Last week, the United States Department of Health and Human Services ended the COVID-19 public health emergency, marking a turning point after more than three years of pandemic-related challenges. As individuals and institutions begin the post-pandemic transition, new research led by UC Berkeley and UC San Francisco suggests that the mental health effects of quarantining, isolation, and social distancing were more pronounced than some have estimated.
Published today in PLOS ONE, the study shows that the COVID-19 outbreak caused a 3-percent increase in depression risk from 2019 to 2021, relative to 2018’s pre-pandemic risk, and that specific demographic groups—like women, young adults, and low-income workers—experienced the largest jumps in depression risk during the pandemic.
“Over the past few years, the media covered the mental health effects of the COVID-19 pandemic across different demographic groups,” explained lead author Sofia Villas-Boas, a professor in the Department of Agricultural & Resource Economics (ARE) at UC Berkeley. “While there were certain subgroups that were particularly affected by the pandemic, we found that not every group mentioned experienced a significant increase in depression risk.”
Measuring depression risk
Co-author Renee Hsia, MD, a professor and associate chair of health services research in the Department of Emergency Medicine at UCSF, said the authors used data from the Behavioral Risk Factor Surveillance System survey administered by the Centers for Disease Control and Prevention to determine pre- and post-pandemic rates of depression risk.
The annual survey gathers information regarding health-related risk behaviors, the use of preventive services, and chronic health conditions from 400,000 residents across 50 states, the District of Columbia, and three U.S. territories. The authors used responses to the question “Have you ever been told you had a depressive disorder?” to calculate depression risk for 2019, 2020, and 2021.
State-level measurements of COVID case rates and annual unemployment levels were also included to estimate how the pandemic, its severity, and unemployment correlated with the evolution of depression risk across the U.S.
“We wanted to determine whether this increase was something recent, or if this was part of an increase in depression that was on its way up even before COVID,” Hsia said. “We didn’t want to falsely attribute any potential increase in depression risk to the pandemic.”
Tracking shifts in risk
According to Villas-Boas, the average reported risk of depression increased by .59 percentage points between 2019 and 2021—corresponding to a 3-percent relative increase over 2018—as the pandemic continued into its second year. While depression risk for men and women was increasing even before the pandemic, between 2019 and 2021 the study did not find a significant increase in depression risk among men while women experienced a 4.5 percent increase in depression risk relative to 2018.
The authors did find evidence that young adults—especially those between the ages of 18 to 24—were disproportionately affected by the pandemic. By 2021, individuals within that age group reported a 13-percent increase in depression risk relative to 2019. Smaller increases in depression risk were reported among adults between the ages of 25 to 34, and 35 to 44.
The study also showed that the pandemic resulted in an increased depression risk for workers who made between $15,000 and $50,000. While the lowest-income workers—those who make under $15,000 per year—experienced the highest depression risk prior to the pandemic, the authors did not find a significant pandemic-related increase within that group. According to Hsia, workers who made between $25,000 and $35,000 experienced the largest increase (12.5 percent) compared to their pre-pandemic level.
The authors also found that the depression risk for individuals with less than a high school education was linked to changes in the unemployment rate, while those with more than a high school education were affected by COVID case severity.
While Villas-Boas and Hsia note that the model did not find a significant association between the pandemic, its severity, and unemployment rates and the depression risk experienced by racial or ethnic minority groups, both researchers caution that other metrics—like self-reported symptoms of depression or hospital visits—can provide important context and data not captured by the CDC’s survey.
“If someone's not talking about depression or they don't have access to therapists or physicians, then they’re not captured in this survey,” Hsia said.
“This doesn't mean that these minority groups are not hit, but they’re not reporting as much,” Villas-Boas added. “People may be very depressed but might not seek or report needing help.”
Ultimately, the authors said the study’s findings across the impacted demographic groups are consistent with how COVID-19 upended society. For instance, women were likely more heavily affected by the pandemic due to leaving the labor force and assuming additional care duties.
Young adults were most likely to be pursuing their education; employed in front-line service jobs; or attempting to raise their children while navigating schooling, professional commitments, and caregiving duties throughout the pandemic. They were also the group most likely entering the job market or working in states that stopped hiring due to the pandemic-induced economic shutdown.