National and State Trends in Anxiety and Depression Severity Scores Among Adults During the COVID-19 Pandemic — United States, 2020–2021
Authors: Haomiao Jia, Rebecca J. Guerin, John P. Barile, Andrea H. Okun, Lela McKnight-Eily, Stephen J. Blumberg, Rashid Njai, William W. Thompson
Journal: MMWR Morbidity and Mortality Weekly Report (2021)

Recent studies indicate an increase in the percentage of adults who reported clinically relevant symptoms of anxiety and depression during the COVID-19 pandemic (1-3).For example, based on U.S. Census Bureau Household Pulse Survey (HPS) data, CDC reported significant increases in symptoms of anxiety and depressive disorders among adults aged ≥18 years during August 19, 2020-February 1, 2021, with the largest increases among adults aged 18-29 years and among those with less than a high school education (1).To assess more recent national trends, as well as state-specific trends, CDC used HPS data (4) to assess trends in reported anxiety and depression among U.S. adults in all 50 states and the District of Columbia (DC) during August 19, 2020-June 7, 2021 (1).Nationally, the average anxiety severity score increased 13% from August 19-31, 2020, to December 9-21, 2020 (average percent change [APC] per survey wave = 1.5%) and then decreased 26.8% from December 9-21, 2020, to May 26-June 7, 2021 (APC = -3.1%).The average depression severity score increased 14.8% from August 19-31, 2020, to December 9-21, 2020 (APC = 1.7%) and then decreased 24.8% from December 9-21, 2020, to May 26-June 7, 2021 (APC = -2.8%).State-specific trends were generally similar to national trends, with both anxiety and depression scores for most states peaking during the December 9-21, 2020, or January 6-18, 2021, survey waves.Across the entire study period, the frequency of anxiety and depression symptoms was positively correlated with the average number of daily COVID-19 cases.Mental health services and resources, including telehealth behavioral services, are critical during the COVID-19 pandemic.Data were obtained from HPS (4), a biweekly, online survey.The survey, developed with assistance from CDC and other federal agencies to assess the social and economic impacts of the COVID-19 pandemic on U.S. households, began on April 23, 2020.Samples for HPS are drawn from an extract of the U.S. Census Bureau's master address file that includes email and mobile telephone numbers of approximately 117 million U.S. housing units.Survey data include sample weights to be used in analyses to generate results representative of U.S. adults aged ≥18 years based on age, sex, race/ethnicity, and educational attainment; the data from this experimental product were * U.S. Census Bureau experimental data products are statistical products created using new data sources or previously untested methodologies.† HPS includes a modified version of the validated PHQ-4 measure for depression and anxiety with a 1-week (versus a 2-week) recall period to reflect the weekly administration of the questions.The two anxiety questions asked about 1) feeling nervous, anxious, or on edge and 2) not being able to stop or control worrying.The two depression questions asked about 1) having little interest or pleasure in doing things and 2) feeling down, depressed, or hopeless.