What does mental health look like in the pandemic?

The Household Pulse Survey, a biweekly survey that measures household experiences during the COVID-19 pandemic, asks versions of the GAD-7, a short diagnostic test used by physicians to screen for generalized anxiety disorder (GAD), and the PHQ-9, a questionnaire for major depressive disorders.

In October, 37% of adults said they felt hopeless more than half of the days in the past week.

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Anxiety symptoms increased nationwide from the start of the pandemic, peaking in July when over 30% of respondents reported feeling anxious or on edge more than half of the days in the previous week. However, the proportion of Americans reporting feeling hopeless more than half of the time increased steadily and reached a high of 37% October. These figures are much higher than previous estimates of depression and anxiety; 21% of adults reported any mental illness in 2019.

The pandemic is likely part of this. But because the survey emphasizes symptoms rather than the label of mental illness, it may also be capturing Americans who were less likely to be formally diagnosed or to view themselves as dealing with a medical disorder in previous data.

A person feeling nervous, anxious, or on edge, in addition to not being able to control worrying more than half the time would score a 4 on the GAD-7 questionnaire, indicating a very high likelihood of GAD. Similarly, a person having little interest or pleasure, in addition to feeling hopeless for more than half the time would score a 4 on the PHQ-9 questionnaire, indicating a very high likelihood of a major depressive disorder.

While young adults suffered worse mental health pre-pandemic, the Household Pulse Survey finds that throughout the pandemic, those aged 30-39 are slightly more anxious than adults aged 18-29, perhaps because of increased fears about job loss and pressure to provide for themselves or families. Adults younger than 30 exhibit the highest rates of hopelessness, with over half reporting feeling hopeless more than half of the time. The survey results also reflect gender divides, with female respondents reporting these symptoms of depression and anxiety around 6-8% more often than male respondents.

What was the state of mental health before the pandemic?

While the Household Pulse Survey was not conducted until after the pandemic began, other surveys asking about self-reported mental health diagnoses can provide a baseline for US mental health pre-pandemic. According to the Substance Abuse and Mental Health Services Administration (SAMHSA)’s annual survey, the percentage of US adults reporting any mental illness has hovered between 17% and 21% for the past decade. This figure includes depression, anxiety, eating disorders, and any other self-reported mental or neurological disorder.

One in five adults reported having mental illness in 2019.

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However, young adults and millennials report higher rates of mental illness than older generations. A 2019 SAMHSA survey found that young women are most impacted, with over one-in-three people ages 18 to 29 reporting mental illness.

Women are likelier to report having mental illness than men.

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Are adults seeking mental health treatment in the pandemic?

According to SAMHSA, 16.1% of adults received mental health treatment at some point during in 2019. The Household Pulse Survey collects information only on mental health treatment in the past seven days. Between October 14 and October 26, 7.8% of adults reported receiving mental health treatment in the past week. Despite generally having worse mental health, adults under 30 are less likely to receive mental health treatment than adults between ages 30 and 39. Adults under 30 also report the highest rates of needing counseling or therapy but not getting it.

Younger adults are more likely to not receive needed counseling than older adults.

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Access to treatment for mental illness also correlates with income. Over 15% of adults making less than $25,000 reported needing counseling or therapy but not getting it in the most recent Household Pulse Survey.

Adults from lower-income households are more likely to be unable to access needed counseling than those in higher-income households.

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As the pandemic continues to have adverse impacts on mental health, access to treatment will become increasingly important.

Household Pulse Survey
National Survey of Drug Use and Health