COVID-19 has rightly raised widespread public concern about mental health around the world. In the US, the pandemic was an unprecedented blow to society at a time when the nation was already facing a crisis of despair and deaths related to suicide, overdose and alcohol poisoning. Meanwhile, the impact of COVID-19 was uneven: deaths were concentrated among the elderly and minorities working in essential jobs, the group reporting better mental health until the pandemic. We still do not fully understand how the shock affects the well-being and mental health of society.
In a recent paper in which we compared trends for 2019-2020 using several nationally representative datasets, we found a number of contrasting stories. While data from the 2019 National Health Interview Survey (NHIS) and the 2020 Household Pulse Survey (HPS) include similar mental health screening questions for depression and anxiety, it shows that both have increased significantly, especially among young people in 2020. And among low-income Americans, we found no such change when we analyzed optional depression questions asked in a consistent manner in the 2019-2020 Behavioral Risk Factor Surveillance System (BRFSS) and the 2019-2020 NHIS. Despite the difference in trends, the basic determinants of mental health were similar across the three data sets over the same two years.
Our findings raise questions about the robustness of several studies claiming an unprecedented increase in depression and anxiety in the young compared to older peers. Many of them, due to the urgency created by COVID-19 and the lack of good, consistent data, used different questions in their attempt to identify matched datasets and changes in trends between the two years. The inconsistency in results over time in datasets points to the need for caution in drawing conclusions, as well as relying too heavily on a single study; The results generated from different data can be quite different.
Given the lack of comparable data and the usual one-year lag in the release of final mortality data from the Centers for Disease Control and Prevention (CDC), we also sought to control for changes in mental health patterns by conducting emergency screening. Medical Services (EMS) data calls related to behavior, overdose, suicide attempts and gun violence. The EMS data has the advantage of using the same methods and samples over a two-year period. We saw an increase in gun violence and opioid overdose calls in 2020 post-lockdown, but surprisingly, there was a sharp decrease in behavioral health calls and no change in suicide-related EMS activities. The latter trend is an enigma, but possible explanations include a marked increase in opioid overdose deaths and possibly replacement for deaths by suicide. Alternatively, many older men – the demographic group most likely to commit suicide – died of COVID-19 in the same period; Another sad “replacement” effect.
Finally, we looked to see if there was an association between poor mental health in the long run and later deaths from depression in micropolitan and metropolitan statistical areas (MMSAs). We found modest support for that possibility. Based on the Mental Health Reports in BRFSS and CDC mortality data, we find that two to three years of poor mental health days (at the individual level) are associated with higher rates of depression-related deaths (at the MMSA level). , and that the two- to four-year lag rate of deaths from depression is associated with a higher number of poor mental health days in subsequent years. We cannot establish a causal direction, but it is possible that mental health has vicious cycles at play with individual tendencies that contribute to widespread community distress, with more depression-related deaths later in communities. Mental health problems are likely. ,
Our analysis, based on several different datasets and indicators of depression, does not contradict other studies into the finding that depression is an ongoing problem in the US, as reflected by both mental health reports and trends in EMS activities. However, we find that the effects of the COVID-19 pandemic are mixed, and while some trends, such as opioid overdose deaths, worsened in 2020 compared to 2019, others, such as in some mental health reports and suicide rates , improved a bit. Our work does not speak to the long-term mental health consequences of the pandemic, but suggests that it contained deep pockets of both hopelessness and resilience. It also suggests that caution is necessary in drawing policy implications from a single study.