TABLE 2. Prevalence of and adjusted odds ratios for adverse mental health symptoms, by parent/caregiver role and reason for providing care for adults — The COVID-19 Outbreak Public Evaluation Initiative, United States, December 2020 and February–March 2021.
| Caregiver role and reason for providing care | Symptoms |
|||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Total |
Anxiety or depression* |
COVID-19 TSRD† |
Past-month passive suicidal ideation§ |
Past-month serious suicidal ideation§ |
Any of these symptoms |
|||||||
|
Total,
no. (%) (95% CI)¶
|
10,444 (100)
|
—
|
3,780 (36.2)
|
(35.1–37.3)
|
3,596 (34.4)
|
(33.3–35.5)
|
2,321 (22.2)
|
(21.2–23.2)
|
1,697 (16.2)
|
(15.4–17.1)
|
5,001 (47.9)
|
(46.8–49.0)
|
|
Parent role/caregiver role,** no. (%) (95% CI)¶
|
|
|||||||||||
| Nonparent/
Noncaregiver |
6,008 (57.5)
|
(56.4–58.7)
|
1,327 (22.1) |
(20.8–23.4) |
1,209 (20.1) |
(18.8–21.4) |
580 (9.6) |
(8.7–10.7) |
269 (4.5) |
(3.8–5.3) |
1,925 (32.0) |
(30.6–33.5) |
| Parent only, caregiver of adults only, or parent-caregiver |
4,436 (42.5)
|
(41.3–43.6)
|
2,453 (55.3) |
(53.4–57.2) |
2,387 (53.8) |
(51.9–55.7) |
1,741 (39.3) |
(37.4–41.1) |
1,428 (32.2) |
(30.4–34.0) |
3,076 (69.3) |
(67.6–71.0) |
| Parent only |
875 (8.4)
|
(7.8–9.0)
|
315 (35.9) |
(32.2–39.8) |
304 (34.8) |
(31.0–38.7) |
162 (18.5) |
(15.2–22.2) |
79 (9.0) |
(6.9–11.4) |
443 (50.6) |
(46.6–54.6) |
| Caregiver of adults only |
1,170 (11.2)
|
(10.4–12.0)
|
454 (38.8) |
(35.2–42.5) |
425 (36.3) |
(32.8–40.0) |
187 (16.0) |
(13.5–18.7) |
118 (10.1) |
(8.1–12.4) |
591 (50.5) |
(46.8–54.2) |
| Parent-caregiver |
2,391 (22.9)
|
(21.9–23.9)
|
1,685 (70.5) |
(67.9–72.9) |
1,658 (69.3) |
(66.8–71.8) |
1,392 (58.2) |
(55.6–60.9) |
1,232 (51.5) |
(48.8–54.2) |
2,043 (85.4) |
(83.5–87.2) |
|
Parent role/caregiver role,** aOR (95% CI)††
| ||||||||||||
| Parent only |
—
|
—
|
1.4 (1.1–1.7) |
1.5 (1.2–1.9) |
1.5 (1.2–2.0) |
1.6 (1.1–2.2) |
1.5 (1.2–1.8) |
|||||
| Adult caregiver only |
—
|
—
|
1.9 (1.6–2.3) |
1.8 (1.5–2.2) |
1.3 (1.0–1.7) |
1.7 (1.2–2.3) |
1.8 (1.5–2.1) |
|||||
| Parent-caregiver |
—
|
—
|
3.7 (3.1–4.5) |
3.6 (3.1–4.3) |
5.8 (4.8–7.1) |
8.2 (6.5–10.4) |
5.1 (4.1–6.2) |
|||||
|
Reason for care for adults, aOR (95% CI)§§
| ||||||||||||
| Age-related health decline |
—
|
—
|
1.8 (1.4–2.3) |
1.8 (1.5–2.3) |
1.4 (1.1–1.8) |
1.8 (1.3–2.3) |
1.9 (1.5–2.4) |
|||||
| Cognitive challenges |
—
|
—
|
2.0 (1.5–2.7) |
2.0 (1.5–2.6) |
2.3 (1.7–3.0) |
3.1 (2.2–4.4) |
2.2 (1.7–2.8) |
|||||
| Chronic health condition |
—
|
—
|
2.8 (2.2–3.5) |
1.9 (1.6–2.4) |
2.8 (2.2–3.5) |
3.3 (2.5–4.3) |
2.3 (1.8–2.9) |
|||||
| Acute health condition |
—
|
—
|
2.7 (1.9–3.7) |
2.8 (2.1–3.7) |
2.4 (1.8–3.2) |
3.6 (2.6–4.9) |
3.0 (2.1–4.3) |
|||||
| Mental health or substance use condition |
—
|
—
|
3.7 (2.8–5.0) |
3.7 (2.8–4.8) |
3.0 (2.3–3.9) |
3.8 (2.9–5.0) |
5.0 (3.7–6.9) |
|||||
| Active case of COVID-19 |
—
|
—
|
3.8 (2.7–5.1) |
3.1 (2.3–4.1) |
4.2 (3.2–5.6) |
5.5 (4.1–7.5) |
4.4 (3.0–6.4) |
|||||
| Risk for severe COVID-19 |
—
|
—
|
3.4 (2.6–4.4) |
2.8 (2.2–3.6) |
3.5 (2.8–4.5) |
4.7 (3.6–6.1) |
3.9 (3.0–5.2) |
|||||
| Other | — | — | 1.6 (1.1–2.5) |
1.4 (1.0–1.9) |
1.2 (0.8–1.9) |
2.4 (1.6–3.6) |
1.5 (1.0–2.2) |
|||||
Abbreviations: aOR = adjusted odds ratio; ASD = acute stress disorder; CI = confidence interval; CII = Caregiving Intensity Index; GAD-2 = two-item Generalized Anxiety Disorder scale; IES-6 = six-item Impact of Event scale; PHQ-2 = two-item Patient Health Questionnaire; PHQ-4 = four-item Patient Health Questionnaire; PTSD = posttraumatic stress disorder; TSRD = trauma- and stressor-related disorder.
* Symptoms of anxiety and depression were assessed via PHQ-4. Those who scored ≥3 out of 6 on the GAD-2 or PHQ-2 subscales were considered symptomatic for anxiety or depression symptoms.
† Disorders classified as TSRDs in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, include PTSD, ASD, and adjustment disorders, among others. Symptoms of a TSRD attributed to the COVID-19 pandemic were assessed via IES-6 to screen for overlapping symptoms of PTSD, ASD, and adjustment disorders. The COVID-19 pandemic was specified as the traumatic exposure to record peritraumatic and posttraumatic symptoms associated with the range of stressors introduced by the COVID-19 pandemic. Those who scored ≥1.75 out of 4 were considered symptomatic.
§ Passive suicidal ideation was assessed using an item from the Columbia-Suicide Severity Rating Scale adapted to refer to the past 30 days: “At any time in the past 30 days, have you wished you were dead or wished you could go to sleep and not wake up?” Serious suicidal ideation was assessed using an item from the National Survey on Drug Use and Health adapted to refer to the past 30 days: “At any time in the past 30 days, did you seriously think about trying to kill yourself?”
¶ Weighted numbers and percentages might not sum to expected values because of rounding.
** Parents and unpaid caregivers of adults were self-identified. For this analysis, parents were defined as persons who had provided unpaid care to relatives or friends aged <18 years to help them take care of themselves at any time in the last 3 months. Unpaid caregivers of adults were defined as persons who had provided unpaid care to relatives or friends aged ≥18 years to help them take care of themselves at any time in the last 3 months. Respondents answered questions about these two roles separately. Respondents were categorized as parents only, caregivers of adults only, parents-caregivers (persons in both roles), or nonparents/noncaregivers. Whether adults in parenting roles were biologic or legal parents or guardians of the children for whom they were providing care is not known, nor is it known whether adults were legal dependents of their caregivers.
†† Referent: nonparent/noncaregiver. Weighted multivariable logistic regression models were used to estimate aORs for each adverse mental health symptom, with survey wave, gender, age group, race/ethnicity, sexual orientation, disability status, education attainment, region, urbanicity, and employment (work hours per week and remote work percentage) as covariates. P values <0.05 were considered statistically significant. Models with all unpaid caregiver statuses included 10,017 respondents because persons who answered “prefer not to say” for sexual orientation or disability status and those who reported invalid zip codes were excluded. Models with unpaid caregivers of adults included 3,155 respondents; respondents were excluded for the same reasons.
§§ Referent: not providing care to an adult for this reason. This referent group includes all adults not providing care for the listed reason, including those who were nonparents/noncaregivers, parents only, and caregivers of adults who were providing care for different reasons.