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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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“Depression [5,6], anxiety [5,6], family violence [7–10] and excessive alcohol and substance use [5,11,12] have increased.”
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“Our findings demonstrate that even in the midst of the global pandemic, psychosocial factors, such as grit and resilience, can serve as protective factors (Liu et al., 2020).”
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BackgroundResultInfluentialImpact of COVID-19 Pandemic on Mental Health and Socioeconomic Aspects in Greece
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“Young people like university students were psychologically burdened even before the pandemic (Patel et al., 2007; Twenge et al., 2019; Xiao et al., 2017) and were especially vulnerable to the impact of the COVID-19 crisis on their mental health (Liu et al., 2020; Xiong et al., 2020).”
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“Similar to other studies (Cao et al., 2020; Chirikov et al., 2020; Liu et al., 2020), participants in our sample indicated high scores in the areas of depression and anxiety symptomatology.”
BackgroundResultNápoles, A. M., Stewart, A. L., Strassle, P. D., Alhomsi, A., Quintero, S. M., Ponce, S. A., Wilkerson, M. J., & Bonilla, J. (2023) · Health Equity · doi:10.1089/heq.2022.0178 · Cited by 16
“Our distress prevalence estimates are similar to prior studies.(3,28) A longitudinal comparison of waves of the Nápoles, et al.”
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Stressful life events and depressive symptoms during COVID‐19: A gender comparison
Qian, Y., & Fan, W. (2023) · British Journal of Sociology · doi:10.1111/1468-4446.13067 · Cited by 15
Access and efficacy of university mental health services during the COVID-19 pandemic
Wagner, B. A., Snoubar, Y., & Mahdi, Y. S. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1269010 · Cited by 15
Carries, S., Sigwadhi, L. N., Moyo, A., Wagner, C., Mathews, C., & Govindasamy, D. (2024) · Adolescents · doi:10.3390/adolescents4010013 · Cited by 15
“While few studies have reported depression outcomes among AGYW in SSA during COVID-19, our estimate is comparable with global estimates [18,37,38].”
BackgroundResultInfluentialRuffini, G., Salvador, R., Castaldo, F., Baleeiro, T., Camprodon, J. A., Chopra, M. P., Cappon, D., & Pascual‐Leone, Á. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1427365 · Cited by 15
Understanding the COVID-19 Pandemic Through the Lens of Population Health Science
Galea, S., & Keyes, K. M. (2020) · American Journal of Epidemiology · doi:10.1093/aje/kwaa142 · Cited by 15
Responding to the pressing yet unrecognized needs of student-parents amid the COVID-19 pandemic
Lin, H., Zeanah, P. D., Olivier, D. F., Bergeron, M. A., & Liu, C. H. (2021) · Journal of American College Health · doi:10.1080/07448481.2020.1870474 · Cited by 15
“Other common psychological symptoms in response to the quarantine may include emotional exhaustion, low mood, nervousness, uncertainty, anxiety, grief, depression, frustration, irritability, anger, and posttraumatic stress.(2,13) The pandemic-related psychological stress student-parents are experiencing can “spill ove…”
BackgroundSelf-citationChen, W., Song, S.-Y., & Yap, K.-H. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.598302 · Cited by 15
Sleep and Resilience during the COVID-19 Pandemic
Cloonan, S., Taylor, E. C., Persich, M. R., Dailey, N. S., & Killgore, W. D. S. (2021) · IntechOpen eBooks · doi:10.5772/intechopen.98298 · Cited by 15
Luo, Y. (2021) · JMIR Aging · doi:10.2196/29953 · Cited by 15
“Using different measures for depression, previous studies have reported high depression levels among US adults during the pandemic [8-11].”
BackgroundResultInfluentialPre-Pandemic Peer Relations Predict Adolescents’ Internalizing Response to Covid-19
Mlawer, F., Moore, C. C., Hubbard, J. A., & Meehan, Z. M. (2021) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-021-00882-1 · Cited by 15
Shen, X., Yan, S., Jiang, H., Cao, H., Dowling, R., Feng, J. B., Lei, Z., Li, C. J., Han, X., Lv, C., et al. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.766127 · Cited by 15
“During the COVID-19 outbreak, researchers in the United States (9), Italy (10), and Spain (11) performed studies on the prevalence of PTSD in the residents of their countries and found that the occurrence of PTSD was significantly related to demographic characteristics, risk perception and other…”
BackgroundEffect of the COVID-19 pandemic on complications and mortality of patients with cardiac surgery
Wang, X., Heng Jun, G. A. O., Zhang, Z., Deng, C., Yang, Y., & Shi, T. (2021) · Journal of Cardiothoracic Surgery · doi:10.1186/s13019-021-01744-z · Cited by 15
Tran, D. D., Fitzke, R. E., Wang, J., Davis, J. P., & Pedersen, E. R. (2022) · Psychological Reports · doi:10.1177/00332941221080413 · Cited by 19
“Reports of increased anxiety and psychological distress during the pandemic have been highlighted (Gallagher et al., 2020; Liu et al., 2020; Rajkumar, 2020).”
BackgroundTang, Q., Wang, Y., Li, J., Luo, D., Hao, X., & Xu, J. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.830334 · Cited by 15
Wang, H., Farokhnia, F., & Sanchuli, N. (2022) · Work · doi:10.3233/wor-220136 · Cited by 15
“WHO intended that HCWs are vulnerable and prone to the onset of psychological repercussions predisposing them to PTSD, depressive symptoms, and burnout syndrome (BOS) during the pandemic [13].”
Alatawi, Y. M., Alshehri, F. S., Alhifany, A. A., Alharbi, A. S., & Alghamdi, B. S. A. (2020) · Risk Management and Healthcare Policy · doi:10.2147/rmhp.s290181 · Cited by 16
“8% of the respondents had PTSD symptoms.(26) Similarly, a study in Italy found that the prevalence of PTSD was 29.”
BackgroundWolf, S., Zeibig, J., Seiffer, B., Welkerling, J., Brokmeier, L. L., Atrott, B., Ehring, T. W., & Schuch, F. B. (2020) · doi:10.21203/rs.3.rs-81150/v1 · Cited by 15
Influence of post-COVID-19 deconfinement on psychiatric visits to the emergency department
Flament, J., Scius, N., Zdanowicz, N., Régnier, M., Cannière, L. D., & Thonon, H. (2021) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2021.05.014 · Cited by 14
“The trends of an increase of visits with younger patients is consistent with other findings around the world showing the fragility of this group possibly related to the social and economic repercussions of isolation [18,19].”
Negrão, L. D., Natacci, L. C., Alfino, M. C. Z., Marchiori, V. F., Oliveti, D. H., Carioca, A. A. F., & Torres, E. A. F. D. S. (2022) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2022.06.017 · Cited by 17
“Social isolation and loneliness are directly associated with stress [54], depression, anxiety, and post-traumatic stress [55].”
Hahm, H. C., Hsu, K. C., Hyun, S., Kane, K., & Liu, C. H. (2022) · Women s Health Issues · doi:10.1016/j.whi.2022.09.002 · Cited by 14
“Items include, “Having enough groceries during city lockdowns/social distancing protocols,” “obtaining a COVID-19 test if I become sick,” “getting treated for COVID-19 if I contract it,” and “keeping in touch with loved ones during social distancing protocols” (Liu et al., 2020a,b).”
Self-citationSun, L., Wang, X., Hong, Y., Li, C., Zeng, W., Liu, P., Xiong, Y., Chen, Y., Lian, Y., & Wang, Y. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1100242 · Cited by 15
“Social support is a multidimensional concept characterized by the emotional, instrumental, and informational support from families, friends and important others (26), which was identified as a protective factor against depression and anxiety during the COVID-19 pandemic (12, 24).”
BackgroundResultNgamasana, E. L., Zarwell, M., & Gunn, L. H. (2023) · BMC Public Health · doi:10.1186/s12889-023-17164-8 · Cited by 14
Cannabis use among adolescents and young adults during the COVID-19 pandemic: A systematic review
Tang, Y., Kirk, B., Olanrewaju, F. S., Abildso, C. G., Winstanley, E. L., Lilly, C. L., & Rudisill, T. M. (2024) · Drug and Alcohol Dependence Reports · doi:10.1016/j.dadr.2024.100232 · Cited by 13
“…on daily activities may be associated with a rising prevalence of depression (Ettman et al., 2020; McGinty et al., 2020), anxiety (Holingue et al., 2020), loneliness (Kill-gore et al., 2020; Liu et al., 2020), and alcohol use (Barbosa et al., 2021; Nordeck et al., 2022; Pollard et al., 2020).”
BackgroundSujadi, E., Fadhli, M., Meditamar, M. O., Kamil, D., Jamin, A., Yandri, H., & Indra, S. (2021) · International Journal of Public Health Science (IJPHS) · doi:10.11591/ijphs.v10i1.20633 · Cited by 12
“This pandemic affects the psychological aspects of college students [12], teachers and students [13], presents a major mental health challenge to older adults [14], young adult [15], and internal migrant worker [16].”
BackgroundMegías‐Robles, A., Gutiérrez‐Cobo, M. J., Cabello, R., Gómez‐Leal, R., & Fernández‐Berrocal, P. (2021) · Journal of Health Psychology · doi:10.1177/1359105321990794 · Cited by 13
Islam, M. R., Sultana, S., Khan, A. H., Hossain, S., Sikder, M. T., Hasan, M. T., & Li, Z. (2021) · Heliyon · doi:10.1016/j.heliyon.2021.e07395 · Cited by 15
Impact of COVID-19 Campus Closure on Undergraduates
Telli, O., Mountcastle, L., Jehl, B. L., Osorio, A. M., Dahlquist, L. M., Jayasekera, A., Dougherty, A., Castillo, R., & Miner, K. (2021) · Teaching of Psychology · doi:10.1177/00986283211043924 · Cited by 16
“In a study of 898 18- to 30-year-old adults in the general public in the United States, 43% reported clinically elevated levels of depression, with 45% and 31% of participants reporting clinically elevated levels of anxiety and PTSD symptoms, respectively (Liu et al., 2020).”
BackgroundResultZhang, Y., Zhao, J., Xi, J., Fan, B., Wang, Q., Yao, Z.-Y., Huang, T., & Bai, H. (2021) · Healthcare · doi:10.3390/healthcare9101383 · Cited by 14
“However, there are few cross-sectional studies on PTSD under the influence of the pandemic [9].”
BackgroundResultLei, L., Zhu, H., Li, Y., Dai, T., Zhao, S., Zhang, X., Muchu, X., & Su, S. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03527-1 · Cited by 17
Plenty, S. M., Bracegirdle, C., Dollmann, J., & Spiegler, O. (2021) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-021-00418-x · Cited by 17
“As each of these risk factors are associated with poorer mental health (e.g., depression, anxiety, stress, PTSD) [8, 28, 29, 40], greater declines in mental well-being among young adults from ethnic minorities compared to the ethnic majority could be expected.”
BackgroundMetin, B., Somer, E., Abu‐Rayya, H. M., Schimmenti, A., & göçmen, B. S. (2021) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-021-00678-w · Cited by 14
“…condition (Wathelet et al., 2020), (5) previous exposure to depressive episodes (Holingue et al., 2020), and finally, (6) introversion and emotional instability personality traits, which elevate individuals’ vulnerability to threat during the pandemic (Preti et al., 2020; Liu et al., 2020).”
Liu, C. H., Wong, G. T. F., Hyun, S., & Hahm, H. C. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2022.01.048 · Cited by 15
Self-citationGründahl, M., Weiss, M. H., Maier, L. A., Hewig, J. S., Deckert, J., & Hein, G. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.798596 · Cited by 15
“In the context of social distancing, increases in loneliness seem inevitable, and previous work has already highlighted the relevance of measuring loneliness and isolation in the context of social distancing for the protection and enhancement of wellbeing and mental health (65, 131).”
BackgroundResultYoung Adults’ Loneliness and Depression During the COVID-19 Pandemic: A Moderated Mediation Model
Lv, F., Yu, M., Li, J., Tan, J., Ye, Z., Xiao, M., Zhu, Y., Guo, S., Liu, Y., & Gao, D. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.842738 · Cited by 14
“Overall, our findings broaden our understanding of loneliness and depression (Cindy et al., 2020; Palgi et al., 2020; Rossi et al., 2020; Groarke et al., 2021) and contribute toward research that links depression with resilience (Zhao et al.”
BackgroundResultInfluentialKarbasi, Z., & Eslami, P. (2022) · Middle East Current Psychiatry · doi:10.1186/s43045-022-00240-x · Cited by 15
Wu, J., & Liu, Q. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115058 · Cited by 16
“Due to the demands of entertainment and productivity during the period of home-quarantine, people spent more time using smartphones to connect with the world (Liu, 2020).”
BackgroundZhu, K., Wang, S., Yue, Y., Smith, B. A., Zhang, Z., Freudenheim, J. L., Niu, Z., Zhang, J., Smith, E., Ye, J., et al. (2023) · Scientific Reports · doi:10.1038/s41598-023-35981-0 · Cited by 17
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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