SAMHSA

Disaster Technical Assistance Center 

Supplemental Research Bulletin

A Preliminary Look at the Mental Health 

and Substance Use-related Effects of 

the COVID-19 Pandemic

May 2021
CONTENTS

INTRODUCTION 3

MENTAL HEALTH IMPACTS OF THE COVID-19 PANDEMIC 4

Overall Mental Health 4

Stress 4

Anxiety 5

Depression 5

SUBSTANCE USE-RELATED IMPACTS OF THE PANDEMIC 6

Increases in Substance Use 6

Changes in Substance Use Disorder Treatment 6

SUICIDE RISK AND SUICIDAL IDEATION 7

SPECIAL POPULATIONS 7

Youth 7

Women 9

Health Workers and Healthcare Workers 10

Racial and Ethnic Minorities 10

Individuals With Lower Incomes and Less Money in Savings 11

Individuals Who Are Homeless 11

Older Adults 12

IMPACTS ON INDIVIDUALS WITH PREEXISTING MENTAL ILLNESS 13

Greater Risk of Becoming Sick With or Dying of COVID-19 13

Mental Health Effects of the Pandemic on People With Preexisting Mental Illness 14

MENTAL HEALTH IMPACTS OF GETTING SICK WITH COVID-19 14

INTERVENTIONS AND APPROACHES TO SUPPORT MENTAL HEALTH DURING AND AFTER 

THE PANDEMIC 15

Risk Communication 15

Screening and Assessment 17

Approaches for the Public 17

Approaches for Health Workers and Healthcare Workers 17

Telehealth 18

Partnerships 18

Policy and Funding 19

CONCLUSION 19

REFERENCES 20

The focus of the Supplemental Research Bulletin is to provide an overview of the current literature on a specific 

topic and make it easy to understand for disaster behavioral health professionals who are not otherwise exposed 

to the research. The product aims to assist professionals and paraprofessionals involved in all-hazards planning, 

disaster behavioral health response and recovery, and/or Crisis Counseling Assistance and Training Program 

grant activities.
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INTRODUCTION

This issue of the Supplemental Research Bulletin focuses on preliminary research (through November 

30, 2020) on the mental health and substance use-related impacts of the coronavirus disease 2019 

(COVID-19) pandemic in the United States. It covers changes in rates of mental health and substance 

use issues and conditions, suicide risk, and suicidal thoughts, and it identifies populations who are 

faring more poorly in terms of mental health and substance use. It describes effects of the pandemic on 

individuals with preexisting mental illness. It also features expert suggestions for practices and policy to 

support the mental health of the U.S. public.

Since the first U.S. diagnosis in January 2020, the COVID-19 pandemic has taken more U.S. lives 

than World War I, the Vietnam War, and the Korean War combined (Hennein & Lowe, 2020; American 

Psychological Association [APA], 2020). In addition to morbidity and mortality, the pandemic has had a 

major psychological impact in communities and nations around the world. As Simon et al. write in JAMA,

“The necessary social distancing and quarantine measures . . . have significantly amplified emotional 

turmoil by substantially changing the social fabric by which individuals, families, communities, and nations 

cope with tragedy. The effect is multidimensional disruption of employment, finances, education, health 

care, food security, transportation, recreation, cultural and religious practices, and the ability of personal 

support networks and communities to come together and grieve” (2020).

It may not be surprising, then, that research on effects of the pandemic has found increased anxiety, 

depression, traumatic stress, and substance use across the United States. One study found that the 

percentage of individuals who had seriously considered suicide in the past 30 days had nearly tripled 

compared to before the pandemic (Czeisler et al., 2020). 

Owing to the ongoing stressors and uncertainties linked to the pandemic, mental health experts have 

expressed concern about a potential “second wave” of rising rates of distress, mental illness, and 

substance use as a result of the pandemic (Simon et al., 2020; Öngür et al., 2020). It has also been 

noted that different types and intensities of stressors may have different effects on mental health, with 

stressors such as exposure to the virus and severe, even life-threatening illness differing substantially in 

their impacts from secondary stressors such as reduction in social contact and support due to physical 

distancing, loss of a job or business, or inability to pay for housing or food. When this bulletin was written, 

research had not yet elucidated these relationships, but future research may provide a more detailed 

picture.

In light of the pandemic and the threats it poses to mental as well as physical health, experts have 

proposed several measures to improve public mental health and well-being. Experts have also highlighted 

the opportunities inherent in the crisis of the pandemic, pointing out that the pressure to attend to the 

mental health needs of the public may spur progress toward long-needed changes to address inequities, 

meet public mental health and substance use treatment needs, and improve services and supports in the 

United States (Moutier, 2020). 

This issue of the Supplemental Research Bulletin is based on literature and scientific publications 

found through the National Center for Biotechnology Information and U.S. National Library of Medicine 

(PubMed), APA PsycNet, and Scopus databases. All research cited in this issue was published in English, 

and most was conducted in the United States (with exceptions where investigations in other countries 

proved useful to the topic). 
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In addition, as noted, research in this issue is preliminary; it includes research conducted through the 

end of November 2020. Because of timelines required for research, including data collection, analysis, 

reporting, review, and publishing, many studies included in this issue focus on the effects of the pandemic 

in or before April or May 2020. 

Also, primarily because of the need for physical distancing to minimize the spread of COVID-19, many 

studies in this issue are based on surveys administered online. These studies involve measurement of 

symptoms using scales on which individuals report their own symptoms, rather than full assessment of 

diagnostic criteria for mental illnesses and specific substance use disorders. While this is understandable 

given the constraints placed by the pandemic, it means that conclusions cannot be drawn from these 

studies on how prevalent specific mental illnesses or substance use disorders are in the population; 

the studies reflect levels of distress in the population as opposed to psychopathology (mental illness 

or substance use disorder). From a public health perspective, this distinction is critical, as it can inform 

allocation of limited resources—individuals with mental illness and substance use disorder should be 

provided with treatment, whereas individuals experiencing distress may benefit from other, less intensive 

and generally less expensive, psychosocial interventions. 

MENTAL HEALTH IMPACTS OF THE COVID-19 PANDEMIC

Pfefferbaum and North write that “extensive research in disaster mental health has established that 

emotional distress is ubiquitous in affected populations — a finding certain to be echoed in populations 

affected by the COVID-19 pandemic” (2020). Research highlights increases in anxiety, depression, and 

traumatic stress, as well as stress and loneliness, in the United States.

Overall Mental Health

The APA (2020) fields an annual, nationally representative survey on stress and mental health in 

the United States. Administered in August, the 2020 survey included 3,409 adult and 1,026 teenage 

participants (ages 13–17 years). In a report on the 2020 survey, the APA (2020) writes that 19 percent of 

adults describe their mental health as worse than at the same time last year.

Stress

The APA reports that 78 percent of adult respondents to its Stress in AmericaTM survey in 2020 said that 

the COVID-19 pandemic is a significant source of stress in their lives, and about two-thirds (67 percent) 

of adult respondents reported increased stress during the pandemic (2020). Forty-nine percent of adult 

respondents also reported negative effects of increased stress, such as increased bodily tension (21 

percent), being very quick to anger (20 percent), unexpected mood swings (20 percent), or screaming or 

yelling at a loved one (17 percent).
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Anxiety

Studies have found larger percentages of the public meeting clinical cutoff scores1 for generalized anxiety 

disorder (GAD) than is typical in population-representative studies. For example, in a survey of 5,412 

U.S. adults in late June 2020, researchers found that about 26 percent of respondents were symptomatic 

for GAD (i.e., they scored at or above 3 on the GAD-2 subscale of the Patient Health Questionnaire 

for Depression and Anxiety [PHQ-4]) (Czeisler et al., 2020). This was approximately three times the 

percentage of respondents scoring at or above 3 on the GAD-2 subscale in comparable survey research 

reported in 2019 (Czeisler et al., 2020). On the other hand, a survey of a nationally representative sample 

of 10,368 U.S. adults fielded in late March 2020 found a mean GAD-7 score indicating only mild anxiety, 

although more than 12 percent of respondents had scores indicating severe anxiety (Fitzpatrick, Drawve, 

et al., 2020).

In a study in the United Kingdom, researchers found that mean anxiety scores on the GAD-7 scale were 

significantly higher than mean GAD-7 scores found in general population studies (Rettie & Daniels, 

2020). Also, the percentage of individuals in the study with GAD-7 scores above the clinical cutoff—the 

score indicative of a probable case of the disorder—was 24.3 percent, whereas in similar studies the 

percentages above this cutoff were closer to 5 percent.

Depression

In the June 2020 survey of 5,412 U.S. adults, researchers also found that 24.3 percent of respondents 

were symptomatic for depressive disorder (measured using the two-item Patient Health Questionnaire 

[PHQ] subscale of the PHQ-4) (Czeisler et al., 2020). This percentage is roughly four times the 

percentage of respondents at or above the symptomatic level for depressive disorder in comparable 

research from 2019 (Czeisler et al., 2020).

Other research examined depression rates in the National Health and Nutrition Examination Survey 

(NHANES) in 2017 and 2018 and in a study called COVID-19 and Life Stressors Impact on Mental Health 

and Well-being (CLIMB) in March and April 2020 (Ettman et al., 2020). Both surveys were nationally 

representative, and both measured symptoms of depression using the nine-item PHQ (PHQ-9) and 

categorized symptoms according to severity, from none (with a PHQ-9 score of 0–4) to severe (a score at 

or above 20). Prevalence of symptoms of depression increased in every severity category (except none), 

and more than tripled in the full study population, from before to during the pandemic (Ettman et al., 

2020). 

In the survey of 10,368 U.S. adults that found only mild levels of anxiety, respondents had elevated levels 

of depression as assessed with a shortened form of the Center for Epidemiologic Studies Depression 

(CES-D) scale (Fitzpatrick, Drawve, et al., 2020). The mean score on the CES-D was higher than the 

clinical cutoff score for a diagnosis of depression. 

1 The APA Dictionary of Psychology defines a cutoff score as “a value or criterion that is held to mark the 

lowest point at which a certain status or category is attained. For example, the cutoff score for passing a 

course is often 60%. Similarly, the cutoff score for being considered overweight is a body mass index of 

25 to 29” (n.d.). A clinical cutoff score is the score on a questionnaire, survey, or similar assessment tool 

above (or sometimes below) which an individual is likely to meet clinical criteria for a mental illness.
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In the aforementioned United Kingdom study, researchers also found mean depression scores (measured 

using the eight-item PHQ, or PHQ-8) that were significantly higher than scores found in similar studies 

(Rettie & Daniels, 2020). They also found that the percentage of respondents with PHQ-8 scores above 

the clinical cutoff of 10 (25.8 percent) was about three times the percentage found in a comparable study.

SUBSTANCE USE-RELATED IMPACTS OF THE PANDEMIC

Researchers have found increases in substance use during the pandemic, including cases in which 

participants reported using substances in an attempt to cope with the pandemic. They also have reported 

on positive developments, such as trends in treatment of opioid use disorder (OUD) that allow greater 

flexibility and may continue once the pandemic ends.

Increases in Substance Use

In the June survey of 5,412 U.S. adults, about 13 percent of respondents said they had begun or 

increased substance use to cope with stress or emotions associated with the COVID-19 pandemic 

(Czeisler et al., 2020). Osofsky et al. (2020) cite early reports of increases in substance use in tandem 

with the pandemic.

Research has also found increases specifically in alcohol use. In a short report on survey research in 

2019 (before the pandemic) and 2020 (once the pandemic had begun) involving 1,540 U.S. adults, 

investigators note that frequency of alcohol consumption increased by 14 percent across the full sample 

of participants (Pollard et al., 2020). In a survey of 170 U.S. adults, 30.1 percent of respondents said their 

alcohol use had increased during the pandemic (Peterson et al., 2020). 

Changes in Substance Use Disorder Treatment

A team of investigators conducted a small study in April 2020 with 18 clinicians waivered to prescribe 

buprenorphine as part of medication-assisted treatment (MAT) for OUD (Uscher-Pines et al., 2020). A 

key aim of the study was to explore the impact of the dramatic change in healthcare delivery during the 

pandemic, and specifically the transition many healthcare practitioners had made to telemedicine. As 

the researchers explain, “In a matter of weeks in March 2020, many healthcare providers began using 

telemedicine to treat OUD . . . . To facilitate this rapid transition, states, the U.S. Department of Health 

and Human Services, private payers, and the Drug Enforcement Administration all announced temporary 

changes to the regulation and reimbursement of telemedicine for the duration of the pandemic (Long, 

2020).” 

The researchers found that some clinicians were reluctant to accept new patients; those who did 

generally arranged an in-person intake appointment before transitioning to telemedicine. The clinicians 

identified benefits of telemedicine, including increased convenience for patients and reduction in fear 

patients would otherwise have experienced about travel to appointments and sitting in a crowded waiting 

room. They also noted drawbacks, such as what they perceived as reduced accountability in a remote 

appointment format, greater difficulty in establishing rapport with patients, and technological difficulties. 

Clinicians reported reductions in other treatment services that are beneficial in combination with MAT 

for their patients, including peer support resources such as Narcotics Anonymous, which had canceled 

meetings or moved them to online formats, and psychotherapy (Uscher-Pines et al., 2020). 
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SUICIDE RISK AND SUICIDAL IDEATION

“With the added physical and mental health, social, and economic burdens imposed by the pandemic, 

many populations worldwide may experience increased suicide risk,” writes Christine Moutier, Chief 

Medical Officer of the American Foundation for Suicide Prevention, in JAMA Psychiatry (2020). She 

emphasizes, however, that increases in suicides are not inevitable, noting that “emerging suicide data 

from several countries show no evidence of an increase in suicide during the pandemic thus far.”

One cause for concern has been a historic surge in sales of firearms in the United States in March 2020, 

as research has indicated that access to a firearm is a risk factor for death by suicide (Moutier, 2020; 

Sacks & Bartels, 2020). In March 2020, nearly 2 million guns were purchased in the United States, the 

second highest monthly total of gun purchases since records have been kept (Sacks & Bartels, 2020). 

In a study involving 26.3 million first-time handgun owners in California from 2004 to 2016, researchers 

found that rates of suicide by any method were higher among handgun owners, with rates driven by far 

higher rates of suicide by firearm (Studdert et al., 2020). In addition, although handgun owners’ risk of 

suicide by firearm peaked shortly after they bought their first handgun, over half of suicides by firearm 

among handgun owners occurred more than a year after the purchase (Studdert et al., 2020).

In the Czeisler et al. (2020) study, approximately 11 percent of respondents reported that they had 

seriously considered suicide in the 30 days prior to the survey. In the comparison data from 2018 used in 

the study, 4.3 percent of respondents reported serious consideration of suicide in the previous 12 months. 

The percentage from 2018 to 2020 more than doubled, even though the 2020 question was based on a 

far shorter timeframe (Czeisler et al., 2020). 

SPECIAL POPULATIONS

Past research in disaster behavioral health has shown that some populations may be at elevated risk 

for mental health and substance use-related issues during and after disasters. This risk often relates 

to disparate levels of power in society and social capital, as groups with less power in a society may 

experience more, and more severe, stressors in and after a disaster and have fewer resources to mitigate 

and cope with those stressors. In the current pandemic, some research has found elevated rates of 

mental health issues among populations unified by age, gender, occupation, race, ethnicity, and other 

factors. In addition, one population (older adults) seems to be experiencing mental health issues to a 

lesser extent than others. 

Youth

Researchers have found higher rates of anxiety, depression, traumatic stress, and other issues among 

young adults (ages 18 to up to 35 years). While there are exceptions, young people seem to be a 

uniquely vulnerable population in the current pandemic. 

ANXIETY AND DEPRESSION

A team of researchers found an elevated rate of symptoms of anxiety (measured using the GAD-7, with 

a cutoff score of 10 or higher) in a sample of 898 adults ages 18 to 30 years who completed an online 

survey in April and May 2020 (Liu et al., 2020). To illustrate the elevated nature of the rate (45.4 percent), 

the researchers provide examples of rates from other research using the same cutoff score with the 
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GAD-7, including 23 percent among U.S. primary care patients, 21 percent among U.S. college students, 

and 17.4 percent among U.S. nonveteran community college students. The researchers also found an 

elevated rate of depression symptoms (assessed using the PHQ-8, with a score of 10 or higher indicating 

clinical symptom elevation). The rate, 43.3 percent, is many times higher than rates found in a prior study 

using the PHQ-8, in which 6.2 percent of 18- to 24-year-olds and 13.1 percent of 25- to 34-year-olds 

scored at or above the cutoff (Kroenke et al., 2009; as cited in Liu et al., 2020). 

Czeisler et al. note that symptoms of anxiety disorder or depressive disorder (measured with the PHQ-4) 

were most commonly reported by respondents ages 18 to 24 years (at a weighted rate of 62.9 percent), 

with prevalence decreasing across the study population with increasing age (2020). Another research 

team assessed changes in symptoms of anxiety and depression (using the PHQ-4) from before to during 

the pandemic among 564 young adults ages 22 to 29 years and did not find a statistically significant 

change in anxiety symptoms, though they did find a statistically significant increase in symptoms of 

depression (Lee et al., 2020). 

TRAUMATIC STRESS

In the Czeisler et al. study, prevalence of symptoms of pandemic-related trauma- and stressor-related 

disorders such as acute stress disorder, posttraumatic stress disorder (PTSD), and adjustment disorder 

(with symptoms measured using the Impact of Event Scale [IES]-6) was highest among respondents ages 

18 to 24 years. As with symptoms of anxiety disorder and depressive disorder, prevalence of symptoms of 

trauma-and stressor-related disorders decreased with increasing age of respondents (2020).

In addition to elevated rates of anxiety and depression symptoms among adults ages 18 to 30 years, Liu 

et al. also found a high rate of symptoms of PTSD—31.8 percent of their respondents had scores on the 

PTSD Checklist—Civilian Version (PCL-C) at or above 45. They offer examples of rates from comparable 

studies using the PCL-C and the same cutoff, including 22 percent of U.S. patients after hospital 

discharge from traumatic orthopedic injury after 1 year, and 26.3 percent after the Wenchuan, China, 

earthquake, also 1 year post-event (Liu et al., 2020).

SERIOUS PSYCHOLOGICAL DISTRESS

In a study comparing nationally representative survey data from 2018 to data from the first wave of 

a nationally representative survey fielded in early April 2020, researchers found a rate of serious 

psychological distress among young adults ages 18 to 29 years of 24.0 percent, whereas the rate 

was 13.6 percent across all ages in the full sample and 3.7 percent for the same demographic in 2018 

(McGinty, Presskreischer, Han, et al., 2020). The researchers measured serious psychological distress 

using the Kessler 6 Psychological Distress Scale, or K6, with a score of 13 or higher taken to indicate 

serious distress. Through a second wave of the survey in July, researchers did not find a significant 

change in level of distress among respondents in any age range; the rate for adults ages 18 to 29 years 

in July was 26.5 percent, and for the full sample was 13.0 percent (McGinty, Presskreischer, Anderson, et 

al., 2020). 

HIGH LEVELS OF STRESS AND LONELINESS

The APA reports that Generation Z adults (ages 18–23 years) had the highest past-month stress level, 

at 6.1 on a scale of 1 to 10, of all age groups, and that their level was significantly higher than levels for 
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all other age groups (2020). In addition, 63 percent of Generation Z adults said they have felt very lonely 

during the pandemic, and this is the highest percentage across age ranges in the report (2020). The 

study with 564 young adult participants also examined loneliness, using the Loneliness Scale, and found 

a statistically significant increase in loneliness in respondents from before to during the pandemic (Lee et 

al., 2020). 

SUBSTANCE USE AND MISUSE AND SERIOUS CONSIDERATION OF SUICIDE

Czeisler et al. (2020) report that nearly 1 in 4 (24.7 percent) of respondents ages 18 to 24 years said that 

they had started or increased substance use to cope with stress or emotions linked to the pandemic. This 

was the largest percentage within any age demographic across respondents. They also report that 25.5 

percent of young adults said they had seriously considered suicide in the 30 days preceding the survey, 

while 10.7 percent of all respondents had done so.

Women

In general, studies found higher levels of anxiety, depression, and traumatic stress among women 

than men.

ANXIETY, DEPRESSION, DISTRESS, AND STRESS

In the Fitzpatrick, Drawve, et al. study, women reported significantly more symptoms of depression 

(assessed through a shortened version of the CES-D) and anxiety (assessed with the GAD-7) than men 

(Fitzpatrick, Drawve, et al., 2020; Fitzpatrick, Harris, et al., 2020). In the survey study of 170 U.S. adults, 

women reported more general psychological distress and pandemic-related peritraumatic distress than 

men (Peterson et al., 2020). Through a survey of 1,015 U.S. adults, researchers found women were more 

likely to be exposed to stressors and to appraise events as significantly more stressful than men (Park et 

al., 2020).

SUBSTANCE USE AND MISUSE

In the above-mentioned study involving surveys of 1,540 U.S. adults before and during the pandemic, 

frequency of alcohol consumption increased by 17 percent among women; this exceeded the increase 

across the full sample of 14 percent (Pollard et al., 2020). The researchers also found that there was 

a significant increase (41 percent) among women in the study in days of heavy drinking. Using an 

instrument called the Short Inventory of Problems scale to assess adverse consequences of alcohol use 

over the 3 months prior to the survey, the researchers also found a 39 percent increase among women in 

problems associated with alcohol use. 

EFFECTS ON MOTHERS

In a Canadian study, 641 women, including expectant mothers and mothers of children up to age 8 years, 

completed an online survey in April 2020 including assessments of anxiety (GAD-7 or Perinatal Anxiety 

Screening Scale, depending on the age of the mother’s child) and depression (CES-D or CES-D-Revised 

and the Edinburgh Postnatal Depression Scale) (Cameron et al., 2020). The researchers found rates 
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of clinically relevant anxiety ranging from 29.59 to 36.27 percent of respondents2 and rates of clinically 

relevant depression ranging from 33.16 to 43.37 percent of respondents. The researchers note that these 

rates are much higher than those found in past research on maternal depression or anxiety, citing metaestimates of prenatal and postpartum anxiety and depression as 11.9 percent and 14.8 to 24.6 percent in 

other studies.

Health Workers and Healthcare Workers

In a survey of 158 labor and delivery employees in a Philadelphia hospital, 62 percent of respondents 

reported minimal job anxiety before the pandemic (Bender et al., 2020). After the pandemic started, 54 

percent reported moderate job anxiety, and the percentage reporting significant anxiety increased from 1 

(pre-pandemic) to 27 percent (during the pandemic).

In a May 2020 survey of 1,132 health workers, another research team found rates of probable major 

depression (assessed with the PHQ-9, with a cutoff value of ≥ 10 for probable clinical depression) and 

GAD (assessed with the GAD-7, with a cutoff value of ≥ 10 for probable GAD) as 14.0 percent for major 

depression and 15.8 percent for GAD (Hennein & Lowe, 2020). The researchers also found a rate of 

probable PTSD of 23.1 percent (measured using the Primary Care-PTSD [PC-PTSD] screening tool, 

with a cutoff value of ≥ 3 for probable PTSD). The researchers observed that this rate is similar to a rate 

(27 percent) found among frontline workers in China, and substantially higher than a rate among health 

workers in Singapore (7.7 percent), during the pandemic.

Racial and Ethnic Minorities

Racial and ethnic minorities including Blacks, Hispanics, and American Indians and Alaska Natives have 

experienced disproportionate COVID-19 mortality, as well as death at younger ages due to COVID-19, 

than non-Hispanic Whites (Bassett et al., 2020). In recent analyses of COVID-19 cases and deaths, the 

Centers for Disease Control and Prevention (CDC) has reported that Hispanics, non-Hispanic Blacks, 

and non-Hispanic American Indians and Alaska Natives are disproportionately represented among deaths 

of individuals under age 21 years, and among people of all ages, Hispanic, non-Hispanic Black, and 

American Indian and Alaska Native people were overrepresented relative to their percentages in the U.S. 

population (Bixler et al., 2020; Stokes et al., 2020; CDC, 2020). Osofsky et al. (2020) identify several 

causes of these disparities, including socioeconomic differences, preexisting conditions, and a healthcare 

system that does not serve racial and ethnic minorities as well as it serves White Americans. CDC (2020) 

highlights additional possible causes, including greater likelihood of working in an essential job that 

cannot be done from home; of living in a home with more people, in which physical contact is greater and 

COVID-19 can spread more easily; and of difficulty in accessing and/or reluctance to access health care 

due to historical trauma and racism, lack of health insurance coverage, lack of ability to pay for health 

care, and difficulties with transportation and getting time off work. 

2 The rates were determined for mothers of children in specific age ranges, and so more than one rate 

was found.
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Czeisler et al. (2020) report that Black respondents to their June 2020 survey were more likely than White 

or Asian respondents to report increased substance use associated with the pandemic. They also note 

that Black respondents were more likely to report serious consideration of suicide in the 30 days prior 

to the survey (15.1 percent of Black respondents had seriously considered suicide in the past 30 days, 

relative to 10.7 percent of respondents across the full sample).

Czeisler et al. also found that Hispanic respondents had higher prevalence of symptoms of anxiety 

disorder or depressive disorder, as well as COVID-19-related trauma- and stressor-related disorders, than 

non-Hispanic White and Asian respondents. In the study of 10,368 U.S. adults, researchers found that 

Hispanic respondents had significantly more symptoms of depression than non-Hispanics (Fitzpatrick, 

Harris, et al., 2020). 

In the comparison of the first wave of nationally representative survey data from 2020 during the 

pandemic and similar data from 2018, researchers found a rate of serious psychological distress among 

Hispanic adults (18.3 percent) that was more than four times higher than the 2018 rate for Hispanic 

adults (4.4 percent) and higher than the rate for all adults across the study sample (13.6 percent) 

(McGinty, Presskreischer, Han, et al., 2020). In the second wave of the survey, 19.2 percent of Hispanic 

respondents reported serious psychological distress (relative to 13.0 percent of the full study sample) 

(McGinty, Presskreischer, Anderson, et al., 2020).

Czeisler et al. (2020) also reported higher rates of increased substance use (21.9 percent) and past30-day serious consideration of suicide (18.6 percent) among Hispanic respondents. Rates across all 

respondents were 13.3 percent for increased substance use and 10.7 percent for serious consideration of 

suicide in the past 30 days (Czeisler et al., 2020). 

Individuals With Lower Incomes and Less Money in Savings

In the study examining depression rates in the 2017 and 2018 NHANES and in the CLIMB study in March 

and April 2020, researchers found respondents to be at greater risk of symptoms of depression during the 

COVID-19 pandemic if their incomes were lower or they had less than $5,000 in savings (Ettman et al., 

2020). In the comparison of data from the two waves of the nationally representative 2020 survey, among 

individuals with household incomes of $35,000 or less, 19.3 percent in April and 21.2 percent in July 

reported symptoms of serious psychological distress, whereas across the full sample these rates were 

13.6 percent in wave 1 and 13.0 percent in wave 2 of the survey (McGinty, Presskreischer, Han, et al., 

2020; McGinty, Presskreischer, Anderson, et al., 2020). 

Individuals Who Are Homeless

Some researchers and other experts have pointed out that those most vulnerable during the COVID-19 

pandemic are those with intersecting and overlapping vulnerabilities. In perhaps no population are these 

intersections and overlaps more apparent than among people experiencing homelessness. For example, 

individuals experiencing homelessness who also have substance use disorders may not be able to 

access their usual services and treatment, engage in physical distancing, or isolate themselves from 

others if they develop symptoms or test positive for COVID-19 (Kimmel, Bazzi, & Barocas, 2020). In an 

article about this population, researchers relate that Boston, Massachusetts, rapidly established testing 

programs and emergency respite and recuperation facilities for individuals experiencing homelessness 

who tested positive for SARS-CoV-2 but that they saw individuals with substance use disorders leaving 
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the facilities, where drug use was prohibited, temporarily or prematurely, presumably to obtain drugs to 

avoid withdrawal (Kimmel, Bazzi, & Barocas, 2020).

As noted, evidence suggests that young adults are experiencing negative mental health and substance 

use-related impacts of the pandemic at higher rates than individuals in middle or older adulthood. A study 

of 90 young adults (ages 18 to 25 years) currently experiencing homelessness or with recent experience 

of homelessness found that, over the 7 days preceding survey administration during the pandemic, 

nearly half (48 percent) had experienced hopelessness, 44 percent anxiety, 38 percent loneliness, 36 

percent depression, and 34 percent sleep problems (Tucker et al., 2020). Forty-four percent reported 

greater difficulty in obtaining mental health services, and 32 percent reported greater difficulty in obtaining 

substance use services.

The recent literature also includes case reports on provision of services to individuals experiencing 

homelessness during the COVID-19 pandemic. In one such report, medical students recount their 

experience providing medical and mental health services via telehealth to individuals who were homeless 

and being housed by the Vermont Economic Services Division at local motels (Heflin et al., 2020). The 

students report that it was challenging to connect individuals who were homeless with mental health care 

at a time when many practitioners had less availability due to the pandemic. To address this issue, they 

worked to arrange mental health services through psychiatry residents on community psychiatry rotations. 

A case study on work done in Connecticut in support of the health and human rights of people who use 

drugs (PWUD) describes the work of a coalition comprising PWUD, advocates, service providers, and 

academics (Heimer et al., 2020). The coalition identified several at-risk subpopulations among PWUD 

during the pandemic, including individuals experiencing homelessness or individuals who are marginally 

housed. They worked with local officials and agencies to secure more space for individuals experiencing 

homelessness, allow for some drug use in shelters and respite facilities, and establish sanitary facilities 

including portable lavatories and handwashing stations (Heimer et al., 2020). 

In another case study, researchers report on efforts in Los Angeles, California, to address the challenges 

of pregnant women and survivors of domestic violence who are experiencing homelessness (Goodsmith 

et al., 2020). The researchers explain that individuals in these subpopulations face many mental health 

issues, noting that domestic violence is a risk factor for suicidality, depression, and PTSD, and that 

women experiencing homelessness, including pregnant women, are more likely to have experienced 

childhood abuse, sex and human trafficking, and sexual assault. They describe work done in Los Angeles 

County to place medically vulnerable individuals experiencing homelessness in temporary housing, 

including creation of additional shelters to increase capacity and provision of 15,000 hotel rooms to 

individuals with high-risk medical conditions through an interim housing program. They note that this work 

involved collaboration and advocacy—for example, to add pregnant women to the high-risk populations 

eligible for interim housing (Goodsmith et al., 2020).

Older Adults

Some evidence suggests that older adults may be experiencing lower levels of psychosocial distress than 

other age groups. It is important to note that these findings are in a context in which full study populations 

often show signs of increased distress; it is just that increases are more moderate or rates are lower 

among older adults. For example, in the study in which researchers compared national survey data in 

2020 to national data from 2018, they found that the rate of serious psychological distress in April 2020 
| Page 13

among adults ages 55 years and older was 7.3 percent, relative to the rate of 13.6 percent across the full 

survey sample in 2020 (McGinty, Presskreischer, Han, & Barry, 2020). The serious psychological distress 

rate among adults ages 55 years and older was still elevated relative to rates found in 2018; in that earlier 

year, in the nationally representative survey, only 3.9 percent of all adult respondents reported serious 

psychological distress (McGinty, Presskreischer, Han, & Barry, 2020). 

In its report on its latest Stress in America survey, APA (2020) reports lower levels of stress among older 

adults (ages 75 years and older) than among respondents of any other age range (3.3, on average, 

for older adults, in comparison to an average of 5.0 across all adult respondents). Nineteen percent of 

adults, but only 8 percent of older adults, reported worse mental health than at the same time last year. 

Lower percentages of older adults than adults of other age ranges reported negative health impacts 

of the pandemic, feeling very lonely during the pandemic, negative impacts of the pandemic on their 

relationships, and that they could have used more emotional support than they had received over the past 

12 months. On the other hand, a slightly smaller percentage of older adults (69 percent) said they feel 

hopeful about the future than the percentage of the full set of respondents (71 percent) (APA, 2020).

In a study based on a late April 2020 survey of a representative sample of American adults, with the 

sample comprising adults ages 18 to 76 years, researchers found that older age was inversely and 

significantly associated with frequency of negative emotions, even when accounting for perceived health 

risks from COVID-19, personality traits, and demographics (Carstensen, Shavit, & Barnes, 2020). They 

found that older age was also significantly associated with greater frequency of positive emotions. In 

addition, they found that age was negatively associated with the intensity of negative emotions and 

positively associated with the intensity of positive emotions (Carstensen, Shavit, & Barnes, 2020). 

Similarly, a study based on surveys of a sample of 325 U.S. adults ages 20 to 70 years found that older 

adults reported higher positive affect and lower negative affect than other adults, though their trajectories 

of affect over time were not significantly different (Ebert, Bernstein, Carney, & Patrick, 2020). 

IMPACTS ON INDIVIDUALS WITH PREEXISTING MENTAL ILLNESS

Evidence suggests that people with preexisting mental illness may be at greater physical risk during the 

pandemic. They may also be experiencing the pandemic differently from those without mental illness in 

terms of symptoms, stress, and coping.

Greater Risk of Becoming Sick With or Dying of COVID-19

A commentary early in the pandemic identifies several reasons that individuals with serious mental illness 

(SMI) may be at higher risk than the general public in terms of morbidity and mortality related to the 

pandemic (Druss, 2020). Risk factors include high rates of smoking, unstable housing and homelessness, 

insufficient sick leave and insurance coverage, and small social networks.

In keeping with this idea, in research involving electronic health record data, investigators found that 

individuals with a diagnosis of a psychiatric disorder in the year before the pandemic had a 65 percent 

increased risk of getting sick with COVID-19 in relation to a cohort matched for physical risk factors for 

COVID-19 but lacking a psychiatric diagnosis (Taquet et al., 2020). The data the researchers used in 

this study came from 69.8 million patients, including 62,354 diagnosed with COVID-19. Another study 

involving review of medical records for 1,685 patients hospitalized for COVID-19 in the northeastern 
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United States found that those with a psychiatric diagnosis had a significantly greater risk of death, even 

after researchers controlled for demographics, medical comorbidities, and hospital location (Li et al., 

2020).

Mental Health Effects of the Pandemic on People With Preexisting Mental Illness

In an online survey of 6,854 adults in Canada and the United States, respondents with anxiety-related 

disorders (in this study, these included GAD, PTSD, social anxiety disorder, panic disorder, and 

obsessive-compulsive disorder, among other mental illnesses) reported significantly higher pandemicrelated stress than respondents with mood disorders (such as major depressive disorder [MDD] and 

bipolar disorder) or with no mental disorder (Asmundson et al., 2020). To assess COVID-19 pandemicrelated stress, researchers used a newly developed instrument called COVID Stress Scales (CSS), 

which includes 36 items in five scales: danger and contamination fears, fears about socioeconomic 

consequences, xenophobia, compulsive checking and reassurance seeking, and traumatic stress 

symptoms (Asmundson et al., 2020). 

A small study involving 73 older adults (ages 61 years and older) with MDD found that their scores on 

the Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety scale and the 

PHQ-9 during the pandemic were significantly lower than at baseline for another study they were part 

of (the participants were part of a study on treatment strategies for older adults with treatment-resistant 

depression) (Hamm et al., 2020). In addition, participants’ scores did not increase from just before the 

pandemic to during the pandemic. However, in qualitative interviews that were also part of this study, 

the researchers add, “many participants did describe themselves as more depressed (n = 32) or more 

anxious (n = 33)” (Hamm et al., 2020). The research team did not find an increase in suicidal thoughts 

among participants in their study relative to the period immediately before the pandemic. The study was 

conducted early in the pandemic; the researchers also reported that participants expected their mental 

health would worsen as physical distancing continued (Hamm et al., 2020).

Both articles made observations about coping efficacy. Asmundson et al. (2020) report that there were 

no significant differences in the perceived effectiveness of coping strategies used by respondents with 

anxiety-related disorders, respondents with mood disorders, and respondents with no mental disorder, 

except that respondents with anxiety-related disorders assessed meeting with a doctor or counselor via 

the internet as more helpful than respondents with no mental disorder. Hamm et al. (2020) write that 

many of the older adults who participated in interviews mentioned using coping strategies during the 

pandemic that they also used to deal with their depression. 

MENTAL HEALTH IMPACTS OF GETTING SICK WITH COVID-19

As noted in the introduction to this bulletin, the experience of COVID-19 illness may affect people very 

differently from secondary stressors such as financial problems or reduced social contacts and support, 

with the former type of exposure expected to have more severe consequences for mental health. In 

line with this idea, in the earlier-mentioned study involving electronic health record data from nearly 70 

million patients, including 62,354 with a COVID-19 diagnosis, investigators found that individuals with 

a diagnosis of COVID-19 were more likely than individuals with diagnoses of several other illnesses 

and conditions (including influenza, another respiratory tract infection, and skin infection) to have a first 
| Page 15

psychiatric diagnosis in the 14 to 90 days after the COVID-19 diagnosis (Taquet et al., 2020). The most 

common first diagnosis was of an anxiety disorder (with the probability of diagnosis within 90 days being 

4.7 percent), with the most common anxiety disorder diagnoses being adjustment disorder, GAD, PTSD, 

and panic disorder.3 The second most common first diagnosis was of a mood disorder (with a 2 percent 

probability of diagnosis within 90 days). The researchers found a low probability (0.1 percent) of a new 

diagnosis of a psychotic disorder in the 14 to 90 days after a COVID-19 diagnosis.

INTERVENTIONS AND APPROACHES TO SUPPORT MENTAL HEALTH 

DURING AND AFTER THE PANDEMIC

Several of the articles mentioned in this bulletin offer suggestions for how to support public mental health, 

help reduce maladaptive substance use, and prevent suicide during and after the COVID-19 pandemic. 

Suggestions relate to risk communication, screening and assessment, approaches for the public and 

specific populations, telehealth, partnerships, and policies and funding.

Risk Communication

The World Health Organization (WHO) has defined risk communication as “‘the exchange of real-time 

information, advice and opinions between experts and people facing threats to their health, economic 

or social well-being’” (Abrams & Greenhawt, 2020). In an article on the topic, Abrams and Greenhawt 

note that “the importance of risk management and effective risk communication cannot be overstated,” 

explaining that how people perceive and respond to risk affects public health outcomes. Public health 

outcomes in turn affect mental health outcomes, because if fewer people experience illness or death, a 

smaller proportion of the population will experience stressors linked to a pandemic or other public health 

emergency. In addition, effective risk management and communication can help reduce the stressors 

individuals experience by providing information, addressing concerns, and fostering a sense of selfefficacy and control.

3 Throughout this bulletin, we discuss research in which PTSD is mentioned in relation to the COVID-19 

pandemic. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the 

primary reference manual in the United States for diagnosis, treatment, and research involving individuals 

with mental illness and substance use disorders, the first criterion for a diagnosis of PTSD is experience 

of a traumatic event (American Psychiatric Association, 2013). In its description of PTSD, the DSM5 notes that “a life-threatening illness or debilitating medical condition is not necessarily considered a 

traumatic event. Medical incidents that qualify as traumatic events involve sudden, catastrophic events 

(e.g., waking during surgery, anaphylactic shock).” While people may experience sudden or catastrophic 

events associated with COVID-19 illness, everyone who gets sick with COVID-19 does not experience 

such events. As such, studies reporting data on PTSD with COVID-19 illness as the index trauma are 

in violation of current American diagnostic criteria. These studies do provide information about levels 

of distress, as several symptoms of PTSD involve distress (e.g., “recurrent, involuntary, and intrusive 

distressing memories of the traumatic event(s)”) or are themselves distress symptoms (e.g., “intense or 

prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an 

aspect of the traumatic event(s)”). Like other authors whose work is cited in this bulletin, Taquet et al. do 

not identify the index trauma for the new PTSD diagnoses in their study.
| Page 16

In a recent report, an expert panel identifies 10 evidence-based risk communication strategies to support 

adoption of behaviors to reduce the spread of COVID-19 (National Academies of Science, Engineering, 

and Medicine [NASEM], 2020). Following are some highlights:

• Use clear, consistent, and transparent messaging. The authors of the report note that officials 

should “concede uncertainty, proactively and transparently. Information communicated in plain and 

simple language needs to reflect that evidence is evolving so recipients can make informed choices 

and be prepared for changes in the evidence as the science advances (Fischhoff and Davis, 2014). 

For example, messages could use the phrase, ‘Based on what we know today . . .’” (NASEM, 

2020). In another article, researchers write that “To effectively promote key COVID-19 preventive 

behaviors (i.e., wash hands, physically distance, wear a mask), we need to communicate with the 

public not only what to do but also why, and to communicate clearly, consistently, repeatedly (i.e., 

high exposure), and with credible, nonpolitical sources (Covello, 2003; Noar, 2006)” (Noar & Austin, 

2020).

• Avoid undue attention to the frequency of socially undesirable behaviors. The authors 

relate that research has shown that communications that highlight cases in which people are not 

behaving according to public health guidelines actually increase focus on those behaviors and give 

the mistaken impression that the behaviors are more common than they are. They suggest instead 

focusing on and featuring the larger proportion of the population that is behaving according to 

public health guidelines.

• Foster a sense of efficacy and avoid fatalism. The authors note that people must feel that the 

actions they take can have a positive impact on public health in order to take these actions.

• Use messengers trusted by the target audience. In another article, researchers suggest 

that clinicians may be able to play such a role, countering misinformation within their existing 

relationships with their patients (Chou et al., 2021).

• Tailor the framing of the message to the audience. The authors write that the population could 

be segmented for messaging purposes based on level of misinformation, level of risk, and where 

they obtain information, among other factors. In another article, Noar and Austin (2020) point out 

that motivating factors will differ by population, and so different messaging will be needed.

• Highlight the growing prevalence of behavior change within the target audience when it 

occurs. For example, communicators can point out the growing proportion of the U.S. population 

wearing masks at all times in public.

• Avoid repeating misinformation, even to debunk it. The authors explain that “efforts to debunk 

information can have the unintended effect of reinforcing false beliefs” (NASEM, 2020).

Some researchers have encouraged risk communication that acknowledges and takes into account 

the emotions that target audiences are experiencing (Chou & Budenz, 2020; Chou et al., 2021). In 

communications encouraging people experiencing heightened negative emotion to get vaccinated 

against COVID-19, researchers recommend “framing vaccination as a concrete, actionable strategy to 

reduce COVID-19 risk” (Chou & Budenz, 2020). They also recommend activating positive emotions in 

the public through messaging that emphasizes getting vaccinated as an altruistic act with benefits for the 

community, as well as through messaging that highlights that vaccination may enable more in-person 

contact with family and community connections. 
| Page 17

Screening and Assessment

Some experts in disaster behavioral health recommend development of new screening tools specific to 

the current pandemic. For example, Czeisler et al. (2020) suggest that screening instruments specific to 

the COVID-19 pandemic be developed to allow for early identification of COVID-19-related symptoms of 

trauma- and stressor-related disorders. 

In addition, a team of researchers has already developed the earlier-mentioned CSS, an instrument 

specifically for the current pandemic (Asmundson et al., 2020). They report that the scales have 

performed well on measures of reliability and validity, and that the correlation of scales suggests the 

existence of a COVID Stress Syndrome involving the elements measured with the CSS (Taylor et al., 

2020; Asmundson et al., 2020).

Pfefferbaum and North (2020) recommend psychosocial assessment and monitoring during the 

pandemic, including inquiries about stressors associated with the pandemic; secondary stressors such 

as economic losses; psychosocial impacts of pandemics and other disasters such as depression, anxiety, 

insomnia, increases in substance use, and domestic violence; and preexisting vulnerabilities. Responses 

to these questions should guide referrals of some for formal evaluation and mental health care, and 

others to supportive interventions (Pfefferbaum & North, 2020). 

Pfefferbaum and North (2020) also recommend ongoing monitoring and assessment for suicidal 

ideation, and, if an individual has suicidal ideation, that he or she be referred for immediate consultation 

with a mental health professional or emergency psychiatric hospitalization. Sacks and Bartels (2020) 

recommend inquiries about gun ownership, as well as an understanding among those conducting 

assessment that first-time gun ownership in combination with other risk factors may indicate urgent need 

for assessment and risk mitigation (Studdert et al., 2020).

Approaches for the Public

Pfefferbaum and North suggest that the public be provided with information about common reactions 

to events like the COVID-19 pandemic. Several experts suggest educating the public about coping 

strategies. Hamm et al. (2020) suggest educating the public about the coping strategies that their 

older adult interviewees cited as helpful in dealing with MDD and the pandemic, such as maintaining a 

regular schedule and mindfulness. Pfefferbaum and North suggest that healthcare professionals offer 

suggestions for stress management and coping. In light of physical distancing practices and orders, 

several also suggest educating the public about ways to maintain relationships during the pandemic 

(Osofsky et al., 2020; Hamm et al., 2020). 

Approaches for Health Workers and Healthcare Workers

Based on their study involving 1,132 health workers, Hennein and Lowe (2020) recommend adaptation of 

existing peer support interventions for health workers to help them manage the stressors they are facing 

at work during the pandemic. Several experts suggest support for healthcare workers including screening, 

assessment, and monitoring; acknowledgement of challenges they are facing; allowing time for adequate 

rest; offering and adapting peer support systems and programs; and ensuring access to mental health 

care without negative career impacts (Simon et al., 2020; Moutier, 2020; Pfefferbaum & North, 2020). 
| Page 18

Telehealth

Experts have highlighted the impressive efficiency with which mental healthcare practitioners have 

transitioned to provision of services via telehealth, including telephone and remote meeting technologies 

(Öngür et al., 2020; Uscher-Pines et al., 2020). They have also proposed ways to ensure that barriers are 

addressed in and after the pandemic.

Because concerns about telehealth have been identified among individuals with SMI about establishing 

rapport with a mental healthcare practitioner, privacy, safety, security, and technological limitations, Kahl 

and Correll (2020) suggest providing patients with information about telemedicine and the opportunities 

it allows. They and others also note the importance of making reimbursement for telehealth services 

sufficient to support ongoing use of this method of treatment and patient care in and after the pandemic 

(Kahl and Correll, 2020; Öngür et al., 2020). 

Individuals in need of mental health care via telehealth may not have access to a computer in a private 

location with the level of internet connectivity needed for remote appointments (Öngür et al., 2020). 

Osofsky et al. relate an example of a partnership in New Orleans, Louisiana, that may address these 

concerns and serve as a model for others: “The Department of Psychiatry faculty, in collaboration with the 

Mayor of New Orleans, the city health department, police department, fire department, and emergency 

medical services, are initiating no-cost confidential virtual support and clinical services. The services 

will be provided for those agencies, city employees, and others requesting services using home-based 

telehealth and telephone for those without internet connectivity for adults, children, and family members” 

(Osofsky et al., 2020). 

Partnerships

Also emphasized is the importance of partnerships in meeting mental health needs during the pandemic. 

Pfefferbaum and North (2020) write that “ideally, the integration of mental health considerations 

into COVID-19 care will be addressed at the organizational level through state and local planning; 

mechanisms for identifying, referring, and treating severe psychosocial consequences; and ensuring the 

capacity for consulting with specialists.” 

Some highlight the need for partnerships as part of suicide prevention. Sacks and Bartels (2020) 

recommend that those involved in suicide prevention partner with gun shop owners to coordinate 

dissemination of information about suicide prevention at the point of sale. Moutier suggests that mental 

and public health experts work with the community of gun owners in the United States in educational 

efforts to prevent suicide.
| Page 19

Policy and Funding

In addition to the suggestions about ensuring ongoing reimbursement for telehealth services, experts 

offer other policy- and funding-related suggestions for during and after the pandemic. In its report on 

the 2020 Stress in America survey results, the APA recommends facilitating access to mental health 

services during and after the pandemic, particularly for young people ages 13 to 23 years, in part through 

funding to support mental health services provided in schools after the pandemic (2020). Moutier (2020) 

recommends federal investments in and after the pandemic in mental health and addiction services 

with an emphasis on increasing access to mental health care. She and Sacks and Bartels (2020) also 

recommend greater federal investment in support for research on lethal means such as firearms and the 

role they play in suicide. Several also suggest federal economic support of the U.S. public to reduce the 

financial stress many are experiencing during the pandemic (Czeisler et al., 2020; Moutier et al., 2020). 

CONCLUSION

The COVID-19 pandemic involves disruption of employment, finances, educational systems, health care, 

and other core areas of community life. While individuals and organizations have responded quickly and 

with ingenuity, including a broad-scale transition to providing more mental health services via telehealth, 

there have been impacts on the U.S. population. Mental health impacts include increased rates and 

levels of anxiety, depression, traumatic stress, and serious psychological distress. Substance use has 

increased. Research has found that some segments of the U.S. population are struggling more with 

mental health and substance use issues during the pandemic, including youth, women, health workers 

and healthcare workers, and racial and ethnic minorities. Older adults in general seem to be faring better 

than the rest of the population, though it is unclear whether this difference will hold over time. While 

individuals with preexisting mental illness may be at greater risk of COVID-19 morbidity and mortality, 

evidence regarding mental health effects is mixed, with individuals with SMI in some cases showing 

resilience and enhanced coping skills. Getting COVID-19 may increase the likelihood of development of 

a new psychiatric disorder. Experts have made many suggestions to support the U.S. public during and 

after the pandemic in areas including risk communication, screening and assessment, public education, 

support for health and healthcare workers, telehealth, partnerships, and policy and funding.

SAMHSA is not responsible for the information provided by any of the web pages, materials, or 

organizations referenced in this communication. Although the Supplemental Research Bulletin

includes valuable information and links, SAMHSA does not necessarily endorse any specific products 

or services provided by public or private organizations unless expressly stated. In addition, SAMHSA 

does not necessarily endorse the views expressed by such sites or organizations nor does SAMHSA 

warrant the validity of any information or its fitness for any particular purpose.
| Page 20

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