Article Synthesis Paper

The Psychological Impact of Preexisting Mental and Physical Health Conditions During the COVID-19 Pandemic

Sarah Alonzi, Adelaide La Torre, and Madison W. Silverstein Loyola University New Orleans

The COVID-19 pandemic has substantially changed our daily lives, career trajectories, and sense of safety. Current research posits that younger adults without persisting health conditions may be at reduced risk for complications of COVID-19 infection. However, young adults are often in unstable places in their careers, education, and social lives, which may be more disrupted by policy changes than those of older adults. Thus, it is imperative to identify young adult subgroups who are at increased risk for mental health difficulties to develop targeted interventions to mitigate emotional distress. This study recruited 620 young adults, Ages 18 –35 (M � 26.59; SD � 5.24), to determine whether there were differences in self-reported anxiety and depression in the weeks following the pandemic declaration by gender (male, female, or nonbinary) and health status (i.e., the absence of health conditions, the presence of either physical or mental health conditions, and the presence of both physical and mental health conditions) using a 3 � 4 analysis of variance. For both depression and anxiety, nonbinary participants reported the highest levels, followed by female participants. For health status, those with both mental and physical health conditions reported the highest anxiety and depression, followed by those with mental health conditions, physical health conditions, and no health conditions. These findings call for resources to be directed toward individuals who fall into groups reporting greater emotional distress, so that clinicians can intervene as early as possible to prevent mental health decline.

Keywords: gender, health status, anxiety, depression, COVID-19

The COVID-19 pandemic has substantially changed our daily lives, career trajectories, and sense of safety, causing a differential impact on mental health (Qiu et al., 2020). As such, it is imperative to identify subgroups of the population who are at increased risk for mental health difficulties so that intervention efforts are more targeted and effective (Horesh & Brown, 2020). Young people might be a particularly important target group as they are experi- encing high levels of emotional distress despite being at lower risk for COVID-19 complications (Qiu et al., 2020). This emotional distress could be associated with the volatility of this developmen- tal stage as well as young adults’ higher rates of pandemic imagery exposure through media (Garfin, Silver, & Holman, 2020; Qiu et al., 2020). Individuals with mental health conditions also appear to be an important target group as they have experienced changes to their daily routines, disruptions in their mental health care, and

barriers to social support, all of which are factors that lead to deteriorated mental health (Francis, Moitra, Dyck, & Keller, 2012; Reich, 2000). Additionally, individuals with physical health con- ditions have reduced access to health care, which could worsen their physical condition, thus increasing their risk for mental health difficulties (Cornelius, van der Klink, de Boer, Brouwer, & Groothoff, 2016; Kraaij & Garnefski, 2012). Further, the stress and associated social barriers of being at increased risk for COVID-19 complications likely exacerbates this risk (Lee, Kang, Cho, Kim, & Park, 2018).

Research highlights gender differences in mental health due to the pandemic, with women reporting higher levels of distress than men (Qiu et al., 2020). Although no known research investigates the COVID-19 mental health impact on nonbinary individuals, this group is likely another important target group due to having a higher prevalence of mental illness than men and women due to stigmatization and marginalization (Scandurra et al., 2019). To further understand the impact of the COVID-19 pandemic on mental health, the present study sought to identify subgroups of young people that are at increased risk for depression and anxiety. We hypothesized that women and nonbinary individuals with both preexisting physical and mental health conditions would have the highest levels of depression and anxiety.

Method

Sample

Participants were 616 young adults Ages 18 –35 (M � 26.59; SD � 5.24) predominately from the United States and Canada

Editor’s Note. This commentary received rapid review due to the time- sensitive nature of the content. It was reviewed by the Journal Editor.— KKT

This article was published Online First June 11, 2020. X Sarah Alonzi, X Adelaide La Torre, and X Madison W. Silver-

stein, Department of Psychological Sciences, Loyola University New Or- leans.

Correspondence concerning this article should be addressed to Madison W. Silverstein, Department of Psychological Sciences, Loyola University New Orleans, 6363 Street Charles Avenue, New Orleans, LA 70118. E-mail: [email protected]

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Psychological Trauma: Theory, Research, Practice, and Policy

© 2020 American Psychological Association 2020, Vol. 12, No. S1, S236 –S238 ISSN: 1942-9681 http://dx.doi.org/10.1037/tra0000840

S236

recruited via social media platforms. The majority of participants identified as male (48.9%), followed by female (48.1%) and non- binary (3%). Most participants did not report any mental or phys- ical health conditions (38.6%), followed by mental health condi- tion only (32.5%), both mental and physical health conditions (17.7%), and physical health condition only (11.2%). The majority of participants identified as White (79.5%).

Measures

Demographics. Information about participants’ age, race, eth- nicity, and mental and physical health status was collected using an investigator-developed demographics questionnaire.

Patient-Reported Outcomes Information System (PROMIS) short-form. Participants completed the PROMIS anxiety and depression short-form (Schalet et al., 2016), which asks partici- pants how often (1 � never to 5 � always) they experienced symptoms in the past week. Higher scores indicate greater depres- sion (a � .92) or anxiety (a � .89).

Procedure

All procedures were approved by the university institutional review board. Analyses were conducted using SPSS (Version 26). We conducted two 3 � 4 analyses of variance with gender and health status as fixed factors and depression or anxiety as the dependent variable. The gender variable had three levels: male, female, and nonbinary. The health status variable had four levels: no mental or physical health conditions, mental health condition only, physical health condition only, and both mental and physical health conditions. We also conducted Hochberg’s post hoc tests to compare differences in means across groups.

Results

For depression, there were significant main effects of gender, F(2, 608) � 4.591, p � .011 and health status, F(3, 608) � 14.498, p � .001. There was not a significant interaction between gender and health status, F(5, 608) � .958, p � .443. Gender and health status accounted for 19.5% of the variance of depression. Post hoc comparisons for health status indicated significant differences be-

tween (a) the no health condition and the mental health condition groups, (b) the no health condition and the both physical and mental health conditions groups, and (c) the mental health condi- tion and the physical health condition groups. There was not a significant difference between (a) the no physical or mental health conditions and the physical health condition groups, or (b) the mental health condition and the both mental and physical health conditions groups. Post hoc comparisons for gender indicated significant differences between all groups’ means except between the nonbinary group and the female group.

For anxiety, there were significant main effects of gender, F(2, 603) � 15.659, p � .001 and health status, F(3, 603) � 15.950, p � .001. There was not a significant interaction between gender and health status, F(5, 603) � .1.327, p � .251. Gender and health status accounted for 24.6% of the variance of anxiety. Post hoc comparisons indicated significant differences between all groups’ means except for the no physical or mental health conditions group and the physical health condition group. Post hoc comparisons for gender indicated significant differences between all groups’ means except between the nonbinary group and the female group. Table 1 presents descriptive statistics.

Discussion

Results demonstrated that women and nonbinary individuals as well as individuals with both preexisting physical and mental health conditions had higher levels of depression and anxiety following the COVID-19 pandemic declaration. Although women are already at higher risk for mental health difficulties (Astbury, 2001; Scandurra et al., 2019), the high levels of consumption of COVID-19 media (Garfin et al., 2020), disproportionate economic impact, and increased domestic responsibilities (Alon, Doepke, Olmstead-Rumsey, & Tertilt, 2020) likely cause additional emo- tional distress. Notably, a more robust sample of nonbinary indi- viduals is necessary to understand the relationship between non- binary gender and negative affect during the COVID-19 pandemic. Future research should explore these topics with the goal of mitigating mental health risk at the individual and policy level.

Individuals with both physical and mental health conditions must cope with emotional distress pertaining to decreased access

Table 1 Descriptive Statistics of the PROMIS Depression and Anxiety by Gender and Health Status

DV IV Level M Mdn SD

Depression Gender Male 9.28 9.00 4.06 Female 10.69 11.00 4.31 Nonbinary 12.53 12.00 4.35

Health status No conditions 8.07 8.00 3.55 Mental health condition only 11.55 12.00 4.10 Physical health condition only 8.81 9.00 3.68 Both physical and mental health conditions 12.40 12.00 4.12

Anxiety Gender Male 8.82 8.00 3.97 Female 11.36 12.00 4.14 Nonbinary 12.29 13.00 4.88

Health status No conditions 7.99 7.00 3.56 Mental health condition only 11.52 12.00 4.03 Physical health condition only 9.12 9.00 3.67 Both physical and mental health conditions 12.92 13.00 3.99

Note. PROMIS � Patient-Reported Outcomes Information System; DV � dependent variable; IV � independent variable.

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S237MENTAL HEALTH AND COVID-19

to physical and mental health care, potential adverse effects of COVID-19 infection, and isolation from social support systems. As such, these individuals might benefit from a multimodal mul- tidisciplinary approach. Telehealth services might include individ- ual psychotherapy to bolster coping skills, group psychotherapy to increase social support, and frequent meetings with nurses and doctors for medical assistance. Wraparound services might include prescription and grocery delivery services and home visits by medical or mental health professionals to ensure that medical and basic needs are met.

As health care rapidly adapts to telemedicine, quality remote mental health care access must be made available to those at greatest risk for emotional distress. According to the results of the current study, women, nonbinary individuals, and individuals with both preexisting mental and physical health conditions should be prioritized.

References

Alon, T. M., Doepke, M., Olmstead-Rumsey, J., & Tertilt, M. (2020). The Impact of COVID-19 on gender equality. National Bureau of Economic Research Working Paper Series. Retrieved from https://www.nber.org/ papers/w26947.pdf

Astbury, J. (2001). Gender disparities in mental health. Paper presented at the Mental health ministerial round tables, WHO 54th World Health Assembly, Geneva, Switzerland. Retrieved from https://www.who.int/ mental_health/media/en/242.pdf

Cornelius, L. R., van der Klink, J. J. L., de Boer, M. R., Brouwer, S., & Groothoff, J. W. (2016). High prevalence of early onset mental disorders among long-term disability claimants. Disability and Rehabilitation: An International, Multidisciplinary Journal, 38, 520 –527. http://dx.doi.org/ 10.3109/09638288.2015.1046566

Francis, J. L., Moitra, E., Dyck, I., & Keller, M. B. (2012). The impact of stressful life events on relapse of generalized anxiety disorder. Depres- sion and Anxiety, 29, 386 –391. http://dx.doi.org/10.1002/da.20919

Garfin, D. R., Silver, R. C., & Holman, E. A. (2020). The novel corona- virus (COVID-2019) outbreak: Amplification of public health conse- quences by media exposure. Health Psychology, 39, 355–357. http://dx .doi.org/10.1037/hea0000875

Horesh, D., & Brown, A. D. (2020). Traumatic stress in the age of COVID-19: A call to close critical gaps and adapt to new realities. Psychological Trauma: Theory, Research, Practice and Policy, 12, 331–335. http://dx.doi.org/10.1037/tra0000592

Kraaij, V., & Garnefski, N. (2012). Coping and depressive symptoms in adolescents with a chronic medical condition: A search for intervention targets. Journal of Adolescence, 35, 1593–1600. http://dx.doi.org/10 .1016/j.adolescence.2012.06.007

Lee, S. M., Kang, W. S., Cho, A. R., Kim, T., & Park, J. K. (2018). Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Comprehensive Psychiatry, 87, 123–127. http://dx.doi.org/10.1016/j.comppsych.2018.10.003

Qiu, J., Shen, B., Zhao, M., Wang, Z., Xie, B., & Xu, Y. (2020). A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: Implications and policy recommendations. General Psychiatry, 33, e100213. http://dx.doi.org/10.1136/gpsych- 2020-100213

Reich, J. W. (2000). Routinization as a factor in coping and the mental health of women with fibromyalgia. Occupational Therapy Journal of Research, 20:41S–51S. http://dx.doi.org/10.1177/15394492000200S104

Scandurra, C., Mezza, F., Maldonato, N. M., Bottone, M., Bochicchio, V., Valerio, P., & Vitelli, R. (2019). Health of non-binary and genderqueer people: A systematic review. Frontiers in Psychology, 10, 1453. http:// dx.doi.org/10.3389/fpsyg.2019.01453

Schalet, B. D., Pilkonis, P. A., Yu, L., Dodds, N., Johnston, K. L., Yount, S., . . . Cella, D. (2016). Clinical validity of PROMIS depression, anxiety, and anger across diverse clinical samples. Journal of Clinical Epidemiology, 73, 119 –127. http://dx.doi.org/10.1016/j.jclinepi.2015.08 .036

Received April 30, 2020 Revision received May 15, 2020

Accepted May 18, 2020 �

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S238 ALONZI, LA TORRE, AND SILVERSTEIN