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Despair and resilience in the US: Did the COVID pandemic worsen mental health outcomes?

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The COVID-19 pandemic was an unprecedented shock to U.S. society at a time when the nation was already coping with a crisis of despair and related deaths from suicides, overdoses, and alcohol poisoning. COVID’s impact was inequitable: Deaths were concentrated among the elderly and minorities working in essential jobs, groups who up to the pandemic had been reporting better mental health. Yet how the shock has affected society’s well-being and mental health is not fully understood. Exploring the impact by comparing 2019 to 2020 as reflected in nationally representative datasets, we found a variety of contrasting stories. While data from the 2019 National Health Interview Survey (NHIS) and the 2020 Household Pulse Survey (HPS) show that depression and anxiety increased significantly, especially among young and low-income Americans in 2020, we found no such changes when analyzing alternative depression questions in the 2019-20 Behavioral Risk Factor Surveillance System (BRFSS). Nevertheless, for the same period, determinants of mental health were similar in the NHIS, BRFSS, and HPS data.

We also explored whether the pandemic affected physical health and behaviors by examining Emergency Medical Services (EMS) data calls related to behavior, overdoses, suicide attempts, and gun violence. (Notably, gun violence and opioid overdose calls increased after lockdowns, but suicide-related calls decreased). Finally, we looked at whether over the long run there is a relationship between poor mental health and deaths of despair in a geographic area and found some support for that possibility. Our results highlight two findings: (1) Scholars investigating mental and behavioral health trends must be cautious about relying too heavily on a single dataset; results generated from different data may differ considerably. (2) High metropolitan rates of depression and anxiety may be correlated with higher rates of suicide and overdose years later.

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