The COVID States Project #54: Mental health in the United States

With rapid progress toward vaccination in the United States along with falling COVID-19 case rates and a reopening economy, federal and state leaders speak optimistically about a return to normalcy this summer. But as cases diminish, have the unprecedented rates of depression and anxiety documented in our reports, and in other US surveys, also begun to normalize? On the one hand, as a recent New York Times op-ed notes, people in general are remarkably resilient. And in our prior work we showed that depression and anxiety were tied closely to economic stress; as the economy improves, we might expect mental health to improve as well. On the other hand, the impact of a year of COVID-19 quarantine and fear of illness – perhaps compounded by political and societal turmoil – might not resolve so readily. In this report, we characterize rates of depression, anxiety, and sleep disturbance, as we have done on a regular basis since May 2020. We used a standard screening measure drawn from primary care, the Patient Health Questionnaire-9 (PHQ-9), which asks about the symptoms of major depression, as well as 2 items that ask about anxiety (the Generalized Anxiety Disorder-2, or GAD-2). We define major depression as a score on the PHQ-9 of 10 or greater, or moderate depression, often the point at which an individual would be referred for treatment. Sleep disruption and thoughts of suicide are defined based on items on the PHQ-9.