About four in ten American adults (41%) have experienced high levels of psychological distress at least once since the early stages of the coronavirus outbreak, according to a new analysis from the Pew Research Center that examines survey responses from same Americans over time.
Experiences of great psychological distress are particularly prevalent among young adults. A 58% majority of people aged 18-29 experienced high levels of psychological distress at least once in four Center surveys conducted between March 2020 and September 2022.
This assessment of the public’s psychological reaction to the COVID-19 outbreak is based on surveys of members of the Pew Research Center’s American Trends Panel (ATP) conducted online multiple times since March 2020. Questions about mental health were included in four surveys. The first survey was conducted with 11,537 American adults from March 19-24, 2020; a second survey with the series of questions was conducted from April 20 to 26, 2020, with a sample of 10,139 adults; a third survey was conducted from February 16 to 21, 2021 among 10,121 adults; and the most recent survey was conducted September 13-18, 2022 among 10,588 adults. Additionally, the researchers analyzed a subsample of 5,007 respondents who participated in each of the four surveys to examine psychological distress over time.
The ATP is an online survey panel that is recruited by random national sampling of residential addresses. In this way, almost all American adults have a chance of being selected. Surveys are weighted to be representative of the adult US population by gender, race, ethnicity, party affiliation, education and other categories. The group of respondents who participated in each of the four surveys was weighted equally to be representative of the US adult population. Here is more information about the ATP.
The Psychological Distress Index used here measures the total amount of mental distress that individuals reported experiencing over the past seven days, as captured by questions measuring insomnia, anxiety, depression, loneliness and the physical reactions felt when thinking about the epidemic. The low distress category comprises about half of the sample; very few people in this group reported experiencing any type of distress most or all of the time. The medium category comprises about a quarter of the sample, while the high distress category comprises 21%. A large majority of those in the high distress group reported feeling at least one type of distress most or all of the time in the past seven days.
This research benefited from the guidance and advice of the COVID-19 and Mental Health Measurement Group at the Johns Hopkins Bloomberg School of Public Health (JHSPH): Catherine K. Ettman (JHSPH); Mr. Daniele Fallin (JHSPH, now at Emory University); Calliope Holingue (Kennedy Krieger Institute, JHSPH); Renee Johnson (JHSPH); Luke Kalb (Kennedy Krieger Institute, JHSPH); Frauke Kreuter (University of Maryland, Ludwig-Maximilians University of Munich); Elizabeth Stuart (JHSPH); Johannes Thrul (JHSPH); and Cindy Veldhuis (Columbia University, now at Northwestern University).
The following are the mental health questions used for this analysis, along with the responses, and detailed statements of survey methodology for surveys conducted in March 2020, late April 2020, February 2021, and September 2022.
The analysis highlights the fluid nature of psychological distress among Americans, as measured by a five-item index that asks about experiences such as loneliness, anxiety and sleep disturbances.
In the September 2022 survey, 21% of American adults fell into the high psychological distress category; in each of the four surveys, no more than 24% of adults fell into this category. But because individuals experience varying levels of distress at different points in time, a significantly larger share of Americans (41%) experienced elevated psychological distress. at least one time in the four surveys conducted over the past two and a half years.
In addition to age, experiences of high psychological distress are strongly related to disability status and income. About two-thirds (66%) of adults who have a disability or health condition that prevents them from fully participating in work, school, household chores or other activities reported a high level of distress in least once in the four surveys. And those with lower household income (53%) are more likely than those in middle (38%) and high (30%) income households to have experienced high psychological distress at least once since March 2020.
See also: In CDC survey, 37% of US high school students report regular mental health issues during COVID-19 pandemic
While many Americans faced mental health issues before the coronavirus pandemic, public health officials warned in early 2020 that the pandemic could exacerbate psychological distress. The negative effects of the epidemic have hit some people harder than others, with women, low-income adults, and black and Hispanic adults among groups who have experienced disparate health or financial impacts.
Americans’ personal worry levels about getting or spreading the coronavirus have continued to decline over the course of 2022. The coronavirus is one of many potential sources of stress, including the economy and concerns about the future of the nation.
Psychological distress levels have changed for most Americans during the pandemic
Amid the changing landscape of COVID-19 in the United States, only 35% of Americans recorded the same level of psychological distress – whether high, medium or low – in the four surveys conducted by the Center since March 2020.
Instead, a majority of respondents (60%) moved from one level of psychological distress to another. Psychological distress increased for some but decreased for others. An illustration of the fluid nature of these experiences is that while 41% of American adults faced high psychological distress at least one time out of four surveys, only 6% felt great distress in all four surveys. Almost five times as many (28%) felt low distress across all surveys.
The Psychological Distress Index is based on measures of five possible types of distress experienced over the past week, such as anxiety or insomnia, which are adapted from standard psychological measures. As used in the current survey, the questions are not a clinical measurement or diagnostic tool; they describe people’s emotional experiences in the week before the interview.
Only one question specifically refers to the coronavirus outbreak. He asks how often over the past week Americans have “had physical reactions, such as sweating, difficulty breathing, nausea, or racing heartbeat” when thinking about their experience with the coronavirus outbreak. In the last September poll, 14% of Americans answered yes to this question. In March 2020, in the early stages of the epidemic, 18% said they had experienced it.
Sleep disturbance is one of the most common forms of distress measured in surveys. In the latest survey, around two-thirds of adults (64%) reported having trouble sleeping at least some or a small part of the time in the past week. A similar proportion (61%) said they felt nervous, anxious or nervous.
Experiences of depression and loneliness also occur among significant shares of Americans. In the most recent survey, 46% of adults said they felt depressed at least one or two days in the past week, and 42% said they felt lonely.
All four surveys included a question about positive feelings, although it is not part of the psychological distress index. Overall, 78% of American adults said they felt optimistic about the future at least one or two days in the past week, according to the latest September survey. However, 22% of adults said they had felt optimistic about the future rarely or never in the past week.
Note: The following are the mental health questions used for this analysis, along with responses and detailed statements of survey methodology for surveys conducted in March 2020, late April 2020, February 2021, and September 2022.
Giancarlo Pasquini is a research associate specializing in science and social research at the Pew Research Center.
Scott Keter is a senior polling consultant at the Pew Research Center.
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