Depression Symptoms, Perceived Stress, and Loneliness During the COVID-19 Pandemic Among Diverse US Racial-Ethnic Groups

Anna María Nápoles; Anita L Stewart; Paula D Strassle; Alia Alhomsi; Stephanie Quintero; Stephanie Ponce; Miciah Wilkerson; Jackie Bonilla

doi:10.1089/heq.2022.0178

Depression Symptoms, Perceived Stress, and Loneliness During the COVID-19 Pandemic Among Diverse US Racial-Ethnic Groups

Health Equity. 2023 Jun 15;7(1):364-376. doi: 10.1089/heq.2022.0178. eCollection 2023.

Authors

Anna María Nápoles¹, Anita L Stewart², Paula D Strassle¹, Alia Alhomsi¹, Stephanie Quintero¹, Stephanie Ponce¹, Miciah Wilkerson¹, Jackie Bonilla¹

Affiliations

¹ Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA.
² Center for Aging in Diverse Communities, Institute for Health and Aging, University of California San Francisco, San Francisco, California, USA.

Abstract

Introduction: Studies have reported increases in psychological distress during the COVID-19 pandemic. This study aimed to estimate associations between race-ethnicity and psychological distress during the COVID-19 pandemic among nationally representative samples of all major racial-ethnic groups in the United States.

Methods: We conducted a nationally representative cross-sectional survey between December 2020 and February 2021 of Asian, black/African American, Latino (English and Spanish speaking), American Indian/Alaska Native, Native Hawaiian/Pacific Islander, white, and multiracial adults (n=5500). Distress measures included: anxiety-depression (Patient Health Questionnaire-4 [PHQ-4]), stress (modified Perceived Stress Scale), and loneliness-isolation (frequency felt lonely and isolated). Multinomial logistic regression models estimated associations between race-ethnicity and psychological distress, adjusting for demographic and health characteristics.

Results: Overall, 23.7% reported moderate/severe anxiety-depression symptoms, 34.3% reported moderate/severe stress, and 21.3% reported feeling lonely-isolated fairly/very often. Compared with white adults and adjusting for covariates, the prevalence of moderate/severe anxiety-depression was significantly lower among Asian (adjusted odds ratio [aOR]=0.44, 95% confidence interval [CI]=0.34-0.58), black (aOR=0.49, 95% CI=0.38-0.63), English-speaking Latino (aOR=0.62, 95% CI=0.45-0.85), Spanish-speaking Latino (aOR=0.31, 95% CI=0.22-0.44), and Native Hawaiian/Pacific Islander (aOR=0.66, 95% CI=0.49-0.90) adults. Similar trends were seen for moderate/severe stress and feeling lonely-isolated fairly/very often. Worse distress profiles of American Indian/Alaska Native and multiracial adults were attenuated after adjustment.

Conclusions: Minoritized groups tended to have less distress than white adults. Collective experiences of cumulative disadvantage could engender shared resiliency/normalization among these groups.

Keywords: American Indian/Alaska Native; Asian; COVID-19; Hispanic/Latino; Native Hawaiian/Pacific Islander; black/African American; national survey; psychological distress; race-ethnicity.