“The COVID-19 pandemic caused not only millions of hospitalizations and over a million deaths in the United States but a widespread and enduring mental health crisis.”
That is the conclusion of a study last month in the Journal of Adult Development by Jeffrey J. Arnett, senior research scholar at Clark University, and Deeya Mitra, assistant professor of psychology at Salisbury University. Their study examined the prevalence of anxiety and depression symptoms in a large sample of American adults between 2019 and the summer of 2024.
Arnett and Mitra found evidence of a steep rise in anxiety and depression that affected all adult age groups but was especially pronounced in young adults aged 18 to 29. Although the anxiety diminished after the introduction of vaccines in December 2020, higher-than-baseline rates of anxiety and depression persisted throughout 2023, with Delta and Omicron waves, “even though by then there were no requirements for social isolation or social distancing and no major disruptions to daily life.”
Given the scale of mass death and illness globally across these years, a significant rise in anxiety and depression is not just understandable but altogether unsurprising. In the United States, according to the World Health Organization last year, over 100 million people have been infected, and over one million people have died from SARS-CoV-2, or Severe Acute Respiratory Syndrome Coronavirus 2, the airborne neuroinvasive virus known to cause COVID-19 and Long Covid.
Since April 2000, the highly transmissible pathogen has also been known to cause brain inflammation and multiorgan damage, particularly of the heart and lungs. According to the WHO, infections in the United States peaked at over 800,000 per day in January 2022, while deaths from COVID-19 peaked at roughly 3,300 per day in January 2021, resulting in a three-year “national emergency” that was declared over by May 2023.
“It would certainly be expected that such a massive threat to health and life would arouse substantial fear, anxiety, and depression,” note Arnett and Mitra, making it “reasonable to hypothesize that the mental health effects would be greatest in the age group that was most at-risk for infection, hospitalization, and death—that is, the oldest adults.” They also speculate that COVID-related mental health symptoms would be “inversely related to age, so that the youngest, healthiest adults, who were least likely to be hospitalized or die from the pandemic, would also have been the least likely to respond to the pandemic with anxiety and depression.”
However, and for reasons not fully explained by their study, the data upend both assumptions. Analysis of psychological responses to the pandemic in the United States reveals “a pattern just the opposite of what might be expected based on physical vulnerability: It is the youngest American adults who have been most likely to respond to COVID-19 with psychological distress, not the oldest, and reports of distress decreased, not increased, with age.”
COVID-related distress turned out to be “lower in all older age groups—lowest of all, 27 percent, among the oldest Americans ages 65 and up,” though this last group experienced much higher-than-average rates of hospitalization, illness, and death than before the pandemic.
“Just the opposite of what might be expected”
Arnett and Mitra speculate that young adults have been particularly vulnerable to the mental health effects of COVID-19 because of its “disruption to distinctive developmental processes such as identity formation and progress toward independent decision-making and financial self-sufficiency.” Accordingly, they focus on “lost learning time in school” and isolation from friends “during the lockdown period,” even though most schools and colleges transitioned in Spring 2020 to online or distant learning (“Zoom school”), reducing practical interruptions and supporting continuity, albeit under adjusted circumstances.
At the same time, while “many of the oldest Americans were also isolated and vulnerable,” fueling assumptions that they would resemble their younger counterparts, their COVID-related anxiety appears to have fallen more quickly. Both researchers also stress the rise of “telehealth” as a means of treating and reducing anxiety, with many welcoming teletherapy for its “convenience and accessibility,” even as preference for in-person therapy remained strong.
Additional complications arise from the researchers’ tendency to conflate the “high psychological distress” that might reasonably accompany four-plus years of mass death and illness with symptoms considered “serious enough to signify a psychiatric disorder,” raising concerns about the risk of overdiagnosis and overtreatment by anxiolytics and antidepressants. DSM–defined psychiatric conditions such as Generalized Anxiety Disorder, invoked by the study as a way to measure psychological distress, are determined by questions asking if, over the past 14 days, respondents can report feeling “bothered by the following problems… Feeling nervous, anxious, or on edge,” and “having little interest or pleasure in doing things.”
Though Arnett and Mitra’s 2019 data stems from the National Health Interview Survey, a monthly, in-person interview generating a response rate of “around 60 percent,” their remaining three years of data draw from the nation’s Household Pulse Survey, administered and answered online, which had a substantially lower response rate of “1-3 percent in the early months of the survey, and 6-10 percent subsequently.”
Perhaps most telling in Arnett and Mitra’s framing is the expectation that rates of anxiety and depression would have returned to 2019 levels by now because the pandemic has been declared over, “the economic and social disruptions caused by [it] have ended, and it appears outwardly that life has returned to normal.”
Yet despite the United States and several other governments insisting that normalcy has been achieved, deaths from COVID in the U.S. in 2024 alone reached 46,321 by October 14, following 5.7 million COVID cases and at least 464,050 hospitalizations in just those ten months. Those figures represent the ninth week in a row with more than 1,000 new deaths from COVID and the 238th week with more than 400 new deaths from the virus.
It is difficult to consider any such data as marking a return to normalcy. And when rates of Long Covid and COVID-associated opportunistic infections, like whooping cough and walking pneumonia, are factored back in for young adults, they not only shatter assumptions that this age group could cope with SARS-CoV-2 infections without difficulty but help explain why symptoms of anxiety and depression would persist, following even mitigations such as vaccination, ventilation, and masking. Arguably, we need to examine why a narrative of young people’s invulnerability to the virus has persisted for almost five years now, despite mounting evidence that the opposite is true.
