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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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“This method is in widespread use by researchers around the world [8,17-20].”
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“The COVID-19 pandemic has also had a profound effect on mental health, owing to the strains and pressures created by the abrupt change in the way of life (Liu et al., 2020).”
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“35 Liu et al. (2020) 36 conducted a survey across the US and found that young adults aged 18 to 30 years reported high levels of depression (43.3”
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“Consistent with our findings, a previous study of young adults conducted during the COVID-19 pandemic has reported that higher perceived social support from family is associated with higher resilience and lower depression and anxiety scores [24].”
BackgroundResultInfluentialResilience and well‐being among expatriate entrepreneurs: Envisioning life after a global crisis
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Post-Traumatic Stress Disorder Trajectories the Year after COVID-19 Hospitalization
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“The reduction in social support consequent to the imposed social restrictions has also been linked to worse mental health outcomes and increased prevalence of depression and anxiety [24,25] and COVID-19 social restrictions might have affected patients in the post-hospitalization period.”
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“Studies conducted during COVID-19 have shown a detrimental impact to mental health among young adults, including increases in post-traumatic stress, depression, and anxiety (Czeisler et al., 2020; Horigian et al., 2021; Liu et al., 2020).”
BackgroundChanges in alcohol use during the COVID-19 pandemic among American veterans
Davis, J. P., Prindle, J., Castro, C. C., Saba, S. K., Fitzke, R. E., & Pedersen, E. R. (2021) · Addictive Behaviors · doi:10.1016/j.addbeh.2021.107052 · Cited by 24
Gattamorta, K. A., Salerno, J. P., Islam, J. Y., & Vidot, D. C. (2021) · Psychology of Sexual Orientation and Gender Diversity · doi:10.1037/sgd0000491 · Cited by 22
Mental health and resilience during the coronavirus pandemic: A machine learning approach
Samuelson, K. W., Dixon, K. E., Jordan, J. T., Powers, T., Sonderman, S., & Brickman, S. (2021) · Journal of Clinical Psychology · doi:10.1002/jclp.23254 · Cited by 21
Lanz, M., Sorgente, A., Vosylis, R., Fonseca, G., Lep, Ž., Li, L., Zupančič, M., Crespo, C., Relvas, A. P., & Serido, J. (2021) · Emerging Adulthood · doi:10.1177/21676968211046071 · Cited by 22
“According to Kujawa et al. (2020), as a result of pandemic constraints in the US, emerging adults experienced several financial stressors (e.g., financial strain, job loss, or reduced working hours).”
BackgroundInfluentialGraupensperger, S. A., Calhoun, B. H., Fleming, C. B., Rhew, I. C., & Lee, C. M. (2022) · Prevention Science · doi:10.1007/s11121-022-01382-4 · Cited by 24
“Research from the first year of the COVID-19 pandemic generally showed that distress related to the pandemic and the stringent measures put in place to combat the spread of SARS-CoV-2 have had detrimental impacts on multiple domains of daily life (Graupensperger et al., 2021; Holmes et al., 2020; Jacobson et al., 2020…”
BackgroundBrooks, J. M., Patton, C., Maroukel, S., Perez, A. M., & Levanda, L. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.902094 · Cited by 22
“In the United States, of particular concern were loneliness, low distress tolerance, and COVID19 worry, which are associated with clinical symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD; Liu et al., 2020).”
BackgroundResultXu, Y., Wu, J., Li, Q., Zeng, W., Wu, C., Yang, Y., Chen, Z., & Xu, Z. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.789844 · Cited by 25
Nia, H. S., Görgülü, Ö., Naghavi, N., Bello, M. A. R., Sánchez‐Teruel, D., Fomani, F. K., She, L., Rahmatpour, P., Allen, K., Arslan, G., et al. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.754831 · Cited by 29
Tam, C. C., Ye, Z., Wang, Y., Li, X., & Lin, D. (2021) · Psychology and Health · doi:10.1080/08870446.2021.2007913 · Cited by 23
Ehmke, M. D., Katare, B., Kiesel, K., Bergtold, J. S., Penn, J., & Boys, K. A. (2022) · Applied Economic Perspectives and Policy · doi:10.1002/aepp.13233 · Cited by 22
International student stressors and mental health during the COVID-19 pandemic: a qualitative study
Zhang, X., Wong, G. T. F., Liu, C. H., Hahm, H. C., & Chen, J. A. (2022) · Journal of American College Health · doi:10.1080/07448481.2022.2068015 · Cited by 21
Self-citationLigus, K., Fritzson, E., Hennessy, E. A., Acabchuk, R. L., & Bellizzi, K. M. (2021) · Translational Behavioral Medicine · doi:10.1093/tbm/ibab020 · Cited by 21
Yu, X.-X., Zhang, Y., & Xin, S.-F. (2024) · Children and youth services review · doi:10.1016/j.childyouth.2024.107601 · Cited by 21
Burrai, J., Barchielli, B., Cricenti, C., Borrelli, A., D’Amato, S., Santoro, M., Vitale, M., Ferracuti, S., Giannini, A. M., & Quaglieri, A. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18095006 · Cited by 20
Post-traumatic Growth in the First COVID Outbreak in Hong Kong
Lau, B. H. P., Chan, C., & Ng, S. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.675132 · Cited by 20
AI-Based Prediction and Prevention of Psychological and Behavioral Changes in Ex-COVID-19 Patients
Ćosić, K., Popović, S., Šarlija, M., Kesedžić, I., Gambiraža, M., Dropuljić, B., Mijić, I., Henigsberg, N., & Jovanović, T. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.782866 · Cited by 27
“…et al., 2019a; Šarlija et al., 2021), is the “early identification of individuals who are at risk of developing PTSD or depression” (Walker et al., 2017), which becomes particularly valuable in the face of the COVID-19 pandemic (´Cosi´c et al., 2020a; Liu C. H. et al., 2020; Mazza et al., 2020).”
BackgroundPedersen, E. R., Fitzke, R. E., Bouskill, K., & Sedano, A. (2021) · Frontiers The Interdisciplinary Journal of Study Abroad · doi:10.36366/frontiers.v33i3.602 · Cited by 20
“These mental health symptoms have centered on COVID-19-related health fears for themselves and loved ones, isolation and loneliness, and distress tolerance, as well as academic-related factors such as uncertainty about the future of their education, concerns about falling behind in coursework, and struggles with remot…”
BackgroundInfluentialHurlocker, M. C., Madson, M. B., Lui, P. P., Dvorak, R. D., Ham, L. S., Leffingwell, T. R., Looby, A. R., Meier, E. M., Montes, K. S., Napper, L. E., et al. (2022) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-022-00813-1 · Cited by 20
“Anxiety scores were highest of the mental health symptoms across profiles, signifying a need to better understand how anxiety develops among students and to offer interventions to help prevent emotional, social, and academic impairment due to anxiety (Liu et al., 2020).”
BackgroundAsanjarani, F., Aneesh Kumar, P., & Kalani, S. (2022) · Child Indicators Research · doi:10.1007/s12187-022-09963-z · Cited by 32
Chen, C., Sun, Y., Liu, B., Zhang, X., & Song, Y. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192316031 · Cited by 20
“For example, parents’ divorce was found to predict children’s suicidal behaviors in rural China [24].”
BackgroundYaqoob, S., Ishaq, M. I., Mushtaq, M., & Raza, A. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.889913 · Cited by 29
“, 2017; Tariq and Ding, 2018), and previous research (Rosso et al., 2010; Liu et al., 2020; Zhang et al., 2020) manifested only a few studies exploring the role of the family as a source of meaning in one’s work.”
BackgroundYoung Adult Mental Health Beyond the COVID-19 Era: Can Enlightened Policy Promote Long-Term Change?
Gruber, J., Hinshaw, S. P., Clark, L. A., Rottenberg, J. A., & Prinstein, M. J. (2023) · Policy Insights from the Behavioral and Brain Sciences · doi:10.1177/23727322221150199 · Cited by 24
“The COVID-19 pandemic has been a watershed event in history, leading to severe social and economic dislocations, chronic uncertainty, social isolation, and disruptions of daily routines, particularly for young people and their families (Gruber et al., 2021; Lee et al., 2020; Liu et al., 2020).”
BackgroundAnxiety and depression in relation to news about COVID-19: A study in general Paraguayan population
Torales, J. C., Barrios, I., Ayala, N., O’Higgins, M. G., Palacios, J. M., Ríos-González, C. M., García, Ó., Ruíz-Díaz, N., González, I., Navarro, R. E., et al. (2021) · Revista de salud publica del Paraguay · doi:10.18004/rspp.2021.junio.67 · Cited by 22
Cerecero-García, D., Vermandere, H., Bojórquez, I., Gómez-Castro, J., Sánchez-Ochoa, J. A., Martínez-Dávalos, A., Huerta-Icelo, I., & Bautista-Arredondo, S. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.598921 · Cited by 19
Kim, H. J., Meeker, T. J., Tulloch, I. K., Mullins, R. J., Park, J., & Bae, S. H. (2022) · International Journal of Public Health · doi:10.3389/ijph.2022.1604552 · Cited by 20
“8% of prevalence of PTSS indicative of likely PTSD among young adults [11].”
BackgroundResultMcLeish, A. C., Walker, K. L., & Hart, J. L. (2022) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-022-09990-8 · Cited by 20
“These findings suggest that increases in anxiety and depression that were seen in the first few months of the pandemic (Fu et al., 2021; Liu et al., 2020; Rodriguez-Hidalgo et al., 2020) have been maintained over the course of the pandemic’s first year.”
BackgroundSchiff, M., Pat‐Horenczyk, R., & Benbenishty, R. (2025) · Journal of American College Health · doi:10.1080/07448481.2024.2447854 · Cited by 21
“Congruent with a study conducted among college students in the United States, 40 the current study results pointed to the strong associations between COVID-19-specific stressors 15,41 and students’ anxiety and depression.”
Peritraumatic Distress during the COVID-19 Pandemic in Seoul, South Korea
Yoon, H., You, M., & Shon, C. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18094689 · Cited by 18
Psychiatric comorbidities among COVID-19 survivors in North India: A cross-sectional study
Dar, S. A., Dar, M., Sheikh, S., Haq, I., Azad, A. M.-U.-D., Mushtaq, M., Shah, N. N., & Wani, Z. A. (2021) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_119_21 · Cited by 21
Min, S., Jeong, Y. H., Kim, J., Koo, J. W., & Ahn, Y. M. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.671722 · Cited by 22
“During the Spanish flu in 1918, the birth cohorts in utero displayed reduced educational attainment, increased rates of physical disability, lower income, and lower socioeconomic status in the USA (65).”
BackgroundInfluential
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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