Younger adults hit hardest by pandemic-related anxiety and depression

By Neha MathurDec 4 2023Reviewed by Benedette Cuffari, M.Sc.

In a recent study published in the journal JAMA Network Open, researchers investigate age-related disparities in anxiety and depression during the coronavirus disease 2019 (COVID-19) pandemic.

Study: Age Disparities in Prevalence of Anxiety and Depression Among U.S. Adults During the COVID-19 Pandemic. Image Credit: maxbelchenko / Shutterstock.com

Background

In the ten years before the COVID-19 pandemic, adolescents and young adults in the United States were associated with higher levels of mental health issues than older adults. Yet, studies have not investigated whether mental health worsened during the COVID-19 pandemic among younger adults or all adult age groups.

Research studies focused on the first few months after the onset of the COVID-19 pandemic identified up to a sixfold increase in the levels of anxiety and depression during the COVID-19 pandemic among U.S. young adults. However, there remains a lack of studies examining their persistence throughout the pandemic.

Age disparity likely widened or narrowed during the COVID-19 pandemic; however, its prevalence would have been higher for younger adults than their older counterparts at the pandemic's beginning and later fell for all age groups as vaccines became available.

About the study

The researchers investigated three million responses to the Household Pulse Survey (HPS) completed between April 2020 and August 2022. Additionally, state-level week-on-week data on COVID-19 cases and deaths, including all pandemic- and non-pandemic-related stressors measured in the HPS, were also analyzed.

These data included younger adults' economic state and their responses to COVID-19 case counts and vaccine availability. Each U.S. Census Bureau-sponsored HPS survey covered about 63,000 respondents, with a response rate of 6.4%.

A decomposition analysis was performed to measure the age disparity statistically elucidated by differences in stress exposure across age groups versus differences in their susceptibility to these stressors. Two-item screeners were used to measure respondents' anxiety and depression levels, with scores of three or higher indicating clinical significance.

This analysis adjusted for demographic factors, including gender, age, race/ethnicity, educational status, and income, and also considered the impact of historical and ongoing inequalities.

Several variables were used to measure economic precarity based on home ownership, employment status, and experiencing income loss during the COVID-19 pandemic.

In the statistical analysis, the Blinder-Oaxaca decomposition method was used to analyze differences in anxiety and depression between adults aged 18-39 and 40-59 years. Demographic differences in the prevalence of anxiety and depression, as well as the association between stressors and mental health outcomes for young adults versus middle-aged adults, were also analyzed.

Study findings

Young adults aged 18 to 39 years had the highest prevalence of clinically relevant anxiety and depression symptoms, with their prevalence decreasing with age. The authors noted differences based on age, education level, and household income.

Anxiety and depression levels were higher among females than males. Interestingly, over 50% of people with high anxiety scores had higher depression scores, whereas over 80% with high depression scores had higher anxiety scores.

Younger adults also had lower household incomes, lower rates of living alone, and higher scores on the economic risk composite compared to middle-aged adults. However, both groups were associated with comparable income and employment loss rates due to the COVID-19 pandemic. 

Importantly, young adults were the most exposed to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and less likely to report getting vaccinated.

While COVID-19 case numbers were more robustly associated with anxiety and depression in younger adults than older adults, the situation was strikingly opposing concerning improvements in mental well-being after COVID-19 vaccination. Thus, COVID-19 vaccination improved the mental well-being of adults aged 40 years or older to a greater extent as compared to those aged 18 to 39 years. The analysis also confirmed that mental health did not worsen among respondents who lived alone or with their children.

Regardless of age, all individuals with high scores on the economic risk scale showed high levels of anxiety and depression. Decomposition analysis results revealed that about 20% of the age-related disparity in anxiety and depression depended on varying demographic characteristics, including income, which would have translated to an estimated 1.8 million fewer U.S. young adults showing clinically relevant anxiety or depression symptoms. 

Conclusions

The current study offers valuable insights into various factors associated with anxiety and depression symptoms, including stress exposures related to the COVID-19 pandemic and economic precarity, a non-pandemic-related stressor. Furthermore, factors related to the pandemic and economic stress likely influenced each other.

Various events and social stressors, such as mass shootings and geopolitical events, also influenced persistently elevated anxiety and depression observed among young adults, thus highlighting the need for targeted mental health care and economic policies.

Nearly one-third of age-related disparities between young adults and middle-aged adults in the U.S. were attributable to differences in their demographic and economic conditions. Although some older adults also experienced anxiety and depression, the presence of these symptoms reduced with the availability of COVID-19 vaccines, unlike in younger adults.