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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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Self-citationImpact of COVID-19 pandemic on mental health across different populations
MUKHERJEE, K., BANIK, S., & CHAKRABORTY, N. (2021) · Minerva Psychiatry · doi:10.23736/s2724-6612.21.02172-2 · Cited by 5
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“Considering as a traumatic experience, the COVID-19 pandemic had the potential to generate pervasive mental health outcomes, particularly PTSD symptoms (Forte et al., 2020; C. H. Liu et al., 2020; Ochnik et al., 2021; Shek et al., 2021; Tang et al., 2020).”
Janson, M. A., Felix, E. D., Jaramillo, N., Sharkey, J. D., & Barnett, M. L. (2024) · Behavioral Sciences · doi:10.3390/bs14090787 · Cited by 4
“Prospective longitudinal studies observed significant increases in MH symptom severity (e.g., anxiety, depression) from pre-pandemic time points to the spring of 2020 (during-pandemic) among adolescents and young adults [50,52].”
BackgroundGoodwin, J., Hawkins, A., Naughton, C., Donovan, A. O., Connolly, A., Hurley, E. J., & Behan, L. (2025) · International Journal of Community Well-Being · doi:10.1007/s42413-025-00249-0 · Cited by 8
“Following the initial months of COVID-19-related lockdown, Liu et al. (2020) reported low levels of resilience (72%), low distress tolerance (74%), and high levels of depression and anxiety in those aged 18–24 years.”
Chen, W., Dai, X., Chu, X., Jiang, X., Qi, G., Zhao, S., Zhou, Y., & Shi, X. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.09.024 · Cited by 4
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“(2020) identified factors associated with depression, anxiety, and PTSD symptomatology during the COVID-19 pandemic, people reporting high levels of depression, anxiety and PTSD symptoms, and high levels of loneliness [45].”
BackgroundInfluentialPechangou, S. N., Fondjou, C. M., Mandou, C. N., Kumar, S., Emmanuel, M. N., Njayou, F. N., Sehgal, R., & Moundipa, P. F. (2023) · American Journal of Plant Sciences · doi:10.4236/ajps.2023.143023 · Cited by 4
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“Additionally, many studies have explored the experience of PTSD among varying populations, noting an increase in the phenomenon as a result of Covid-19 (e.g. Blekas et al., 2020; Cao et al., 2022; Di Crosta et al., 2020; Liu et al., 2020; Tang et al., 2020; see Grant et al., 2022 for a review).”
Costa-López, B., Ruiz‐Robledillo, N., Moreno, O., Tirado, C., Albaladejo-Blázquez, N., & Ferrer‐Cascales, R. (2025) · Current Psychology · doi:10.1007/s12144-025-07459-x · Cited by 4
“Depression increasing the risk of negative prefrontal symptoms is extensive in the literature (Cuerda-Ballester et al., 2023; Liu et al., 2020; Pizzagalli & Roberts, 2022; Stuijfzand et al., 2020).”
InfluentialShazley, O., Wiciak, M. T., & Santhosh, D. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1521395 · Cited by 4
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“Studies on disasters reveal that resource loss heightens mental health risks, but instrumental support can mitigate distress, especially in the immediate aftermath of traumatic events [36,42].”
InfluentialArmon, D. B., Fine, N. B., Seligman, Z., Ginzburg, K., & Ben‐Zion, Z. (2021) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2021.100252 · Cited by 4
“There is emerging evidence of the detrimental mental health consequences for healthy populations, leading to higher rates of depression and anxiety (Liu et al., 2020).”
Origlio, J., & Stough, C. C. O. (2022) · Journal of American College Health · doi:10.1080/07448481.2022.2047699 · Cited by 4
“19 Further research shows impairments to sleep quality in addition to the increased presence of depressive symptoms, specifically for people under 35 years of age.”
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Peng, S., Luo, X.-H., Liang, S., Deng, F., Liu, Y., Zeng, H., & Yang, X. (2022) · International Journal of Mental Health Promotion · doi:10.32604/ijmhp.2022.020556 · Cited by 4
Nearchou, F. (2022) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-022-00511-z · Cited by 4
“Personal competence and support from family as factors that promote resilience, have been associated with lower levels of depression, anxiety and PTSD symptoms in emerging adults during the course of the COVID-19 pandemic (Liu et al., 2020; Noh & Park, 2022).”
BackgroundResultInfluentialTang, Y.-M., Wu, T.-L., & Liu, H.-T. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20021097 · Cited by 4
“COVID-19 has become a global stressor because it is difficult to predict and control [5].”
InfluentialBlumenthal, A. (2023) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2023.106060 · Cited by 5
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The “Comfort Zoom”: Preservice Teachers’ (PTs’) Perceptions on Distance Learning During the Pandemic
Nissim, Y., & Simon, E. (2023) · International Journal of Instruction · doi:10.29333/iji.2024.17132a · Cited by 4
Holm, M. E., Skogberg, N., Kiviruusu, O. H., & Sainio, P. (2024) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2023.12.006 · Cited by 4
The Covid-19 resilience journey of vulnerable young South Africans
Fouché, A., Cockcroft, K., & Theron, L. C. (2024) · Current Psychology · doi:10.1007/s12144-024-06018-0 · Cited by 4
“Indeed, studies elsewhere (e.g., with young (Americans; Liu et al., 2020) have reported pronounced protective value for family support compared with friends during COVID-19-challenged times.”
Prevalence and risk factors of PTSD symptoms: a 3-month follow-up study
Shang, Z., Pan, X., Cheng, S., Yang, Y., Yan, W., Sun, L., Huang, H., Bai, Y., Xie, W.-F., & Xu, S. (2024) · Therapeutic Advances in Psychopharmacology · doi:10.1177/20451253241298816 · Cited by 5
Li, J., Wilczyńska, D. M., Lipowska, M., Łada‐Maśko, A., Radtke, B. M., Sajewicz‐Radtke, U., Izydorczyk, B., Liu, T., Wang, Z., Lu, J., et al. (2024) · Nutrients · doi:10.3390/nu17010041 · Cited by 4
Differential Effects of Pandemic-Related Stressors on Mental Health by Age and Sex
Borja, J. B., & Patten, S. B. (2025) · Healthcare · doi:10.3390/healthcare13030224 · Cited by 5
Foláyan, M. O., Zúñiga, R. A. A., Aly, N. M., Ellakany, P., Ezechi, O., Gaffar, B. O., Ibigbami, O. I., Idigbe, I. E., Ishabiyi, A. O., Khader, Y. S., et al. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1550719 · Cited by 4
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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