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The coronavirus pandemic turned the lives of millions of Americans upside down. It also exacerbated the trend of more and more Americans dealing with mental illness symptoms, according to data from two government surveys.
The Census Bureau created the Household Pulse Survey to measure the well-being of Americans during the pandemic. Part of the survey focuses on adult mental health, using four questions adapted from the Patient Health Questionnaire and Generalized Anxiety Disorder scale.
The Patient Health Questionnaire asks about the frequency of hopelessness and loss of interest in activities. The Generalized Anxiety Disorder questions measure respondents’ nervousness and uncontrollable worrying. According to the Centers for Disease Control and Prevention, reporting at least one of the symptoms from the Patient Health Questionnaire almost every day in the past week — or one symptom more than half the days and the other at least several days — is associated with major depressive disorder diagnoses. The same responses for the other question set are associated with generalized anxiety disorder diagnoses.
What have been the trends inmental health during COVID-19?
As of May 24, the Household Pulse Survey reported that 30% of American adults had symptoms consistent with an anxiety or depression diagnosis. This is the lowest percentage since the first run of the survey closed on May 5, 2020. Rates peaked in late November at 43%.
In late May, 30% of adults were experiencing anxiety or depression symptoms.
Some demographics reported higher rates of anxiety and depression than others — including young adults, women, Hispanic Americans, and people without a high school diploma.
Over 45% of Americans aged 18 to 29 reported symptoms of anxiety or depression in the latest survey. Younger Americans generally report the highest rates of anxiety or depression symptoms, with rates decreasing for each subsequent age group. People in their 70s reported the lowest percentage at 15%. There was a slight uptick among people 80 or older to 16%.
Younger Americans tend to report higher rates of anxiety and depression symptoms.
Women are more likely than men to report mental health challenges in the survey, with a larger gap for anxiety than depression. As of May 24, 29% of women and 22% of men reported anxiety symptoms. In the same period, 23% of women and 20% of men reported symptoms of depression.
The gender gap for anxiety symptoms is larger than for depression.
People with four-year degrees report the fewest mental health challenges. Twenty-four percent of adults with a bachelor’s degree or higher reported anxiety or depression symptoms as of May 24. The rate was 37% for adults who had not graduated high school.
People who did not graduate high school are reporting the most anxiety or depression.
Since the Household Pulse Survey began at the start of the pandemic, there is no directly comparable data from before. But the Substance Abuse and Mental Health Services Administration (SAMHSA) runs an annual survey that collects similar mental health information and predicts the prevalence of mental health conditions using a statistical model. While the Pulse survey concerns depression and generalized anxiety, SAMHSA also includes phobias, psychotic symptoms, anorexia, and bulimia, as well as obsessive-compulsive, post-traumatic stress, adjustment, bipolar, and panic disorders.
About 21% of American adults faced any mental illness issues in 2019, according to SAMHSA data. That is over nine percentage points lower than the prevalence of anxiety and depression alone in the most recent Pulse survey. SAMHSA reports that 8% of Americans experienced a major depressive episode in 2019, compared to 22% of people exhibiting symptoms associated with major depressive disorder in the May 2021 Pulse surveys.
SAMHSA estimates of Americans with mental illness were trending upward before the pandemic, from 18% in 2008 to 21% in 2019. Young people had the largest percentage point increase, with the rate among Americans 18 to 25 rising from 19% to 29%.
In the past decade, mental illness among Americans under 25 surpassed that of people 26 to 49.
Awareness and stigma play a role in these figures. These statistics only reflect the extent to which people are willing to share symptoms of mental health illness, which may have shifted over time.
The mental health challenges among young people and women during the pandemic is consistent with historical trends from SAMHSA. The survey reported that 25% of women had any mental illness in 2019, compared to 16% of men.
While Hispanic and Black Americans are reporting the highest rates of anxiety and depression symptoms, the pre-pandemic SAMHSA data shows Hispanic and Black Americans as less likely than white, non-Hispanic Americans to report mental illness. In 2019, 14% of Asian Americans, 17% of Black Americans, 18% of Hispanic Americans, and 22% of non-Hispanic white Americans had any mental illness.
Asian Americans, who reported spikes in anxiety and depression symptoms in late summer 2020 and again early this year in the Pulse survey, have also experienced prejudice and hate crimes during the pandemic.
The SAMHSA data shows little difference in mental illness prevalence by educational attainment. The survey reported that 20% of people with bachelor’s degrees had a mental illness in 2019, compared to 24% of people with some college or an associate degree, 19% of people with a high school diploma or equivalent, and 18% of people who did not graduate high school.
Comparisons between the Household Pulse Survey and SAMHSA data should use caution. While SAMHSA data includes more kinds of mental illnesses than the Household Pulse Survey, it also uses more robust statistical modeling to assess which people are most likely to meet the criteria for a diagnosis, which may lower its figures.
Because symptoms are self-reported, variance in education and acceptance around mental health across communities could affect both Pulse and SAMHSA data.