Scientists from the University of North Carolina and City University New York recently found that the majority of US citizens suffered from anxiety disorders during the 2019 coronavirus disease (COVID-19) pandemic. Financial difficulties are a major cause of anxiety symptoms. The study is currently available on the medRxiv * preprint server.
Since its inception in December 2019, the rapid spread of the potentially fatal severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) has put a significant strain on healthcare systems and socio-economic structures in many countries around the world. The United States is among the countries hardest hit by the COVID-19 pandemic, with over 9.4 million confirmed cases of the virus and over 122,000 deaths related to COVID-19. Previous studies conducted in other pandemic conditions, such as the SARS pandemic in 2003, have shown that the incidence of anxiety, attempted suicide, and other emotional distress is increasing in people exposed to pandemic conditions.
In the US, approximately 31% of the general population will experience symptoms of anxiety at some point in their life. Therefore, it is likely that persistent stressful circumstances during the COVID-19 pandemic could trigger or further accelerate episodes of anxiety symptoms in susceptible individuals. In particular, people with comorbid health complications such as diabetes, cardiopulmonary disorders and obesity are at a higher risk of developing anxiety disorders because they also fear developing life-threatening diseases due to a SARS-CoV-2 infection. Similarly, people directly involved in healthcare, such as doctors, nurses, and other medical staff, are more prone to anxiety disorders as the workload increases significantly and they fear becoming infected in the workplace.
In addition, there could be many other factors, such as financial difficulties, unemployment or underemployment, and job insecurity, that can trigger anxiety in susceptible people. In order to better manage people's overall physical and mental well-being during the COVID-19 pandemic, it is important to identify both fear triggers and vulnerable members of the population.
Current study design
Given the potential impact of COVID-19 on mental illness, the scientists aimed to study the prevalence of anxiety disorders among U.S. citizens, as well as the relationship between various stressors and the appearance of anxiety symptoms. The scientists believe the results of the study will help develop appropriate strategies for identifying and treating people who are more likely to experience symptoms of anxiety during the pandemic.
The study was conducted on 5,250 geographically and socio-demographically diverse US citizens. About 27%, 16% and 18% of the study participants reported having mild, moderate and severe anxiety symptoms, respectively.
About 33% of participants reported having various health complications, and the researchers found that all of the health conditions analyzed in the study were associated with moderate to severe anxiety symptoms. Interestingly, around 31% of participants said they had previously been diagnosed with depression.
The relationship between various stressors and anxiety symptoms
The prevalence of anxiety was significantly higher in people who recently experienced COVID-19-like symptoms. Similar consequences were also observed during the SARS pandemic in 2003.
People with medically confirmed depression were also prone to anxiety disorders. This is somewhat expected since depression and anxiety are highly comorbid. In recent years, several cognitive behavioral therapies (CBTs) have been developed to treat these comorbid mental states.
A significant correlation between smoking status and anxiety level was observed in the study. People who smoke daily had a higher prevalence of moderate or severe anxiety symptoms. Previous studies have also shown that people with anxiety disorders tend to smoke on a daily basis. Therefore, an increase in the smoking rate among people with anxiety is likely in adverse conditions such as the COVID-19 pandemic.
People who were extremely afraid of SARS-CoV-2 infection, as well as people who were extremely afraid of infecting their friends and family, were at a higher risk of developing anxiety symptoms.
Regarding work-related stressors, financial difficulties have been found to be the main cause of anxiety. Around 45% and 17% of respondents said they experienced lost income or employment during the pandemic. An increased prevalence of anxiety has also been observed among healthcare workers and non-healthcare workers. Financial hardship is seen as a major contributor to the worst mental health outcomes. Given the pandemic-related financial crisis, appropriate social support systems and coping measures should be developed to minimize the impact of financial burdens on emotional distress.
In terms of demographics, women and transgender people were more likely to develop symptoms of anxiety. Interestingly, older people (age group: 50 years and older) showed a lower prevalence of anxiety than younger people (age group: 18-29 years) despite a higher risk of developing a severe form of COVID-19. A relatively higher impact of unemployment and the financial crisis may be associated with higher levels of anxiety in younger people.
* Important NOTE
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be considered conclusive, guide clinical practice / health-related behavior, or treated as established information.