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Background The COVID-19 pandemic has increased mental distress globally. Theproportion of people reporting anxiety is 26%, and depression is 34% points.Disentangling associational and causal contributions of behavior, COVID-19cases, and economic distress on mental distress will dictate differentmitigation strategies to reduce long-term pandemic-related mental distress.Methods We use the Household Pulse Survey (HPS) April 2020 to February 2021data to examine mental distress among U.S. citizens attributable to COVID-19.We combined HPS survey data with publicly available state-level weekly:COVID-19 case and death data from the Centers for Disease Control, publicpolicies, and Apple and Google mobility data. Finally, we constructed economicand mental distress measures to estimate structural models with lag dependentvariables to tease out public health policies' associational and causal pathcoefficients on economic and mental distress. Findings From April 2020 toFebruary 2021, we found that anxiety and depression had steadily climbed in theU.S. By design, mobility restrictions primarily affected public health policieswhere businesses and restaurants absorbed the biggest hit. Period t-1 COVID-19cases increased job loss by 4.1% and economic distress by 6.3% points in thesame period. Job-loss and housing insecurity in t-1 increased period t mentaldistress by 29.1% and 32.7%, respectively. However, t-1 food insecuritydecreased mental distress by 4.9% in time t. The pandemic-related potentialcausal path coefficient of period t-1 economic distress on period t depressionis 57.8%, and anxiety is 55.9%. Thus, we show that period t-1 COVID-19 caseinformation, behavior, and economic distress may be causally associated withpandemic related period t mental distress.

Associational and plausible causal effects of COVID-19 public health policies on economic and mental distress