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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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Gottlieb, L. Y., & Schmitt, D. P. (2022) · Archives of Sexual Behavior · doi:10.1007/s10508-022-02457-7 · Cited by 13
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Nola, M., Guiot, C., Damiani, S., Brondino, N., Milani, R., & Politi, P. (2021) · Current Psychology · doi:10.1007/s12144-021-02076-w · Cited by 15
Liu, Y., Xie, Y., Li, W., He, X., He, H. G., Chen, L., & Shen, Q. (2022) · Medicina · doi:10.3390/medicina58121704 · Cited by 11
Villatoro, A. P., Errisuriz, V. L., & DuPont‐Reyes, M. J. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20126066 · Cited by 13
Domènech-Abella, J., Gabarrell-Pascuet, A., García-Mieres, H., Mortier, P., Felez-Nobrega, M., Cristóbal-Narváez, P., Vilagut, G., Olaya, B., Alonso, J., & Haro, J. M. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115327 · Cited by 10
Lewis, K. C., Roche, M. J., Brown, F., & Tillman, J. G. (2022) · Personality and Individual Differences · doi:10.1016/j.paid.2022.111672 · Cited by 10
“While cross-sectional surveys have shown elevations in mood and anxiety symptoms since the start of the pandemic (APA, 2020; Liu et al., 2020; McQuaid et al., 2021; Wang et al., 2020), longitudinal studies have yielded less consistent findings.”
Zeng, Y., Xiao, J., Zhang, Q., Liu, X., & Ai, M. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1218825 · Cited by 10
Gray Matter Thickness and Subcortical Nuclear Volume in Men After SARS-CoV-2 Omicron Infection
Du, Y., Zhao, W., Huang, S., Huang, C., Li, C., Chen, Y., Huang, Y., Yang, L., Li, C., Zhang, H., et al. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.45626 · Cited by 11
Bató, A., Brodszky, V., & Rencz, F. (2025) · Health and Quality of Life Outcomes · doi:10.1186/s12955-025-02343-5 · Cited by 12
“Given that our sample was collected during the COVID-19 pandemic, it is also possible that stress resulting from disruptions to social life and daily activities contributed to the poorer mental health outcomes observed [57, 58].”
Schleihauf, E., & Bowes, M. (2021) · Health Promotion and Chronic Disease Prevention in Canada · doi:10.24095/hpcdp.42.2.02 · Cited by 10
Shanahan, M. L., Fischer, I. C., Rogers, S. K., & Rand, K. L. (2022) · Journal of American College Health · doi:10.1080/07448481.2022.2039670 · Cited by 11
Risk and resilience in couple’s adjustment to the COVID-19 pandemic
Xiang, E., Zhang, X., Raza, S. A., Oluyomi, A., Amos, C. I., & Badr, H. (2022) · Journal of Social and Personal Relationships · doi:10.1177/02654075221094556 · Cited by 11
“…of mental health responses ranging in severity from feelings of low mood/worry to clinically significant levels of depression and anxiety (Barzilay et al., 2020; Every-Palmer et al., 2020; Fitzpatrick et al., 2020; Liu et al., 2020;Moccia et al., 2020; Pearman et al., 2020; Wang et al., 2020).”
BackgroundKluwe‐Schiavon, B., Zorzi, L. D., Meireles, J., Leite, J., Sequeira, H., & Carvalho, S. (2022) · PLoS ONE · doi:10.1371/journal.pone.0269496 · Cited by 10
A longitudinal investigation of resilience as a protective factor during the COVID-19 pandemic.
Cusack, S. E., Bountress, K. E., Denckla, C. A., The Spit for Science Working Group, Vassileva, J., Dick, D. M., & Amstadter, A. B. (2022) · Traumatology An International Journal · doi:10.1037/trm0000397 · Cited by 10
Denche-Zamorano, Á. M., Pastor-Cisneros, R., Carlos‐Vivas, J., Franco-García, J. M., Pereira-Payo, D., My works are correct, B. M. I. A. A. I. S. R. L. M. T. I. D. A.-M., Rojo-Ramos, J., & Mendoza-Muñoz, M. (2022) · Healthcare · doi:10.3390/healthcare10091620 · Cited by 12
I hate you when I am anxious: Anxiety during the COVID‐19 epidemic and ideological hostility
Balmas, M., Harel, T. O., & Halperin, E. (2022) · Journal of Applied Social Psychology · doi:10.1111/jasp.12914 · Cited by 11
“(Liu et al., 2020).”
MethodImpact of COVID-19 on Sexual and Gender Minority Communities: Focus Group Discussions
Pharr, J. R., Terry, E., Wade, A., Haboush-Deloye, A. L., Marquez, E., & Coalition, N. M. H. A. E. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20010050 · Cited by 10
A confirmatory factor analysis of a cognitive model of COVID-19 related anxiety and depression
Delz, L. A. K., Gaynor, K., O'Connor, R., Schmieder, L., & Somers, E. (2023) · Acta Psychologica · doi:10.1016/j.actpsy.2023.103861 · Cited by 11
Ryal, J. J., Perli, V. A. S., Marques, D. C. D. S., Sordi, A. F., Marques, M. G. D. S., Camilo, M. L. A., Milani, R. G., Mota, J. A. P. S., Valdés-Badilla, P. A., & Branco, B. H. M. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20054132 · Cited by 16
“Social isolation, the COVID-19 pandemic, low social support, low family income, and other aspects directly influenced the population’s mental health [5,34,35].”
BackgroundPan, W., Zhou, W., Wu, J., Huang, Z., Ding, L.-J., Guo, L., Hang, B., & Li, X. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.05.062 · Cited by 11
“Indeed, it has been shown that people reported more PTSD symptoms during the pandemic than before (Liu et al., 2020; Luo et al., 2020; Nagarajan et al., 2022).”
Covid-19 Demographics from a Tertiary Care Center: Does It Depreciate Quality-of-Life?
Revathishree, K., Sudarsan, S. S., Indu, R., & Srinivasan, K. (2020) · Indian Journal of Otolaryngology and Head & Neck Surgery · doi:10.1007/s12070-020-02144-w · Cited by 10
“Other studies [23, 24] did not reveal any such categorization or clinical scoring.”
BackgroundYoung adults’ experiences with loss and grief during COVID-19
Weaver, R. H., Srinivasan, E., Decker, A., & Bolkan, C. R. (2021) · Death Studies · doi:10.1080/07481187.2021.1984339 · Cited by 10
“Young adults reported higher levels of depression, anxiety, and post-traumatic stress disorder symptoms compared to pre-pandemic levels (Liu et al., 2020; Weaver et al., in press); these mental health concerns were further exacerbated by job insecurity (Ganson, 2021) and increased loneliness (Lee…”
BackgroundWarren, A. M., Bennett, M., Danesh, V. C., Waddimba, A. C., Tovar, M., Gottlieb, R., & Powers, M. B. (2021) · Psychiatry Research Communications · doi:10.1016/j.psycom.2021.100005 · Cited by 10
Messman, B., Rafiuddin, H. S., Slavish, D. C., Weiss, N. H., & Contractor, A. A. (2021) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0001170 · Cited by 12
Keng, S., & Hwang, E. Z. N. (2022) · Behaviour Change · doi:10.1017/bec.2022.2 · Cited by 10
The Societal Impacts of Covid-19: A Transnational Perspective
Bozkurt, V., Dawes, G. D., Gülerce, H., & Westenbroek, P. (2021) · Istanbul University Press eBooks · doi:10.26650/b/ss49.2021.006 · Cited by 19
Yassin, A., Al-Mistarehi, A.-H. W., Soudah, O., Karasneh, R. A., Al-Azzam, S. I., Qarqash, A., Khasawneh, A. G., Al‐Hayk, K., Qawasmeh, M. A., Kofahi, R. M., et al. (2022) · Clinical Practice and Epidemiology in Mental Health · doi:10.2174/17450179-v18-e2206160 · Cited by 13
Post-traumatic stress disorder among COVID-19 survivors in Manipur
Rajkumari, B., Akham, N., Ojit, K., Pangambam, A. D., & Ningthoujam, S. D. (2022) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_1474_21 · Cited by 11
Peifer, J. S., & Taasoobshirazi, G. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191811330 · Cited by 13
Gabarrell‐Pascuet, A., Koyanagi, A., Félez-Nóbrega, M., Cristóbal-Narváez, P., Mortier, P., Vilagut, G., Olaya, B., Alonso, J., Haro, J. M., & Domènech‐Abella, J. (2022) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001146 · Cited by 10
Kim, A. W., Mohamed, R. S., Norris, S. A., Naicker, S. N., Richter, L., & Kuzawa, C. W. (2023) · American Journal of Biological Anthropology · doi:10.1002/ajpa.24791 · Cited by 10
“…between COVID-19 psychosocial stress and adult PTSD symptomatology in general populations (Forte et al., 2020; Jefti (cid:2) c et al., 2023; Liu et al., 2020; Olapegba et al., 2022) as well as the growing literature on the mental health impacts of the COVID-19 pandemic (Hunt et al., 2021;…”
Cipolletta, S., Ronconi, L., & Tomaino, S. C. M. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1529795 · Cited by 15
Goral, A., Feder‐Bubis, P., Lahad, M., & Aharonson‐Daniel, L. (2022) · Trauma Care · doi:10.3390/traumacare2020015 · Cited by 9
“Symptoms described in the literature [37,38,40,41] may well be related to fear or worries about the future—the health of family members or financial implications of the situation.”
BackgroundMarshall, A., Hackman, D. A., Kan, E., Abad, S., Baker, F., Baskin-Sommers, A., Dowling, G., Gonzalez, M., Guillaume, M., Kiss, O., et al. (2022) · Health and Place · doi:10.1016/j.healthplace.2022.102885 · Cited by 10
Bluth, K., Knox, M. C., Press, A., & Lathren, C. (2023) · Emerging Adulthood · doi:10.1177/21676968231189902 · Cited by 10
“…this alarming trend, the recent coronavirus (COVID-19) pandemic introduced a context in which emerging adults suffered from the psychological impact of the pandemic due to the disruption to daily life and restrictions on professional and social activities (Killgore et al., 2020; Liu et al., 2020).”
BackgroundThe long-term effects of consecutive COVID-19 waves on mental health
Novotný, J., Gonzalez-Rivas, J. P., Kunzová, Š., Skladaná, M., Pospíšilová, A., Polcrova, A. B., Vassilaki, M. E., Medina‐Inojosa, J. R., López-Jiménez, F. A., Geda, Y. E., et al. (2023) · BJPsych Open · doi:10.1192/bjo.2023.620 · Cited by 12
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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