Mental health consequences of COVID-19: a nationally representative cross-sectional study of pandemic-related stressors and anxiety disorders in the USA
Open accessAbstract
Objective: To document the prevalence of anxiety disorders in the USA during the COVID-19 pandemic. Design: A cross-sectional analysis. Setting: A nationally representative sample in the USA between 31 March and 13 April 2020. Participants: 1450 English-speaking adult participants in the AmeriSpeak Panel. AmeriSpeak is a probability-based panel designed to be representative of households in the USA. Main outcome measures: Prevalence of probable generalised anxiety disorder (GAD) using the GAD-7 and post-traumatic stress symptoms (PTSS) using the four-item PTSD (post-traumatic stress disorder) checklist. Both outcomes were stratified by demographics and COVID-19-related stressors. Results: The majority of participants were female (51.8%), non-Hispanic white (62.9%) and reported a household saving of $5000 or more. Those between 18 and 29 years old were the largest age group (38.1%) compared with 40–59 years (32.0%) and 60 years or more (29.9%). The prevalence of probable GAD was 10.9% (95% CI 9.1% to 13.2%) and the prevalence of PTSS was 21.7% (95% CI 19.1% to 24.6%). Among participants reporting five or more COVID-19-related stressors, the prevalence of probable GAD was 20.5% (95% CI 16.1% to 25.8%) and the prevalence of PTSS was 35.7% (95% CI 30.2% to 41.6%). Experiencing five or more COVID-19-related stressors was a predictor of both probable GAD (OR=4.5, 95% CI 2.3 to 8.8) and PTSS (OR=3.3, 95% CI 2.1 to 5.1). Conclusions: The prevalence of probable anxiety disorders in the USA, as the COVID-19 pandemic and policies implemented to tackle it unfolded, is higher than estimates reported prior to the pandemic and estimates reported following other mass traumatic events. Exposure to COVID-19-related stressors is associated with higher prevalence of both probable GAD and PTSS, highlighting the role these stressors play in increasing the risk of developing anxiety disorders in the USA. Mitigation and recovery policies should take into account the mental health toll the pandemic had on the USA population.
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Surveys of adults conducted across the globe reveal increased emotional problems during the strictest lockdowns and physical distancing mandates.
“Indeed, surveys of adults conducted across the globe reveal increased emotional problems during the strictest lockdowns and physical distancing mandates (Abdalla et al., 2021, Dawel et al., 2020, O’Connor et al., 2021)”
From Young Adult Adaptability to the Social Challenges of the COVID-19 Pandemic: The Protective Role of Friendships (2022) · cites this paper as Abdalla et al., 2021
The Discussion reports that a survey of US adults conducted from 31 March to 13 April 2020 found probable anxiety and post-traumatic stress symptoms at rates higher than pre-pandemic estimates. The Introduction notes that physical-distancing policies were implemented during the pandemic’s early phase. This source supports the US example, but it does not establish a global survey finding or show that emotional problems increased specifically during the strictest lockdowns. (LLM, conf=0.86)
Experimental — accuracy not yet measuredLockdowns and physical distancing restrictions during the COVID-19 pandemic likely contributed to elevated emotional distress and feelings of loneliness.
“Hence, lockdowns and physical distancing restrictions during the COVID-19 pandemic likely contributed to elevated emotional distress and feelings of loneliness.”
From Young Adult Adaptability to the Social Challenges of the COVID-19 Pandemic: The Protective Role of Friendships (2022) · cites this paper as Abdalla et al., 2021
The Introduction and Conclusion (page numbers unavailable) link physical-distancing policies and the pandemic’s social consequences to psychological harm, and the Discussion identifies feeling lonely as a stressor associated with higher rates of probable anxiety disorders. The paper does not establish that lockdowns or distancing restrictions caused feelings of loneliness; its cross-sectional design also cannot establish that the policies caused the mental-health outcomes. (LLM, conf=0.84)
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Self-citation
- Authors
- Abdalla, S. M., Ettman, C. K., Cohen, G. H., & Galea, S.
- Affiliations
- Boston University (US)
- Corresponding author
- Abdalla, Salma M
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2021-08
- Volume
- 11
- Issue
- 8
- Pages
- e044125
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC8354762
- OpenAlex
- W3188643270
- Cited by
- 68
- References
- 33
- Citations by year
- 2026: 6 · 2025: 12 · 2024: 11 · 2023: 18 · 2022: 19 · 2021: 2
- FWCI
- 8.53
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Rockefeller Foundation (2019 HTH 024)
- 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
- generalized anxiety disorder, posttraumatic stress symptoms, post-traumatic stress disorder, COVID-19 pandemic, anxiety prevalence, mental health, United States adults, GAD-7, PTSD Checklist-Civilian
- MeSH terms
- COVID-19, SARS-CoV-2, Adolescent, Adult, Anxiety, Anxiety Disorders, Cross-Sectional Studies, Depression, Female, Humans, Male, Mental Health, Middle Aged, United States, Young Adult, Pandemics
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