Top 5 Takeaways

1. Increased Anxiety and Depression: Nationally, anxiety and depression severity scores increased significantly from August to December 2020, peaking in December 2020–January 2021.
2. Subsequent Decrease: Both anxiety and depression severity scores decreased from December 2020 to June 2021 but remained elevated compared to pre-pandemic levels.
3. State-Specific Trends: State-specific trends generally mirrored national trends, with most states experiencing peak severity scores in December 2020 or January 2021.
4. Correlation with COVID-19 Cases: The frequency of anxiety and depression symptoms was positively correlated with the average number of daily COVID-19 cases.
5. Importance of Mental Health Services: The study highlights the critical need for mental health services, including telehealth, during the COVID-19 pandemic.

Original Article Author and Citation

Corresponding Author

William W. Thompson, wct2@cdc.gov

Suggested Citation

Jia H, Guerin RJ, Barile JP, et al. National and State Trends in Anxiety and Depression Severity Scores Among Adults During the COVID-19 Pandemic — United States, 2020–2021. MMWR Morb Mortal Wkly Rep 2021;70:1427–1432. DOI: http://dx.doi.org/10.15585/mmwr.mm7040e3

Summary

This study analyzed trends in anxiety and depression severity scores among U.S. adults during the COVID-19 pandemic using data from the U.S. Census Bureau Household Pulse Survey (HPS). Nationally, anxiety and depression scores increased significantly from August to December 2020, peaking in December 2020–January 2021, before decreasing by June 2021. The trends were similar across most states, and the frequency of symptoms was positively correlated with the average number of daily COVID-19 cases. The findings underscore the importance of mental health services during the pandemic.

Methods

Data were obtained from the HPS, a biweekly online survey designed to assess the social and economic impacts of the COVID-19 pandemic on U.S. households. The analysis included data from 19 survey waves conducted between August 19, 2020, and June 7, 2021. Anxiety and depression severity scores were assessed using the four-item Patient Health Questionnaire (PHQ-4), which includes the GAD-2 and PHQ-2 scales. Weighted mean scores were calculated for each wave, and state-specific trends were modeled using linear mixed models with cubic splines.

Discussion

The study found that the frequency of anxiety and depression symptoms increased after August 2020, peaking in December 2020–January 2021, and then decreased but remained elevated compared to pre-pandemic levels. The trends in mental health symptoms mirrored the national weekly number of new COVID-19 cases. The findings highlight the need for real-time monitoring of mental health symptoms and the importance of mental health services during the pandemic.

Conclusion

The increased frequency of anxiety and depression symptoms during the COVID-19 pandemic underscores the critical need for mental health services, including telehealth. Real-time monitoring of mental health symptoms can provide early indicators of potential increases in demand for mental health services and help in planning and responding to surges in demand during national emergencies.

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