Anxiety, Depression Severity Scores Waned as Pandemic Raged On

Haomiao Jia, PhD

Anxiety and depression severity scores have decreased in recent months, after sharp increases at the beginning of the COVID-19 pandemic, according to a report by the US Centers for Disease Control and Prevention (CDC).

A team, led by Haomiao Jia, PhD, Department of Biostatistics, Mailman School of Public Health and School of Nursing, Columbia University, examined trends for depression and anxiety scores throughout the different waves of the pandemic, which could drive policy decisions.

“An international group of clinicians and mental health experts recommends that during pandemics, delivery systems for mental health care be adapted to mitigate disparities in the provision of health care,” the authors wrote. “Predicting and planning for fluctuations in demand for behavioral health services is often difficult; however, real-time monitoring of mental health symptoms can provide important information for responding to surges in the demand for mental health services during national emergencies.”

Severity of Symptoms

There have been studies conducted throughout the pandemic showing an increase in the prevalence of adults with clinically relevant symptoms of anxiety and depression.

Recently, the CDC found significant increases in symptoms of both diseases using US Census Bureau Household Pulse Survey (HPS) data, particularly among adults between 18-29 years and individuals with less than a high school education.

The average anxiety severity score increased 13% nationally between August 19-31, 2020 to December 9-21, 2020. The average anxiety severity scores increased from 2.0 during August 19–31, 2020, to 2.3 during December 9–21, 2020 (APC = 1.5% per wave).

This score then decreased 26.8% from December 9-21, 2020 to May 26-June 7, 2021 with a score that decreased to 1.7 (APC = −3.1% per wave).

The same trends were true for depression.

The average depression severity score increased 14.8% between August 19–31, 2020, to December 9–21, 2020, going from an average depression severity score of 1.6 to 2.0 and then decreased 24.8% from December 9–21, 2020, to May 26–June 7, 2021 with a corresponding average depression severity score decreasing to 1.4 (APC = −2.8% per wave).

State Trends

The state-specific trends fell along similar patterns for anxiety and depression.

“In most states, the average anxiety and depression severity scores increased from August–September 2020 to December 2020–January 2021,” the authors wrote. “By May–June 2021, anxiety and depression severity scores were similar to or lower than those during August–September 2020.”

However, 1 caveat is both scores were directly tied to state-specific COVID-19 case trends.

For example, the largest initial increases in anxiety severity scores with subsequent decreases during the second wave occurred in Mississippi, Oklahoma, and South Carolina.

For depression, this was true for Minnesota, Mississippi, and South Carolina. In addition, Florida and New York had the smallest percentage increases in depression and anxiety scores, respectively.

For the second wave, Minnesota, Rhode Island and Utah had the largest decrease in anxiety scores, while Idaho, Michigan, and Wisconsin had the largest percentage decreases for depression severity scores. New York had the smallest decrease in both scores.

The scores were assessed with the four-item Patient Health Questionnaire (PHQ-4), which included the two-item Generalized Anxiety Disorder (GAD-2) scale and the two-item PHQ-2, which assesses symptoms of depression.

The study, “National and State Trends in Anxiety and Depression Severity Scores Among Adults During the COVID-19 Pandemic—United States, 2020-2021,” was published online in the Morbidity and Mortality Weekly Report (MMWR).