Racial and Ethnic Disparities in the Mental Health Impact of the COVID-19 Pandemic in the United States: Analysis of 3 Million Americans from the National Health Interview Survey and Household Pulse Survey

Abstract

Background: During the coronavirus (COVID-19) pandemic, racial/ethnic minorities in the United States (US) experienced a disproportionate burden of COVID-19 mortality and hospitalization, job losses, food insecurity, and reduced healthcare access, resulting in increased mental health problems. Given heterogeneous findings on the impact of COVID-19 among racial/ethnic minorities, it is worthwhile to examine the differential effects of the pandemic on mental health by race/ethnicity. Methods: This study examines changes in mental health status among US adults aged ≥18 years before and during the pandemic. We pooled data from the 2019 National Health Interview Survey with the 2020-2021 Household Pulse Survey (N=2,980,511). Logistic regression was used for binary outcomes and linear regression was used for the composite Psychological Distress Index (PDI) measure derived from principal components analysis to estimate changes in mental health after controlling for sociodemographic characteristics. Results: Mental health status worsened during the pandemic compared to the pre-pandemic period. The adjusted predicted probabilities of having little interest increased from 3.29% in 2019 to 10.97% in 2020 and 11.28% in 2021. The adjusted predicted probabilities of being depressed increased from 2.69% in 2019 to 11.00% in 2020 and 11.21% in 2021. The adjusted predicted probabilities of feeling anxious increased from 3.95% in 2019 to 18.35% in 2020 and 16.96% in 2021. The adjusted predicted probabilities of worrying increased from 4.18% in 2019 to 13.15% in 2020 and 12.61% in 2021. The adjusted mean PDI score increased from 87.52 in 2019 to 103.18 in 2020 and 101.13 in 2021. In stratified models, Blacks, Hispanics, and Asians had higher odds of depression, anxiety, and worries, compared with non-Hispanic Whites. Asians experienced 10 times higher odds of depression and 15 times higher odds of anxiety in 2020 than their counterparts before the pandemic. Conclusions and Implications for Translation: US adults experienced a marked increase in mental health problems, including depression and anxiety, in 2020 and 2021, compared with their counterparts in 2019. Racial/ethnic disparities in mental health worsened during the pandemic.