A third of Americans are showing signs of clinical anxiety or depression, Census Bureau data shows, the most definitive and alarming sign yet of the psychological toll exacted by the coronavirus pandemic.
When asked questions normally used to screen patients for mental health problems, 24% showed clinically significant symptoms of major depressive disorder and 30% showed symptoms of generalized anxiety disorder.
The findings suggest a huge jump from before the pandemic. For example, on one question about depressed mood, the percentage reporting such symptoms was double that found in a 2014 national survey.
The troubling statistics were released last week in a tranche of data from the Census Bureau. The agency launched an emergency weekly survey of U.S. households at the end of April to measure the pandemic’s effects on employment, housing, finances, education and health. In the most recent data release, 1 million households were contacted between May 7 and 12, and more than 42,000 responded.
Buried within that 20-minute survey, U.S. officials included four questions taken nearly word-for-word from a form used by doctors to screen patients for depression and anxiety. Those answers provide a real-time window into the country’s collective mental health after three months of fear, isolation, soaring unemployment and continuing uncertainty.
New York, which had the worst coronavirus outbreak in the country, ranked 12th nationwide in terms of share of adults showing symptoms. Nearly half of Mississippians screened positive for anxiety or depression – a staggering number. By contrast, in Iowa, just over a quarter screened positive.
Some groups have been hit harder than others. Rates of anxiety and depression were far higher among younger adults, women and the poor. The worse scores in young adults were especially notable, given that the virus has been more likely to kill the elderly or leave them critically ill.
Those results reflect a deepening of existing trends: rising depression, stress and suicide among young adults. “It’s been a problem many have been studying with no clear answers – whether it’s social media or the way this generation was reared or just a greater willingness to talk about their problems,” said Maria Oquendo, a professor psychiatry at the University of Pennsylvania. “What’s worrying is the effect this situation is clearly having on young adults.”
As universities and schools look to reopen, they must take mental health into account, said Paul Gionfriddo, president of the advocacy group Mental Health America. “There’s been plenty of talk about spacing desks apart and classroom ratios but not much at all about mental health support,” Gionfriddo said. “For one thing, we have to do much more mental health screening among young people.”
The toll has also hit the poor much harder, according to the Census Bureau data – throwing into even sharper relief mental health disparities that have long existed.
When asked, for example, how often they worried uncontrollably in the past week, 60% of those making $150,000 or more said they didn’t struggle with it at all. Meanwhile, those numbers were almost inverted among people making less than $25,000 a year – with only 32% saying they didn’t struggle with uncontrollable worry and 23% saying they worried uncontrollably nearly every day.
Throughout the crisis, lower-income people have struggled more with unemployment, food scarcity and low-wage jobs that don’t allow them to work from home and that offer few financial and physical protections.
The findings by the Census Bureau echo growing evidence of accumulating mental harms among Americans. Nearly half of Americans reported the coronavirus crisis is impairing their mental health, according to a Kaiser Family Foundation poll released in April. A survey by the American Foundation for Suicide Prevention found people are experiencing anxiety and sadness more often than before the pandemic and are talking about mental health more frequently. Researchers have projected that without intervention, the country is poised to experience a rise in suicides, substance abuse and overdose deaths.
“It’s understandable given what’s happening. It would be strange if you didn’t feel anxious and depressed,” Oquendo said. “This virus is not like a hurricane or earthquake or even terrorist attack. It’s not something you can see or touch, and yet the fear of it is everywhere.”
The mental health questions were taken from two screening tools called PHQ-2 and GAD-2, used by some primary care doctors to screen patients for depression and anxiety. They were included in the Census Bureau’s emergency coronavirus project – its official name is the 2020 Household Pulse Survey – at the recommendation of the Centers for Disease Control and Prevention’s National Center for Health Statistics, officials said.
Not everyone who screens positive on these tests has clinical depression or anxiety. A Washington Post analysis of research studies on the topic found that about half of those who screen positive on the PHQ-2 in normal times have major depressive disorder. That percentage is lower for the GAD-2.
The Census Bureau plans to conduct the survey every week for three months, which could yield valuable data on how Americans’ experience of this pandemic may change. But the initial results raise questions about what the government plans to do about a looming mental health crisis.
When such screening tools are administered in a hospital or doctor’s office, clinicians are usually obligated to follow up with patients who screen positive by conducting in-depth tests and connecting them to therapy and psychiatrists.
When asked about following up with respondents to the Census Bureau survey, CDC official Stephen Blumberg said, “It is not feasible, nor would it be appropriate, to provide any health advice to respondents on the basis of their responses.”
Mental health experts say the government has a responsibility to address on a wider national scale the problems highlighted by the survey.
Even before the pandemic, mental health care in the country was severely underfunded and riddled with problems of access, disparities and insurance roadblocks. In the wake of the coronavirus pandemic, Congress appropriated trillions of dollars in emergency funds, but almost none of it has gone toward mental health programs and clinics.
“If you measure a problem, presumably it’s because you want to do something about it,” said Oquendo, former president of the American Psychiatric Association.
Doctors don’t diagnose patients with cancer, for instance, only to send them on their way, she said. “Now that the government knows how widely people are suffering, the question is what are they going to do about it.”
If you or someone you know needs help, call the National Suicide Prevention Lifeline at 800-273-TALK (8255). Crisis Text Line also provides free, 24/7, confidential support via text message to people in crisis when they text to 741741.