Predictors of mental health during the Covid-19 pandemic in the US: Role of economic concerns, health worries and social distancing

PLoS One. 2020 Nov 11;15(11):e0241895. doi: 10.1371/journal.pone.0241895. eCollection 2020.


Despite the profound health and economic implications of Covid-19, there is only limited knowledge to date about the role of economic concerns, health worries and social distancing for mental health outcomes during the pandemic. We analyze online survey data from the nationally representative "Understanding America Study" (UAS) covering the period of March 10-31st 2020 (sample size: 6,585). Mental health is assessed by the validated PHQ-4 instrument for measuring symptoms of depression and anxiety. About 29% (CI:27.4-.30.4%) of the US adult population reported some depression/anxiety symptoms over the study period, with symptoms deteriorating over the month of March. Worsening mental health was most strongly associated with concerns about the economic consequences of the pandemic, while concerns about the potential implications of the virus for respondents' own health and social distancing also predicted increases in symptoms of depression and anxiety during the early stages of the pandemic in the US, albeit less strongly. Our findings point towards the possibility of a major mental health crisis unfolding simultaneously with the pandemic, with economic concerns being a key driving force of this crisis. These results highlight the likely importance of economic countermeasures and social policy for mitigating the impact of Covid-19 on adult mental health in the US over and above an effective public health response.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Anxiety / diagnosis
  • Anxiety / epidemiology
  • Betacoronavirus / isolation & purification
  • COVID-19
  • Coronavirus Infections / epidemiology
  • Coronavirus Infections / pathology*
  • Coronavirus Infections / virology
  • Depression / diagnosis
  • Depression / epidemiology
  • Economic Status*
  • Female
  • Health Behavior
  • Humans
  • Male
  • Mental Health*
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / pathology*
  • Pneumonia, Viral / virology
  • Risk
  • SARS-CoV-2
  • Surveys and Questionnaires
  • United States / epidemiology