Trajectories of Mental Distress among U.S. Adults during the COVID-19 Pandemic

Kira E. Riehm, Calliope Holingue, Emily J. Smail, Arie Kapteyn, Daniel Bennett, Johannes Thrul, Frauke Kreuter, Emma E. McGinty, Luther G. Kalb, Cindy B. Veldhuis, Renee M. Johnson, M. Daniele Fallin, Elizabeth A. Stuart

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Cross-sectional studies have found that the coronavirus disease 2019 (COVID-19) pandemic has negatively affected population-level mental health. Longitudinal studies are necessary to examine trajectories of change in mental health over time and identify sociodemographic groups at risk for persistent distress. Purpose: To examine the trajectories of mental distress between March 10 and August 4, 2020, a key period during the COVID-19 pandemic. Methods: Participants included 6,901 adults from the nationally representative Understanding America Study, surveyed at baseline between March 10 and 31, 2020, with nine follow-up assessments between April 1 and August 4, 2020. Mixed-effects logistic regression was used to examine the association between date and self-reported mental distress (measured with the four-item Patient Health Questionnaire) among U.S. adults overall and among sociodemographic subgroups defined by sex, age, race/ethnicity, household structure, federal poverty line, and census region. Results: Compared to March 11, the odds of mental distress among U.S. adults overall were 1.84 (95% confidence interval [CI] = 1.65-2.07) times higher on April 1 and 1.92 (95% CI = 1.62-2.28) times higher on May 1; by August 1, the odds of mental distress had returned to levels comparable to March 11 (odds ratio [OR] = 0.80, 95% CI = 0.66-0.96). Females experienced a sharper increase in mental distress between March and May compared to males (females: OR = 2.29, 95% CI = 1.85-2.82; males: OR = 1.53, 95% CI = 1.15-2.02). Conclusions: These findings highlight the trajectory of mental health symptoms during an unprecedented pandemic, including the identification of populations at risk for sustained mental distress.

Original languageEnglish (US)
Pages (from-to)93-102
Number of pages10
JournalAnnals of Behavioral Medicine
Issue number2
StatePublished - Feb 2021


  • COVID-19
  • Mental health
  • Psychiatric epidemiology
  • Sociodemographic disparities

ASJC Scopus subject areas

  • General Medicine


Dive into the research topics of 'Trajectories of Mental Distress among U.S. Adults during the COVID-19 Pandemic'. Together they form a unique fingerprint.

Cite this