COVID-19 Pandemic Associated with Acute Stress, Depressive Symptoms in Residents of the United States

PTSD Mental health concept. Post Traumatic Stress Disorder. The depressed woman sitting alone on the floor in the dark room background. Film look.
While the COVID-19 pandemic is a stress-inducing event, published empirical studies about mental health consequences are rare.

Study data published in Science Advances outline the psychiatric burden of the coronavirus disease 2019 (COVID-19) pandemic in the United States. Between March and April of 2020, acute stress and depressive symptoms increased significantly among residents in the United States. Media exposure to COVID-19 information was a major predictor of mental health symptoms.

Investigators conducted a rapid response study of 3 samples selected from the NORC AmeriSpeak panel, a probability-based panel of 35,000 households in the United States. A random sample of 11,139 panelists was selected from AmeriSpeak using sample stratification to ensure representativeness with respect to age, gender, race/ethnicity, and educational attainment. Beginning March 18, 2020, researchers administered a 20-minute survey for 10 days to 3 consecutive cohorts: Cohort 1 (March 18-28, 2020); Cohort 2 (March 29-April 7, 2020); Cohort 3 (April 8-18, 2020).

Participants received the survey invitation by email and completed all questions online. Baseline health data were collected at the time of enrollment in the AmeriSpeak panel. Participants were asked to report their degree of exposure to the COVID-19 pandemic by personal, workplace, and community metrics. Participants also rated their degree of media exposure to COVID-19. Acute stress and depressive symptoms were measured using modified versions of the Acute Stress Disorder Scale and the Brief Symptom Inventory, respectively. Least squares regression was used to assess correlates of mental health symptoms in response to the COVID-19 pandemic.

Of 11,139 solicited panelists, a total of 6514 (59.2%) completed surveys: 2122 in Cohort 1; 2234 in Cohort 2; and 2158 in Cohort 3. Mean age in the pooled sample was 47.51 ± 17.45 years, and 51.9% were women. The racial/ethnic distribution was as follows: 63.6% non-Hispanic white; 11.8% non-Hispanic Black; 16.0% Hispanic; and 8.7% other ethnicities. Two-thirds of participants lived in urban areas, 33.6% had earned a bachelor’s degree or higher, and median income was between $40,000 and $49,000 annually.

Overall, 23.5% of the sample reported that they or a personal contact had been exposed to COVID-19. An additional 29.8% reported work-related exposure to the virus. A mean of 1.37 ± 1.21 secondary stressors related to the outbreak were reported, including loss of employment, lower wages, or waiting in line for supplies. Participants reported consuming a mean of 7.06 ± 6.91 hours of outbreak-related coverage daily. In addition, many participants reported receiving “conflicting” information from media sources.

Acute stress symptoms increased over time, with Cohort 1 experiencing significantly lower stress levels than Cohorts 2 and 3 (P <.001). In addition, Cohort 3 had significantly higher Acute Stress Response scores than Cohort 2 (P <.05). Depressive symptoms also increased over time, with Cohort 3 reporting significantly greater depression than Cohort 2 (P <.01) and Cohort 1 (P <.001). In regression models, prior mental and physical health conditions were significantly associated with both acute stress and depressive symptoms. Additionally, increased outbreak-related media consumption strongly predicted acute stress and depressive symptoms. Self-reported “conflicting” media information also correlated with mental health symptoms. Finally, personal exposures to COVID-19 increased the risk for acute stress and depressive symptoms, though work-related or community exposures did not.

These data underscore the psychological impact of the COVID-19 pandemic on individuals in the United States. During a period of escalating case numbers and fatalities, participants experienced increased stress and depressive symptoms. Study results emphasize the necessity of public health interventions focused on mental health and stress management, particularly for those with pre-existing psychological conditions. The primary study limitation is its short follow-up period, which prevented re-assessment of the same cohorts. Further research is necessary to examine the prolonged effects of pandemic exposure.

“[Our] results have implications for targeting of public health interventions and risk communication efforts to promote community resilience as the pandemic waxes and wanes over time,” the investigators wrote.


Holman EA, Thompson RR, Garfin DR, Silver RC. The unfolding COVID-19 pandemic: a probability-based, nationally representative study of mental health in the US [published online September 18, 2020]. Sci Adv. doi: 10.1126/sciadv.abd5390