students using sleep data from wearable devices
Bloomfield, L. S. P., Fudolig, M. I., Kim, J. N., Llorin, J., Lovato, J. L., McGinnis, E. W., McGinnis, R. S., Price, M., Ricketts, T. H., Dodds, P. S., et al. (2024) · PLOS Digital Health · doi:10.1371/journal.pdig.0000473 · Cited by 43
Hou, T., Yin, Q., Xu, Y., Gao, J., Bin, L., Li, H., Cai, W., Ying, L., Dong, W., Deng, G., et al. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.666789 · Cited by 37
Li, Y., & Peng, J. (2021) · BMC Public Health · doi:10.1186/s12889-021-11332-4 · Cited by 43
“experience low levels of anxiety compared to White counterparts [32].”
BackgroundInfluentialYang, S., Yan, Q., Wang, J., Gao, F., Ji, M., Xie, P., Zhu, A., Tan, B., Wang, X., & Zhu, G. (2022) · Phytomedicine · doi:10.1016/j.phymed.2022.154139 · Cited by 38
Cahuas, A., Marenus, M. W., Kumaravel, V., Murray, A., Friedman, K., Ottensoser, H., & Chen, W. (2022) · Annals of Medicine · doi:10.1080/07853890.2022.2154943 · Cited by 36
“Another study examining the mental health of young adults in the US had a similar finding that social support from family, but not from significant others or friends, was associated with lower rates of depression during the COVID-19 pandemic [13].”
BackgroundCheng, X., Bao, Y., Yang, B., Chen, S., Zuo, Y., & Siponen, M. T. (2023) · Group Decision and Negotiation · doi:10.1007/s10726-023-09829-x · Cited by 48
Xiao, X., Xiao, J., Yao, J., Chen, Y., Saligan, L. N., Renynolds, N. R., & Wang, H. (2020) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s277231 · Cited by 43
The Relationship Between Age and Mental Health Among Adults in Iran During the COVID-19 Pandemic
Chen, J., Zhang, S. X., Wang, Y., Jahanshahi, A. A., Dinani, M. M., Madavani, A. N., & Nawaser, K. (2021) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-021-00571-6 · Cited by 40
Varela, J. J., Hernández, C., Miranda, R., Barlett, C. P., & Rodríguez‐Rivas, M. E. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19105886 · Cited by 43
Typologies of coping in young adults in the context of the COVID-19 pandemic
Shigeto, A., Laxman, D. J., Landy, J. F., & Scheier, L. M. (2021) · The Journal of General Psychology · doi:10.1080/00221309.2021.1874864 · Cited by 36
Boden, M. T., Cohen, N., Froelich, J. M., Hoggatt, K. J., Magid, H. S. A., & Mushiana, S. S. (2021) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2021.03.006 · Cited by 35
Anxiety levels and sleep quality in nursing students during the COVID‐19 pandemic
Dalcalı, B. K., Durgun, H., & Taş, A. S. (2021) · Perspectives In Psychiatric Care · doi:10.1111/ppc.12839 · Cited by 34
Sung, C., Chen, C., Fan, C., Chang, J., Hung, C., Fu, C.-M., Wong, L. P., Huang, E. P., & Lee, T. S. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-052184 · Cited by 36
Sasaki, K., Ferdousi, F., Fukumitsu, S., Kuwata, H., & Isoda, H. (2021) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2021.112291 · Cited by 37
Negash, S., Kartschmit, N., Mikolajczyk, R., Watzke, S., Fialho, P. M. M., Pischke, C. R., Busse, H., Helmer, S. M., Stock, C., Zeeb, H., et al. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.743158 · Cited by 46
Racism, Posttraumatic Stress Symptoms, and Racial Disparity in the U.S. COVID-19 Syndemic
Zhou, X., Nguyen‐Feng, V. N., Wamser‐Nanney, R. A., & Lotzin, A. (2022) · Behavioral Medicine · doi:10.1080/08964289.2021.2006131 · Cited by 36
The Impact of SARS-CoV-2 Infection on Youth Mental Health: A Narrative Review
Brasso, C., Bellino, S., Blua, C., Bozzatello, P., & Rocca, P. (2022) · Biomedicines · doi:10.3390/biomedicines10040772 · Cited by 39
Zhai, Y., & Du, X. Y. (2022) · Humanities and Social Sciences Communications · doi:10.1057/s41599-022-01163-y · Cited by 37
Alzueta, E., Podhajsky, S., Zhao, Q., Tapert, S. F., Thompson, W. K., de Zambotti, M., Yuksel, D., Kiss, O., Wang, R., Volpe, L., et al. (2023) · Psychological Medicine · doi:10.1017/s0033291721004062 · Cited by 34
Internet memes related to the COVID-19 pandemic as a potential coping mechanism for anxiety
Akram, U., Irvine, K., Allen, S. F., Stevenson, J. C., Ellis, J. G., & Drabble, J. (2021) · Scientific Reports · doi:10.1038/s41598-021-00857-8 · Cited by 48
Westrupp, E. M., Greenwood, C. J., Fuller‐Tyszkiewicz, M., Olsson, C. A., Sciberras, E., Mikocka‐Walus, A. A., Melvin, G. A., Evans, S., Stokes, M. A., WOOD, A. G., et al. (2021) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674211065365 · Cited by 36
“, 2020); worry/concern about the virus (Chung et al., 2020; Duan et al., 2020; Liu et al., 2020; Oosterhoff et al., 2020; Rosen et al., 2020; Xie et al., 2020); use of news media (Rosen et al.”
BackgroundOh, D. J., Yang, H. W., Suh, S. W., Byun, S., Kim, T. H., Kwak, K. P., Kim, B., Kim, S. G., Kim, J. L., Moon, S. W., et al. (2021) · Psychological Medicine · doi:10.1017/s0033291721005018 · Cited by 33
Torrente, F. M., Yoris, A., Low, D. M., López, P. L., Bekinschtein, P., Vázquez, G. H., Manes, F. F., & Cetkovich, M. (2021) · BJPsych Open · doi:10.1192/bjo.2021.1065 · Cited by 40
Gullo, S., Misici, I., Teti, A., Liuzzi, M., & Chiara, E. (2021) · Research in Psychotherapy Psychopathology Process and Outcome · doi:10.4081/ripppo.2020.494 · Cited by 37
“The study by Liu et al. (2020) reports that high levels of resilience were linked with low levels of anxiety; additionally, high levels of perceived family support were linked with low depression and PTSD symptoms, although levels of perceived friend support were not linked with any psychological…”
BackgroundSubstance use, depression, and loneliness among American veterans during the COVID‐19 pandemic
Fitzke, R. E., Wang, J., Davis, J. P., & Pedersen, E. R. (2021) · American Journal on Addictions · doi:10.1111/ajad.13211 · Cited by 33
“Specifically, during COVID‐19, lack of social support and loneliness are posited to be major risk factors for mental health consequences and substance use.(2,3) Recent research indicates increases in alcohol(4,5) and cannabis use,(6) as well as mental health symptomology,(7,8) among the general population.”
BackgroundSuperstitious beliefs, locus of control, and feeling at risk in the face of Covid-19
Hoffmann, A. O. I., Plotkina, D., Roger, P., & D’Hondt, C. (2022) · Personality and Individual Differences · doi:10.1016/j.paid.2022.111718 · Cited by 39
“Indeed, since it is difficult to predict the development of the crisis and control its effects (Liu et al., 2020), the pandemic has increased individuals' worries about their present and future (Giallonardo et al.”
Zhang, X., Wei, X., Zhang, T., Tan, Y., Dongming Xu, A., & de Pablos, P. O. (2022) · Technovation · doi:10.1016/j.technovation.2022.102556 · Cited by 32
The psychological effects of COVID-19 spread in young Canadian adults
Gill, P. K., Du, C., Khan, F., Karimi, N., Sabharwal, K., & Agarwal, M. (2021) · International Journal of Social Psychiatry · doi:10.1177/0020764020988878 · Cited by 32
“Meanwhile, symptoms for psychological distress related to anxiety, PTSD, and depression were asked through questions based on the Adult Psychiatric Morbidity Survey (McManus et al., 2016).”
BackgroundInfluentialYılmaz, M., Kıraç, Y., & Şahin, M. K. (2021) · International Journal of Clinical Practice · doi:10.1111/ijcp.14813 · Cited by 36
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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