Symptoms of Anxiety and Depression in U.S. Adults Remain Elevated
After improving rapidly in early 2021, rates of poor mental health have remained stubbornly high.
In April/May 2020, 36% of U.S. adults reported symptoms of anxiety or depression, according to the Household Pulse Survey (HPS), an initiative launched by the Census Bureau and other federal statistical agencies to measure the effects of the pandemic. Disturbingly, three years on, the numbers look similar (see Figure 1).
In those early months of the pandemic, no one was surprised to see symptoms of anxiety and depression surge. The health systems in many states were near collapse, effective treatments for COVID-19 were scarce, and scientists were projecting that a vaccine might take years to be developed and approved. The collateral effects of lockdown measures were devastating, causing massive job losses, preventing people from seeing their loved ones, and forcing vacations and social events to be scrapped. Mental health continued to worsen until the end of 2020, perhaps influenced by an acrimonious presidential election and a sharp increase in COVID-19 cases and deaths toward the end of the year.
Partly, these trends reflect big social changes – harmful social media use, the rise in loneliness, falling religiosity. But the pandemic laid bare the vulnerability of the mental healthcare system. At the beginning of 2020, much of the country faced chronic shortages of psychologists, psychiatrists, social workers, and therapists. Additionally, problems accessing care during the pandemic were compounded by many states’ and the federal government’s hostility to telehealth services. While some restrictions on telehealth were waived or suspended during the pandemic, the shift to telehealth in early 2020 would have been much smoother if patients had had time to acclimate to these new modalities prior to the pandemic.
Still, as the economy recovered and the vaccine rollout began in early 2021, mental health rapidly improved. From January to July 2021, rates of anxiety/depression plunged from 42% to 29% of the U.S. adult population. But then progress stalled. Rates ticked back up to 32% in the fall of 2021 and essentially flat-lined. Have we returned to normal? Are rates of 32-35% in symptoms of anxiety or depression the baseline among U.S. adults?
Given that the HPS began in April 2020, directly comparable pre-pandemic data aren’t available. Still, we can get a rough estimate from other health surveys. The CDC notes that estimates of mental health from the 2019 National Health Interview Survey (NHIS) can be used as benchmarks for comparison with HPS data. In 2019, the NHIS found that 11% of adults had symptoms of anxiety or depression, implying that current rates for these conditions are three times their pre-pandemic levels.
Can the discrepancies be chalked up to methodological differences between the 2019 NHIS and the HPS? After all, slight changes in phrasing can notoriously yield significantly different survey results, especially on subjective topics like mental health. Both the NHIS and HPS have large sample sizes and use virtually identical questions to assess symptoms of anxiety and depression. One notable difference is that NHIS data is collected predominantly through face-to-face interviews in respondents' homes, while the HPS uses online questionnaires. Perhaps people are more reluctant to disclose mental health issues with an in-person interviewer than they are on an internet form, leading to an undercount in the NHIS.
Still, it’s hard to believe that the different survey methods of the NHIS and HPS could account for the enormous differences in measures of mental health between the two datasets.
A more likely, if unsettling, explanation is that the psychological scars of the last three years are profound — and will not be easily mended.