TABLE 2. Comparison of symptoms of adverse mental health outcomes among all respondents who completed surveys (N = 5,470), by respondent characteristic* — United States, June 24–30, 2020.
| Characteristic | Prevalence ratio¶ (95% CI¶) |
|||
|---|---|---|---|---|
| Symptoms of anxiety disorder or depressive disorder† | Symptoms of a TSRD related to COVID-19§ | Started or increased substance use to cope with stress or emotions related to COVID-19 | Serious consideration of suicide in past 30 days | |
|
Gender
| ||||
| Female vs. male |
1.04 (0.96–1.12) |
0.88 (0.81–0.97) |
0.85 (0.75–0.98) |
0.70 (0.60–0.82)** |
|
Age group (yrs)
| ||||
| 18–24 vs. 25–44 |
1.56 (1.44–1.68)** |
1.28 (1.16–1.41)** |
1.31 (1.12–1.53)** |
1.59 (1.35–1.87)** |
| 18–24 vs. 45–64 |
3.10 (2.79–3.44)** |
2.67 (2.35–3.03)** |
3.35 (2.75–4.10)** |
6.66 (5.15–8.61)** |
| 18–24 vs. ≥65 |
7.73 (6.19–9.66)** |
5.01 (4.04–6.22)** |
8.77 (5.95–12.93)** |
12.51 (7.88–19.86)** |
| 25–44 vs. 45–64 |
1.99 (1.79–2.21)** |
2.09 (1.86–2.35)** |
2.56 (2.14–3.07)** |
4.18 (3.26–5.36)** |
| 25–44 vs. ≥65 |
4.96 (3.97–6.20)** |
3.93 (3.18–4.85)** |
6.70 (4.59–9.78)** |
7.86 (4.98–12.41)** |
| 45–64 vs. ≥65 |
2.49 (1.98–3.15)** |
1.88 (1.50–2.35)** |
2.62 (1.76–3.9)** |
1.88 (1.14–3.10) |
|
Race/Ethnicity††
| ||||
| Hispanic vs. non-Hispanic black |
1.35 (1.18–1.56)** |
1.15 (1.00–1.33) |
1.19 (0.97–1.46) |
1.23 (0.98–1.55) |
| Hispanic vs. non-Hispanic Asian |
2.27 (1.73–2.98)** |
1.59 (1.24–2.04)** |
3.29 (2.05–5.28)** |
2.82 (1.74–4.57)** |
| Hispanic vs. non-Hispanic other race or multiple races |
1.23 (0.98–1.55) |
1.24 (0.96–1.61) |
1.99 (1.27–3.13)** |
1.89 (1.16–3.06) |
| Hispanic vs. non-Hispanic white |
1.40 (1.27–1.54)** |
1.50 (1.35–1.68)** |
2.09 (1.79–2.45)** |
2.35 (1.96–2.80)** |
| Non-Hispanic black vs. non-Hispanic Asian |
1.68 (1.26–2.23)** |
1.38 (1.07–1.78) |
2.75 (1.70–4.47)** |
2.29 (1.39–3.76)** |
| Non-Hispanic black vs. non-Hispanic other race or multiple races |
0.91 (0.71–1.16) |
1.08 (0.82–1.41) |
1.67 (1.05–2.65) |
1.53 (0.93–2.52) |
| Non-Hispanic black vs. non-Hispanic white |
1.03 (0.91–1.17) |
1.30 (1.14–1.48)** |
1.75 (1.45–2.11)** |
1.90 (1.54–2.36)** |
| Non-Hispanic Asian vs. non-Hispanic other race or multiple races |
0.54 (0.39–0.76)** |
0.78 (0.56–1.09) |
0.61 (0.32–1.14) |
0.67 (0.35–1.29) |
| Non-Hispanic Asian vs. non-Hispanic white |
0.62 (0.47–0.80)** |
0.95 (0.74–1.20) |
0.64 (0.40–1.02) |
0.83 (0.52–1.34) |
| Non-Hispanic other race or multiple races vs. non-Hispanic white |
1.14 (0.91–1.42) |
1.21 (0.94–1.56) |
1.05 (0.67–1.64) |
1.24 (0.77–2) |
|
Employment status
| ||||
| Employed vs. unemployed |
0.96 (0.87–1.07) |
1.28 (1.12–1.46)** |
2.30 (1.78–2.98)** |
3.21 (2.31–4.47)** |
| Employed vs. retired |
3.01 (2.58–3.51)** |
2.84 (2.42–3.34)** |
4.30 (3.28–5.63)** |
5.97 (4.20–8.47)** |
| Unemployed vs. retired |
3.12 (2.63–3.71)** |
2.21 (1.82–2.69)** |
1.87 (1.30–2.67)** |
1.86 (1.16–2.96) |
|
Essential vs. nonessential worker§§
|
1.42 (1.30–1.56)** |
1.52 (1.38–1.69)** |
2.36 (2.00–2.77)** |
2.76 (2.29–3.33)** |
|
Unpaid caregiver for adults vs. not¶¶`
|
2.55 (2.37–2.75)** |
2.63 (2.42–2.86)** |
5.28 (4.59–6.07)** |
8.64 (7.23–10.33)** |
|
Rural vs. urban residence***
|
0.94 (0.82–1.07) |
0.96 (0.83–1.11) |
0.84 (0.67–1.06) |
0.95 (0.74–1.22) |
|
Knows someone with positive SARS-CoV-2 test result vs. not
|
0.95 (0.86–1.05) |
0.78 (0.69–0.88)** |
0.96 (0.81–1.14) |
0.65 (0.52–0.81)** |
|
Knew someone who died from COVID-19 vs. not
|
0.99 (0.85–1.15) |
1.08 (0.92–1.26) |
0.84 (0.64–1.11) |
0.69 (0.49–0.97) |
|
Receiving treatment for anxiety vs. not
|
2.43 (2.26–2.63)** |
2.21 (2.01–2.43)** |
2.27 (1.94–2.66)** |
2.54 (2.13–3.03)** |
|
Receiving treatment for depression vs. not
|
2.20 (2.03–2.39)** |
1.88 (1.70–2.09)** |
2.13 (1.81–2.51)** |
2.35 (1.96–2.82)** |
| Receiving treatment for PTSD vs. not | 2.75 (2.55–2.97)** | 2.87 (2.61–3.16)** | 3.78 (3.23–4.42)** | 4.95 (4.21–5.83)** |
Abbreviations: CI = confidence interval; COVID-19 = coronavirus disease 2019; PTSD = posttraumatic stress disorder; TSRD = trauma- and stressor-related disorder.
* Number of respondents for characteristics: gender (female = 2,784, male = 2,676), age group in years (18–24 = 731; 25–44 = 1,911; 45–64 = 1,895; ≥65 = 933), race/ethnicity (non-Hispanic white = 3453, non-Hispanic black = 663, non-Hispanic Asian = 256, non-Hispanic other race or multiple races = 164, Hispanic = 885).
† Symptoms of anxiety disorder and depressive disorder were assessed via the four-item Patient Health Questionnaire (PHQ-4). Those who scored ≥3 out of 6 on the Generalized Anxiety Disorder (GAD-2) and Patient Health Questionnaire (PHQ-2) subscales were considered to have symptoms of these disorders.
§ Disorders classified as TSRDs in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) include PTSD, acute stress disorder (ASD), and adjustment disorders (ADs), among others. Symptoms of a TSRD precipitated by the COVID-19 pandemic were assessed via the six-item Impact of Event Scale (IES-6) to screen for overlapping symptoms of PTSD, ASD, and ADs. For this survey, the COVID-19 pandemic was specified as the traumatic exposure to record peri- and posttraumatic symptoms associated with the range of stressors introduced by the COVID-19 pandemic. Persons who scored ≥1.75 out of 4 were considered to be symptomatic.
¶ Comparisons within subgroups were evaluated on weighted responses via Poisson regressions used to calculate a prevalence ratio, 95% CI, and p-value (not shown). Statistical significance was evaluated at a threshold of α = 0.005 to account for multiple comparisons. In the calculation of prevalence ratios for started or increased substance use, respondents who selected “Prefer not to answer” (n = 104) were excluded.
** P-value is statistically significant (p<0.005).
†† Respondents identified as a single race unless otherwise specified. The non-Hispanic, other race or multiple races category includes respondents who identified as not Hispanic and as more than one race or as American Indian or Alaska Native, Native Hawaiian or Pacific Islander, or ‘Other’.
§§ Essential worker status was self-reported. The comparison was between employed respondents (n = 3,431) who identified as essential vs. nonessential. For this analysis, students who were not separately employed as essential workers were considered nonessential workers.
¶¶ Unpaid adult caregiver status was self-reported. The definition of an unpaid caregiver for adults was having provided unpaid care to a relative or friend aged ≥18 years to help them take care of themselves at any time in the last 3 months. Examples provided included helping with personal needs, household chores, health care tasks, managing a person’s finances, taking them to a doctor’s appointment, arranging for outside services, and visiting regularly to see how they are doing.
*** Rural-urban classification was determined by using self-reported ZIP codes according to the Federal Office of Rural Health Policy definition of rurality. https://www.hrsa.gov/rural-health/about-us/definition/datafiles.html.