TABLE 3. Odds of incidence* of symptoms of adverse mental health, substance use to cope with stress or emotions related to COVID–19 pandemic, and suicidal ideation in the third survey wave, by essential worker status and unpaid adult caregiver status among respondents who completed monthly surveys from April through June (N = 1,497) — United States, April 2–8, May 5–12, and June 24–30, 2020.

Symptom or behavior	Essential worker† vs. all other employment statuses (nonessential worker, unemployed, retired)				Unpaid caregiver for adults§ vs. not unpaid caregiver
	Unadjusted		Adjusted¶		Unadjusted		Adjusted**
	OR (95% CI)††	p-value††	OR (95% CI)††	p-value††	OR (95% CI)††	p-value††	OR (95% CI)††	p-value††
Symptoms of anxiety disorder§§	1.92 (1.29–2.87)	0.001	1.63 (0.99–2.69)	0.056	1.97 (1.25–3.11)	0.004	1.81 (1.14–2.87)	0.012
Symptoms of depressive disorder§§	1.49 (1.00–2.22)	0.052	1.13 (0.70–1.82)	0.606	2.29 (1.50–3.50)	<0.001	2.22 (1.45–3.41)	<0.001
Symptoms of anxiety disorder or depressive disorder§§	1.67 (1.14–2.46)	0.008	1.26 (0.79–2.00)	0.326	1.84 (1.19–2.85)	0.006	1.73 (1.11–2.70)	0.015
Symptoms of a TSRD related to COVID–19¶¶	1.55 (0.86–2.81)	0.146	1.27 (0.63–2.56)	0.512	1.88 (0.99–3.56)	0.054	1.79 (0.94–3.42)	0.076
Started or increased substance use to cope with stress or emotions related to COVID–19	2.36 (1.26–4.42)	0.007	2.04 (0.92–4.48)	0.078	3.51 (1.86–6.61)	<0.001	3.33 (1.75–6.31)	<0.001
Serious consideration of suicide in previous 30 days	0.93 (0.31–2.78)	0.895	0.53 (0.16–1.70)	0.285	3.00 (1.20–7.52)	0.019	3.03 (1.20–7.63)	0.019

Abbreviations: CI = confidence interval, COVID–19 = coronavirus disease 2019, OR = odds ratio, TSRD = trauma– and stressor–related disorder.

* For outcomes assessed via the four-item Patient Health Questionnaire (PHQ–4), odds of incidence were marked by the presence of symptoms during May 5–12 or June 24–30, 2020, after the absence of symptoms during April 2–8, 2020. Respondent pools for prospective analysis of odds of incidence (did not screen positive for symptoms during April 2–8): anxiety disorder (n = 1,236), depressive disorder (n = 1,301) and anxiety disorder or depressive disorder (n = 1,190). For symptoms of a TSRD precipitated by COVID–19, started or increased substance use to cope with stress or emotions related to COVID–19, and serious suicidal ideation in the previous 30 days, odds of incidence were marked by the presence of an outcome during June 24–30, 2020, after the absence of that outcome during May 5–12, 2020. Respondent pools for prospective analysis of odds of incidence (did not report symptoms or behavior during May 5–12): symptoms of a TSRD (n = 1,206), started or increased substance use (n = 1,408), and suicidal ideation (n = 1,456).

^† Essential worker status was self–reported. For Table 3, essential worker status was determined by identification as an essential worker during the June 24–30 survey. Essential workers were compared with all other respondents, not just employed respondents (i.e., essential workers vs. all other employment statuses (nonessential worker, unemployed, and retired), not essential vs. 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 18 years or older 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.

^¶ Adjusted for gender, employment status, and unpaid adult caregiver status.

** Adjusted for gender, employment status, and essential worker status.

^†† Respondents who completed surveys from all three waves (April, May, June) were eligible to be included in an unweighted longitudinal analysis. Comparisons within subgroups were evaluated via logit–linked Binomial regressions used to calculate unadjusted and adjusted odds ratios, 95% confidence intervals, and p–values. Statistical significance was evaluated at a threshold of α = 0.05. In the calculation of odds ratios for started or increased substance use, respondents who selected “Prefer not to answer” (n = 11) were excluded.

^§§ Symptoms of anxiety disorder and depressive disorder were assessed via the PHQ–4. Those who scored ≥3 out of 6 on the two–item Generalized Anxiety Disorder (GAD–2) and two-item Patient Health Questionnaire (PHQ–2) subscales were considered symptomatic for each disorder, respectively.

^¶¶ Disorders classified as TSRDs in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) include posttraumatic stress disorder (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 potential stressors introduced by the COVID–19 pandemic. Those who scored ≥1.75 out of 4 were considered symptomatic.