Changes in anxiety and depression in patients with different income levels through the COVID-19 pandemic

• Published in: Journal of affective disorders 2023-10, Vol.338, p.17-20
• Main Authors: Qian, Zhiyu, Pines, Andrew, Stone, Benjamin V., Lipsitz, Stuart R., Moran, Lauren V., Trinh, Quoc-Dien
• Format: Article
• Language: English
• Subjects: Anxiety; Anxiety - epidemiology; Anxiety Disorders - epidemiology; COVID-19; COVID-19 - epidemiology; Depression; Depression - epidemiology; Humans; Pandemics; Public health; United States - epidemiology
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2023.06.003

Lower socioeconomic status is known to be associated with high mental health burden, there have been few epidemiological studies showing how socioeconomic status has modified the effect of COVID-19 on anxiety and depression. We analyzed data from the National Health Interview Survey in the United States between 2019 and 2021 and used respondents with a documented income-to-poverty ratio as a measure of income level (n = 79,468). We used frequency of medication use and self-reported frequency of anxious and depressive episodes as the main outcome measures. We performed a multivariable logistic regression with a two-way interaction term between income and survey year. We found a statistically significant worsening of depression and anxiety metrics in respondents with higher income levels from 2019 to 2021. We did not observe a significant change in anxiety and depression metrics for low-income respondents over the same period. The data from the NHIS survey is limited primarily by sampling bias (response rate of 50.7 % in 2021), as well as the self-reported nature of the one of the outcome measures. These findings suggest that, within the limits of the National Health Interview Survey, mental health outcomes were worse but stable in a socioeconomically disadvantaged demographic between 2019 and 2021. In a higher socioeconomic bracket, mental health outcomes were less severe than the disadvantaged demographic but were worsening at a greater rate. •The study assessed 2019-2021 National Health Interview Survey (NHIS) data from 79,468 respondents.•Findings revealed a correlation between socioeconomic status and mental health; lower income corresponded with progressively higher anxiety and depression.•Higher income respondents showed a more pronounced rise in anxiety and depression from 2019-2021 compared to lower income counterparts.•Despite a worse mental health baseline in the poor, COVID-19 may have hit the rich harder with anxiety and depression.