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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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Duran, İ., & Altundağ, E. (2024) · Herkes için Spor ve Rekreasyon Dergisi · doi:10.56639/jsar.1541567 · Cited by 1
Zapata, J. P., Tomas, C. W., Timmer‐Murillo, S. C., deRoon‐Cassini, T. A., Larson, C., Torres, L., Brandolino, A. M., Geier, T. J., Khan, H., & Schramm, A. T. (2024) · Stress and Health · doi:10.1002/smi.3513 · Cited by 1
“Previous research has shown that feeling isolated post-injury may lead one to feel pessimistic about one's recovery altogether, producing negative mood states and arousal (Liu et al. 2020).”
Fields, C., Rawn, K. P., & Keller, P. S. (2025) · Journal of American College Health · doi:10.1080/07448481.2024.2446438 · Cited by 1
Paw, N. L., Htike, K. M., Nawawonganun, R., & Mahato, R. K. (2025) · Mental Health & Prevention · doi:10.1016/j.mhp.2025.200409 · Cited by 2
Chandra, S., Amer, A., Shih, C.-H., Shao, Q., Wang, X., & Xie, H. (2025) · Journal of Personalized Medicine · doi:10.3390/jpm15040127 · Cited by 1
“Significant pandemic-related increases in depression, anxiety, and posttraumatic stress disorder (PTSD) in diverse populations, e.g., healthcare workers, young adults, and others, have been attributed to pandemic-related stress [3,4].”
Keskin, G., Gümüşsoy, S., & Gümüş, A. B. (2025) · International Emergency Nursing · doi:10.1016/j.ienj.2025.101646 · Cited by 1
Senger, A. R., Jo, D., Zvolensky, M. J., & Gallagher, M. W. (2025) · Cognitive Therapy and Research · doi:10.1007/s10608-025-10644-8 · Cited by 1
“During this time, individuals were faced with numerous stressors, many of which were outside of their control, such as supply shortages and the uncertainty surrounding the virus (Liu et al., 2020; Sauer et al., 2020).”
Li, Z., Zhang, X., & Ren, Y. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07274-5 · Cited by 1
Kuwata, H., Ookoshi, K., Shimazu, K., Fukumitsu, S., & Aida, K. (2025) · Journal of Clinical Biochemistry and Nutrition · doi:10.3164/jcbn.25-157 · Cited by 1
Schutt, R. K., O’Donoghue, A. L., Hargraves, J. L., & O'Brien, D. T. (2025) · Wellbeing Space and Society · doi:10.1016/j.wss.2025.100302 · Cited by 1
Adapting to Change: The Positive and Negative Academic Outcomes of the COVID-19 Pandemic
Monroe, K., Kole, J. A., & Karlin, N. J. (2025) · Adversity and Resilience Science · doi:10.1007/s42844-025-00188-x · Cited by 1
“Similarly, Liu et al. (2020) identified emotional resilience as a protective factor against both physical and psychological distress.”
Patterson, C. L., Wilson, J., Herbenick, D., Guerra‐Reyes, L., & Rosenberg, M. S. (2025) · Journal of American College Health · doi:10.1080/07448481.2025.2573110 · Cited by 1
“Given the relevance of physical connection and mental health outcomes, particularly during periods of amplified social isolation, 35,36 future research should examine differences in psychosocial health and wellbeing across various types of sex work involvement.”
COVID-19 Post-Pandemic Adaptation and Resilience: A Cross-Cultural Study of China and Canada
Chen, S.-M., Yan, J., Yang, F., Rebello, C. B., Ignacio, A., Hu, C., & Cupchik, G. C. (2025) · COVID · doi:10.3390/covid5110188 · Cited by 1
Adhikari, A., Mishra, N., & Singh, P. (2025) · Journal of Interpersonal Violence · doi:10.1177/08862605251388624 · Cited by 1
Syrigou, K., Stoforou, M., & Kourtesis, P. (2026) · International Journal of Human-Computer Interaction · doi:10.1080/10447318.2026.2639665 · Cited by 1
Mental health during COVID-19 through Online Photovoice (OPV) in China
Jiang, Y., Cheng, X., Tanhan, A., Francisco, V. T., Ulus, İ. Ç., Hauber‐Özer, M., & Zou, R. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1773369 · Cited by 1
Flanders, C. E., Khandpur, S., Anderson, R. E., Robinson, M., & VanKim, N. A. (2026) · Journal of Bisexuality · doi:10.1080/15299716.2026.2676955 · Cited by 1
Restorative benefits of campus window views: Evidence from an orthogonal experiment
Feng, J., Qu, H., Sun, K., & Ma, F. (2026) · Building and Environment · doi:10.1016/j.buildenv.2026.115204 · Cited by 1
Various Facets of Anxiety during the Pandemic in India - Critical Issues
Laijawala, R., Sonavane, S., & Sousa, A. D. (2021) · IntechOpen eBooks · doi:10.5772/intechopen.97797 · Cited by 1
Staser, T. (2021) · Journal of International Crisis and Risk Communication Research · Cited by 1
Will Home Quarantine Eventually Seize us in the Grip of Loneliness; a systematic Review Study
Firoozi, M., & irannejad, E. (2021) · Health Research Journal · doi:10.52547/hrjbaq.6.4.331 · Cited by 1
The Racial Differences in Impact and Knowledge of COVID-19 Among Patients with Psychiatric Illnesses
Jin, J. W., Nishikawa, M., Ho, T., Manohar, R., Sanches, M., Cavalcanti, S., & Wu, H. (2022) · Current Psychiatry Research and Reviews · doi:10.2174/2666082218666220512111146 · Cited by 1
Fatima, T., Suneel, I., Nazim, A., & Majeed, S. (2022) · Journal of Business and Social Review in Emerging Economies · doi:10.26710/jbsee.v8i2.2245 · Cited by 1
The Effect of Perceived Social Support on Psychological Well-Being in COVID-19 Patients
Kaynak, S., Ergün, S., Karadaş, A., Karaca, P. P., & Duran, S. (2022) · Eurasian Journal of Family Medicine · doi:10.33880/ejfm.2022110205 · Cited by 3
Saxe, L., Wright, G. W., & Hecht, S. (2022) · Studies of Jews in society · doi:10.1007/978-3-030-80872-3_5 · Cited by 1
Johnson, K. F., Hood, K. B., Moreno, O., Fuentes, L., Williams, C. D., Vassileva, J., Amstadter, A. B., Dick, D. M., The Spit for Science Working Group, Dick, D. M., et al. (2022) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-022-01389-1 · Cited by 1
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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