Scientists from the University of North Carolina and City University New York have recently revealed that a majority of United States citizens have suffered from anxiety disorders amid the coronavirus disease 2019 (COVID-19) pandemic. Financial adversity is one of the major causative factors for anxiety symptoms. The study is currently available on the medRxiv* preprint server.
Since its emergence in December 2019, the rapid spread of the potentially lethal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has placed a significant burden on healthcare systems and the socioeconomic structures of many countries across the world. The US has been among the worst-hit countries by the COVID-19 pandemic, with over 9.4 million cases of the virus confirmed and over 122,000 COVID-19-related deaths. Previous studies conducted during other pandemic conditions, such as the SARS pandemic in 2003, have found that the frequency of anxiety episodes, suicidal attempts, and other emotional distress increases among individuals during pandemic conditions.
In the US, about 31% of the general population suffer from anxiety symptoms at some point in their life. Therefore, it is likely that continuous stressful circumstances during the COVID-19 pandemic may excaberate or further accelerate episodes of anxiety symptoms in susceptible individuals. Specifically, people with comorbid health complications, such as diabetes, cardiopulmonary disorders, and obesity, are at higher risk of developing anxiety disorders because of the additional fear of developing life-threatening illnesses from a SARS-CoV-2 infection. Similarly, people directly involved in healthcare settings, such as physicians, nurses, and other healthcare staff, are more susceptible to develop anxiety disorders because of significantly increased workloads and fear of becoming infected on the job.
Besides, there could be many other factors, such as financial hardship, unemployment or underemployment, and job uncertainty, which can trigger anxiety development in susceptible individuals. To better manage the overall physical and mental wellbeing of people during the COVID-19 pandemic, it is important to identify both anxiety triggers and susceptible members of the population.
*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
Current study design
Given the possible impact of COVID-19 on mental health conditions, the scientists aimed at investigating the prevalence of anxiety disorders among US citizens, and the association between various stress factors and the onset of anxiety symptoms. The scientists believe that the study’s findings will help develop appropriate strategies to identify and treat people who are more likely to develop anxiety symptoms during the pandemic.
Important observations
The study was conducted on 5,250 geographically and socio-demographically diverse US citizens. About 27%, 16%, and 18% of the study participants reported having mild, moderate, and severe anxiety symptoms, respectively.
About 33% of participants reported having various health complications, and the scientists found that all the health conditions analyzed in the study were associated with moderate-to-severe anxiety symptoms. Interestingly, about 31% of the participants reported that they were previously diagnosed with depression.
The relationship between various stress factors and anxiety symptoms
The prevalence of anxiety was significantly higher among individuals who recently experienced COVID-19 like symptoms. Similar consequences have also been observed during the SARS pandemic in 2003.
People with medically confirmed depression were also susceptible to anxiety disorders. This is somewhat expected as depression and anxiety are highly comorbid. Several cognitive-behavioral therapies (CBTs) have been developed in recent years to treat these comorbid mental conditions.
A significant correlation was observed between smoking status and anxiety level in the study. People who smoke daily showed a higher prevalence of moderate or severe anxiety symptoms. Previous studies have also pointed out that people with anxiety disorders develop a tendency to smoke daily. Therefore, an increase in the rate of smoking is likely among people suffering from anxiety in adverse conditions like the COVID-19 pandemic.
People who had extreme fears about getting a SARS-CoV-2 infection, as well as those who had extreme fears about their friends and family becoming infected, were at higher risk of developing anxiety symptoms, the study also found.
Regarding work-related stress factors, financial hardship was found to be the major cause of anxiety. About 45% and 17% of participants reported a loss of income or a loss of employment during the pandemic, respectively. An increased prevalence of anxiety was also observed among healthcare and non-healthcare essential workers. Financial hardship is considered to be a major contributing factor to the worst mental health outcomes. Given the pandemic-related financial crisis, appropriate social support systems and coping measures should be developed to minimize the impact of financial stress on emotional distress.
Regarding demographic factors, females and transgender people were more likely to develop anxiety symptoms. Interestingly, despite having a higher risk of developing a severe form of COVID-19, elderly people (age range: 50 years and above) showed a lower prevalence of anxiety than younger people (age range: 18 – 29 years). A relatively higher impact of unemployment and financial crisis may be associated with higher anxiety levels among younger people.
*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
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