Loneliness, Distress Tolerance Play Key Roles in Depression During COVID-19 Pandemic

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More than half (61.5%) of respondents reported having high loneliness, as assessed by the 3-item version of the UCLA Loneliness Scale Short Form.

During the coronavirus disease 2019 (COVID-19) pandemic, individuals who report high levels of loneliness, pandemic-related worries, and low tolerance to distress are more likely to have high clinical levels of depression, according to results published in Psychiatry Research. High family support and self-reported psychological resilience, as well as being Asian American or Hispanic/Latino, were associated with a reduced likelihood of having depression during this period.

The investigators collected data from wave 1 of the CARES (COVID-19 Adult Resilience Experiences Study) 2020 Project, conducted 1 month after the declaration of the US state of emergency because of COVID-19 and 1 month prior to the initial lifting of restrictions (April 13 to May 19, 2020). These data included 898 US-based young adults aged 18 to 30 years who were recruited online.

Approximately 43.3% of respondents to the cross-sectional study reported depression, as assessed by an 8-item Patient Health Questionnaire (PHQ-8) score ≥10. Additionally, respondents reported high levels of anxiety (45.4%; 7-item Generalized Anxiety Disorder Scale scores ≥10) and posttraumatic stress disorder (PTSD) symptoms (31.8%; PTSD Checklist—Civilian Version scores ≥45).

More than half (61.5%) of respondents reported having high loneliness, as assessed by the 3-item version of the UCLA Loneliness Scale Short Form. Scores on the 15-item measure Distress Tolerance Scale indicated that 74.1% of respondents had low distress tolerance, whereas scores on the 10-item Connor-Davidson Resilience Scale indicated that 72% of respondents had low resilience.

In logistic regression models, significant predictors of depression, anxiety, and PTSD included loneliness (odds ratio [OR] range, 1.98–2.72), COVID-19-specific worries (OR range, 2.87–5.05), and distress tolerance (OR range, 0.22–0.42). High levels of psychological resilience were associated with a reduced likelihood of scoring above cutoffs for anxiety and depression. Additionally, participants who reported high levels of family support were less likely to have scores suggestive of depression (OR, 0.46; 95% CI, 0.32-0.66; P <.001) and PTSD (OR, 0.44; P <.001).

No association was found between age and income with depression, anxiety, or PTSD. While men, who identified as transgender were significantly more likely to report high PTSD levels (OR, 4.20; 95% CI, 1.62–10.89; P =.003), no differences were found between cisgender men and women. Compared with whites, Asian Americans were significantly less likely to report high levels of PTSD (OR, 0.40; 95% CI, 0.25–0.64; P <.001) and depression (OR, 0.50; 95% CI, 0.33–0.76; P =.001). Additionally, participants were less likely to report high levels of anxiety if they were Asians American and Hispanic/Latinos.

Limitations of this study included the reliance on self-reported data, its cross-sectional design, and the use of a convenience sample.

The investigators noted that mental health interventions should include the identified predictors of depression and anxiety “to help mediate the impact of COVID-19 on adverse mental health status among US young adults.”


Liu CH, Zhang E, Wong GTF, Hyun S, Hahm HC. Factors associated with depression, anxiety, and PTSD symptomatology during the COVID-19 pandemic: Clinical implications for U.S. young adult mental health [published online June 1, 2020]. Psychiatry Res. doi: 10.1016/j.psychres.2020.113172.