Cited by 1,157COVID-19 and Mental HealthMaternal Mental Health During Pregnancy and PostpartumAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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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

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Liu, Cindy H., Zhang, Emily, Wong, Ga Tin Fifi, Hyun, Sunah, Hahm, Hyeouk “Chris”·2020·Psychiatry Research

DOI 10.1016/j.psychres.2020.113172PMC PMC7263263

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Abstract

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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Enhancing Sharing Capabilities
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Result
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Influential
Construing the COVID-19 Pandemic in the UK: A Qualitative Study
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Method
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Martínez-Seda, G. M., Vélez‐Pastrana, M. C., & Nicasio, A. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph21121564 · Cited by 3
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“Emotional support, which provides a sense of safety and security in stressful situations, influences coping strategies and contributes to an individual’s well-being [41,42], is mainly significant, and promotes lower levels of stress [43] and depression [13,44,45].”
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Huang, J., Chen, N., Cai, Y., Yin, J., & Zhou, X. (2022) · PsyCh Journal · doi:10.1002/pchj.575 · Cited by 4
“, 2020) that has caused substantial mental health problems such as depression, anxiety, and posttraumatic stress disorder symptoms (PTSS; Liu et al., 2020; Xiang et al., 2020; Zhen et al., 2021).”
Background
Posttraumatic Stress Disorder among Secondary School Students during the COVID-19 Lockdown in Enugu
Aronu, A. E., Chinawa, A. T., Ossai, E. N., Chinawa, J. M., Odinka, P. C., Odinka, J. I., & Onukwuli, V. O. (2022) · Nigerian Journal of Medicine · doi:10.4103/njm.njm_163_21 · Cited by 3
The Association between Change in Lifestyle Behaviors and Mental Health Indicators in Immunosuppressed Individuals during the COVID-19 Pandemic
Zeitoun, T., Plante, A., Sabiston, C. M., Dieudé, M., & Doré, I. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20032099 · Cited by 3
“Though it has been observed that overall resilience was lower amongst adults in the USA during the COVID-19 pandemic [66,67], our results suggested that resilience was not significantly associated with lifestyle changes.”
Motivation, co-creation, mental well-being and cross-cultural differences: the case of thalassotherapy in Turkey
Yurcu, G., YUNCU, E. N., & Akıncı, Z. (2023) · Journal of Tourism and Cultural Change · doi:10.1080/14766825.2023.2170238 · Cited by 3
Comparing the effects of reduced social contact on psychosocial wellbeing before and during the COVID-19 pandemic: a longitudinal survey from two Norwegian counties
Kalseth, J., Ådnanes, M., Ose, S. O., Lassemo, E. I., Kaspersen, S. L., & das Nair, R. (2023) · Quality of Life Research · doi:10.1007/s11136-023-03350-z · Cited by 3
Impact of the COVID‐19 pandemic on students with relatives with addiction problems: A longitudinal qualitative study
van Namen, D. M., Hilberink, S. R., de Vries, H., Nagelhout, G. E., & van Staa, A. (2023) · Stress and Health · doi:10.1002/smi.3251 · Cited by 3
Recalling Self-efficacious Memories Reduces COVID-19-Related Fear
Bakke, S. L., Winer, E. S., & Brown, A. D. (2023) · Cognitive Therapy and Research · doi:10.1007/s10608-023-10377-6 · Cited by 3
The moderating role of mental health on the association between COVID-related stress, isolation, and economic hardship and using substances to cope
Arterberry, B. J., Parks, M. J., & Patrick, M. E. (2023) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2023.102229 · Cited by 4
“Studies indicate young adults are at risk of depression, anxiety, and stress related to the pandemic (Liu et al., 2020; Mehus et al., 2021), possibly due to perceived loss of education/employment opportunities, greater loneliness, or greater economic hardship (Ganson et al.”
COVID-19 Impacts on Mexican American College Student Experiences in the Rio Grande Valley of South Texas
Flores, R., & Pedota, J. (2023) · JCSCORE · doi:10.15763/issn.2642-2387.2023.9.1.64-90 · Cited by 3
“Despite an overall increase in uncertainty and stress for college student populations, some researchers found that students from different ethnic and racial groups fared better in managing stress caused by the pandemic when compared to non-minoritized students (Bono et al., 2020; Liu et al., 2020).”
Background
Prevalence of and factors associated with depression, anxiety and stress among adolescents in Bangladesh during the COVID-19 pandemic: A population-based study
Haque, M. A., Anjum, A., Mousum, S., Salwa, M., Ratan, Z. A., Khan, M. M. H., Islam, M. T., Ahmed, H. U., Amin, M. R., & Mamun, M. A. A. (2023) · F1000Research · doi:10.12688/f1000research.132304.1 · Cited by 3
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COVID-19 pandemic among adults with intellectual disabilities: Implementing a social model of disability in crisis and trauma situations
Gouzman, J., Soskolne, V., & Dekel, R. (2023) · Journal of Intellectual Disabilities · doi:10.1177/17446295231196207 · Cited by 3
“Prevalence rates ranging from 7% to 53.8% in the general population in several countries (Xiong et al., 2020), and relatively high PTSD symptomatology has been found worldwide in young adults (Liu et al., 2020)”
BackgroundInfluential
Distance Learning Barriers and Bottlenecks: A Phenomenological Inquiry on the Conduct of English Language Arts (ELA) Standard Assessments
Garbo, J. M., Lopres, J. R., Novenario, M. P., Esternon, C. E. G., Pilapil, G. M. P., Gomez, B. L., Silva, M. F. B., & Anjao, A. R. M. (2023) · International Journal of Learning Teaching and Educational Research · doi:10.26803/ijlter.22.8.3 · Cited by 3
The Influence of Multiple Community Level Traumatic Event Types on Mental Health Outcomes
Grey, I. M., Makki, Z., Kahale, C., Abi‐Habib, R., & Tohme, P. (2023) · Psychological Reports · doi:10.1177/00332941231204796 · Cited by 4
“Additional research has also indicated high rates of PTSD amongst various populations with rates reported of up to 33% during the COVID-19 pandemic (Liu et al., 2020; Rosen et al., 2020).”
Influential
Association between social networks and symptoms of post-traumatic stress during the pandemic: Cohort study in South Korea
Yang, J. S., Lee, Y. J., Kim, H. C., Cho, C., Tsai, A. C., & Jung, S. J. (2023) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2023.152432 · Cited by 3
Better alignment between circadian preference and sleep and work timings during COVID-19 did not benefit work engagement at home
Crowley, R., Javadi, A., & Tamminen, J. (2023) · Chronobiology International · doi:10.1080/07420528.2023.2258954 · Cited by 3
“This suggestion is particularly plausible in light of evidence that young adult students were at high risk of poor mental health during COVID-19 (Holmes et al. 2020; Liu et al. 2020) and young adult students had the greatest improvements in social jetlag and delays in work times here.”
Background
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Goldstein, A. L., Katz, J. L., Shifrin, A., Hamza, C. A., Molnar, D. S., & Scharfe, E. (2023) · Journal of Youth Studies · doi:10.1080/13676261.2023.2277760 · Cited by 3
“EAs were more likely to report higher levels of stress, anxiety, depressive and PTSD symptoms (Cao et al. 2020; Huang and Zhao 2020; Liu et al. 2020; Ozamiz-Etxebarria et al. 2020; Wang et al. 2020) as well as a greater challenges to their psychological health (Wang et al. 2020b), which was partly…”
Perceived Social Support As a Predictor of Personal Growth Initiative in Adolescents
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Polysomnography and Neuropsychological Analysis of Patients With Post-Traumatic Stress Disorder Two Years After the COVID-19 Pandemic in Wuhan
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Dynamic interplay among emotional support, social interaction, COVID-19 news exposure and anxiety symptoms in emerging adults during the early COVID-19 pandemic
Zhang, Y., & Ma, Z. (2025) · Anxiety Stress & Coping · doi:10.1080/10615806.2025.2512922 · Cited by 3
“However, studies on the relation between emotional support and anxiety in emerging adults during COVID-19 has been cross-sectional (e.g., Liu et al., 2020; Mecha et al., 2023), limiting the ability to establish directionality.”
Experiences of student and trainee autism researchers during the COVID ‐19 pandemic
Kaku, S. M., McVey, A. J., Gerber, A. S., Pretzsch, C. M., Jones, D. R., Kodakkadan, F., Lei, J., Singer, L., Chitehwe, L., Poulsen, R. E., et al. (2021) · Autism Research · doi:10.1002/aur.2662 · Cited by 3
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Rajčáni, J., Vytykačová, S., Šuhajdová, B., & Botíková, V. (2022) · Ceskoslovenska psychologie · doi:10.51561/cspsych.66.1.17 · Cited by 3
The impact of the COVID-19 pandemic on the development of anxiety disorders - a literature review
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Earlier Bedtime and Effective Coping Skills Predict a Return to Low-Risk of Depression in Young Adults during the COVID-19 Pandemic
Zhao, Q., Wang, K., Kiss, O., Yüksel, D., de Zambotti, M., Clark, D. B., Goldston, D. B., Nooner, K. B., Brown, S. A., Tapert, S. F., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191610300 · Cited by 5
“For the older individuals in the sample (mid to late twenties), adaptive coping skills were associated with returning to low-risk of depression, confirming the influence of effective coping strategies for staving off depression [47,48] and recovery of psychopathology [23,24] during crises [29,49].”
Background
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COVID-19 impacts and videoconference healthcare preferences in relation to depression and sexual risk behaviors among young adults assigned female at birth: a cross-sectional study
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Gu, W., Liu, X., Sun, R., Jiang, Y., Cao, Z., Wu, M., Ma, J., Chen, Z., Chen, Y., Zhang, Y., et al. (2021) · Frontiers in Medicine · doi:10.3389/fmed.2021.740064 · Cited by 3
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Fındık, O. T. P., Çeri, V., & Fiş, N. P. (2022) · Marmara medical journal · doi:10.5472/marumj.1121368 · Cited by 2
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Theron, L. C., Levine, D. T., & Ungar, M. T. (2022) · South African Journal of Science · doi:10.17159/sajs.2022/13173 · Cited by 4
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“The coronavirus disease 2019 (COVID-19) pandemic threatened people's physical health and also impacted their mental health (Cenat et al., 2021; Liu et al., 2020).”
Background
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de Moor, E. L., Cheng, T.-Y., Spitzer, J. E., Berger, C., Carrizales, A., Garandeau, C. F., Gerbino, M., Hawk, S. T., Kaniušonytė, G., Kumru, A., et al. (2022) · PLoS ONE · doi:10.1371/journal.pone.0279366 · Cited by 3
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Sharma, V., & Bhat, D. A. R. (2023) · Springer eBooks · doi:10.1007/978-3-031-22257-3_16 · Cited by 3
Factors associated with the mental health of adolescent university students during COVID-19 quarantine in JapanPreprint
Hirano, Y., Aramaki, K., & Ota, S. (2020) · doi:10.21203/rs.3.rs-76169/v1 · Cited by 3
“Conversely, social support from family and partners is negatively associated with depression [10].”
Background
The Mental Health of Latinx Adults in the United States During the Coronavirus Pandemic: A Snapshot of Anxiety, Depression, and Posttraumatic Stress SymptomsPreprint
Villalobos, B. T., & Rodríguez, J. H. (2021) · PsyArXiv (OSF Preprints) · doi:10.31234/osf.io/uq5y2 · Cited by 5
“This procedure was similarly done in other studies that have used the PCL-5 in pandemic-related research (e.g., N. Liu et al., 2020).”
MethodResultInfluential
THEMIS: A Framework for Cost-Benefit Analysis of COVID-19 Non-Pharmaceutical InterventionsPreprint
Bertsimas, D., Li, M. L., & Saksham, S. (2022) · medRxiv · doi:10.1101/2022.04.09.22273656 · Cited by 3
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“Studies showed both an increased prevalence of mental health issues among emerging adults during the COVID-19 pandemic (Juvonen et al., 2022; Liu et al., 2020; Sun et al., 2020) and increased mental health issues compared to older age groups (Pierce et al., 2020), as well as a rise in negative…”
BackgroundInfluential
Daily implementation of health‐protective behaviors and family life during the early months of the COVID ‐19 pandemic
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Background
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Park, S. M., Joo, H., & Rodriguez, B. (2024) · Journal of American College Health · doi:10.1080/07448481.2024.2409700 · Cited by 3
“33,52,53 It is possible that Asian and Asian American college students felt anxious and depressed when they did not feel safe on campus during the pandemic, which in turn led to feeling a lack of companionship, left out, or isolated from others.”
Finding Strength Amidst the Crisis: Student Parent Experiences during the COVID-19 Pandemic
Zeanah, P. D., Lin, H., Bergeron, M. A., Ackel, K., Olivier, D. F., Rholdon, R. D., & Templet, T. A. (2025) · Journal of Child and Family Studies · doi:10.1007/s10826-024-02994-w · Cited by 2
“College students experienced dif ﬁ culties including heightened stress, anxiety, mood problems, and detrimental effects on learning (Hu et al., 2022; Liu et al., 2020; Son et al., 2020; Wang et al., 2020), worries about loss of jobs, completing studies, post-graduate employment, and negative impacts on social activiti…”
Influential

Authors: Liu, C. H., Zhang, E., Wong, G. T. F., Hyun, S., & Hahm, H. “.
Affiliations: Boston University (US)
Corresponding author: Liu, Cindy H.
ORCID: Liu, Cindy H.
Hyun, Sunah
Hahm, Hyeouk “Chris”
Venue: Psychiatry Research
Publisher: Elsevier BV
Published: 2020-08
Volume: 290
Pages: 113172
ISSN: 0165-1781 (ISSN-L)
DOI: 10.1016/j.psychres.2020.113172
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: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (am, 308 d)
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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Factors associated with depression, anxiety, and PTSD symptomatology during the COVID-19 pandemic: Clinical implications for U.S. young adult mental health

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