Depression might be the hidden epidemic accompanying the COVID-19 outbreak.

A study in JAMA Network Open finds a high burden of depression symptoms in the United States associated with the pandemic. Noting that mental health effects are exacerbated by the virus and the public health response, Boston University–led researchers says Americans already at increased risk of depression are bearing the most brunt.

The survey study including 1,441 respondents from during the COVID-19 pandemic and 5,065 respondents from before the pandemic found that depression-symptom prevalence was more than threefold higher during the pandemic than before. A greater risk of depression symptoms during the virus outbreak was associated with lower income, having less than $5,000 in savings, and having exposure to more stressors, researchers report.

“The coronavirus disease 2019 (COVID-19) pandemic and the policies to contain it have been a near ubiquitous exposure in the U.S. with unknown effects on depression symptoms,” the authors write. 

They sought to estimate the prevalence of depression and the risk factors associated with depression symptoms among U.S. adults during, versus before, the COVID-19 pandemic.

The nationally representative study used two population-based surveys of adults. For the time period during COVID-19, estimates were derived from the COVID-19 and Life Stressors Impact on Mental Health and Well-being study, conducted from March 31, 2020, to April 13, 2020. Data from before COVID-19 estimates came from the National Health and Nutrition Examination Survey, conducted from 2017 to 2018. Analysis of data occurred from April 15 to April 20, 2020.

Researchers defined depression symptoms using the Patient Health Questionnaire-9 cutoff of 10 or higher. Categories of depression symptoms were defined as none (score, 0-4); mild (score, 5-9); moderate (score, 10-14); moderately severe (score, 15-19); and severe (score, ≥20).

Of the participants during the pandemic, 619 (43.0%) were aged 18-39 years; 723 (50.2%) were men and 933 (64.7%) were non-Hispanic White. The pre–COVID-19 sample included 1,704 participants (37.8%) aged 18-39 years, 2,588 (51.4%) who are women and 1,790 (62.9%) who are non-Hispanic White. 

Results indicate that depression symptom prevalence was higher in every category during COVID-19 compared with before (mild: 24.6% [95% CI, 21.8%-27.7%] vs. 16.2% [95% CI, 15.1%-17.4%]; moderate: 14.8% [95% CI, 12.6%-17.4%] vs. 5.7% [95% CI, 4.8%-6.9%]; moderately severe: 7.9% [95% CI, 6.3%-9.8%] vs. 2.1% [95% CI, 1.6%-2.8%]; severe: 5.1% [95% CI, 3.8%-6.9%] vs. 0.7% [95% CI, 0.5%-0.9%]). 

Researchers reveal that higher risk of depression symptoms during COVID-19 was associated with having lower income (odds ratio, 2.37 [95% CI, 1.26-4.43]), having less than $5000 in savings (odds ratio, 1.52 [95% CI, 1.02-2.26]), and exposure to more stressors (odds ratio, 3.05 [95% CI, 1.95-4.77]).

“These findings suggest that prevalence of depression symptoms in the US was more than 3-fold higher during COVID-19 compared with before the COVID-19 pandemic,” according to the report. 

“Individuals with lower social resources, lower economic resources, and greater exposure to stressors (e.g., job loss) reported a greater burden of depression symptoms. Post–COVID-19 plans should account for the probable increase in mental illness to come, particularly among at-risk populations.”

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