Assessing the Effects of Long-COVID on Mental Health in the United States: A Population Based Study

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Long-COVID conditions have been associated with reduced quality of life. This study estimates the impact of long-COVID on anxiety and depression in the US, using survey data from nearly a million Americans. Methods The Household Pulse Survey, provides the first population based nationally representative data on the prevalence of long-COVID, starting with the survey’s June 2022 wave. A population-based survey allows us to conduct counterfactual research using control groups. Difference-in-differences models are applied to predict anxiety and depression in the population that contracted COVID-19 and had symptoms of long-COVID vis-à-vis control groups. Results Nearly 51.8% of those surveyed reported testing positive for COVID-19 and of these 27.3% reported suffering from long-COVID. Anxiety and depression rates were twice as high in those with long-COVID. Our sub-group analysis reveals that in general COVID-19 is associated with higher rates of anxiety and depression among younger adults and females, and those on the lower income and education scale. Whites, Blacks and Hispanics had higher odds of anxiety and depression symptoms compared to Asians in both the COVID-19 and long-COVID groups. Interestingly, long-COVID was associated with more negative mental health outcomes among males, where reported mortality rates were higher. Conclusion This study fills a significant gap in the literature on the mental health effects of long-COVID. Our results, based on a large population level data, point to a significant association between COVID-19, especially long-COVID, and cognitive impairment and mental health problems Anxiety Depression COVID-19 mental health Figures Figure 1 Figure 2 1. Background The COVID-19 pandemic profoundly impacted individual health and well-being. According to a report by SAMHSA (2023) as of May 2022, there were a total of 81.7 million reported cases and over one million COVID-19 related deaths in the United States alone. While most people make a full recovery from this disease, nearly 30% of survivors reported protracted symptoms that persisted beyond four weeks, often referred to as post-acute COVID-19 or long-COVID. This translates to 7.7 to 23 million people residing in the U.S. who are living with symptoms of long-COVID. Long-COVID encompasses a wide range of symptoms that include fatigue, cognitive impairment, loss of smell and taste, brain fog, sleep disturbance, anxiety and depression, among many others. In June 2023, the U.S. Department of Health and Human Services issued an advisory for the identification and management of mental health symptoms and conditions associated with long-COVID. Long-COVID is increasingly recognized as a potentially chronic health condition, yet mental health and cognitive symptoms associated with it often get dismissed as psychosomatic conditions. Long-COVID conditions have been associated with reduced quality of life. An emerging issue relates to the effects of long-COVID on mental health. A meta-analysis of studies around the world showed that the overall prevalence of depression, anxiety, and sleep disturbances among COVID-19 survivors was nearly 10–15% higher than in the general non-COVID population. A systematic reviews also found indications of cognitive impairment, with difficulty concentrating, generalized anxiety disorder, and depression being among the most prevalent long-COVID consequences. The incidence of neurologic and psychiatric diagnosis among adults with long-COVID was approximately 34%, and it was highest among for those hospitalized (39%) and critically ill (46%). A study using primary data, finds a substantial impact of long COVID on mental health and quality of life. Studies on long-COVID cognitive impairment have largely focused on hospitalized patients, which are not representative of the population. A limitation of such studies is that they mostly come from cross-sectional or cohort based studies with small sample sizes. A systematic review notes that there is marked heterogeneity in the literature about how long-COVID symptoms are investigated and underscores the need for more research with control groups. The Household Pulse Survey provides the first population based nationally representative sample on the prevalence of long-COVID, starting with the survey’s June 2022 wave. The survey, which also includes questions on mental health status of respondents such as anxiety and depression, allows us to assess the mental health effects of long-COVID in the US. A population-based survey also allows us to conduct counterfactual research using control groups. We use a difference-in-differences analysis to compare mental health outcomes in respondents who had COVID-19 against the population that did not. Then we use the COVID-19 sample to compare the outcomes for those with long-COVID against those with mild or asymptomatic COVID-19.. Previous studies have shown that financial hardships, and the disruptions to social life caused by the COVID-19 pandemic led to heightened anxiety and depression in this country. Job loss, housing insecurity, loss of childcare, as well as the loss of loved ones due to COVID-19 are just a few ways in which the pandemic affected mental health. The current study focuses on the mental health risks associated with contracting SARS-COV2 disease, specifically long-COVID. We use Household Pulse Survey data from June 2022 to October 2023 (waves 46–63) to assess the association between long-COVID and the risk of anxiety and depression. 2. Methods The sample for this study is taken from the Census Bureau’s Household Pulse Survey, a nationally representative repeated cross-sectional survey that began in April 2020 and continues through the present. The Census Bureau randomly selects addresses to participate in the Pulse from all 50 states and sends an internet based survey to this randomly selected list of participants. The Pulse survey started collecting data on the incidence of long-COVID starting in their June 2022 wave. This study examines adults from ages 18–65 using survey data from waves 46–63 (June 1, 2022 – October 30, 2023). Long-COVID Measure In the survey the incidence of long-COVID is defined as long term symptoms lasting 3 months or longer, that the respondent did not have, prior to having coronavirus or COVID-19. The survey question identifies a long list of symptoms from physical symptoms like tiredness and fatigue, shortness of breath, heart palpitations and chest pain to cognitive problems like difficulty concentrating, memory problems like forgetfulness and brain fog. Mental Health Measures : The Household Pulse Survey assesses the frequency of anxiety and depression symptoms. For depression, we use the two-item Patient Health Questionnaire (PHQ-2) . Respondents report how often they have been bothered by 1) having little interest or pleasure in doing things and 2) feeling down, depressed, or hopeless over the past seven days. For anxiety, we use the two-item Generalized Anxiety Disorder scale (GAD-2). Respondents report how often they have been bothered by 1) feeling nervous, anxious, or on edge and 2) not being able to stop or control worrying over the past seven days. Each of these questions has four response options: not at all (0), several days (1), more than half the days (2), nearly every day (3). In line with prior research, we consider a score equal to 3 or more on the PHQ-2 to be indicative of major depressive disorder and a score equal to 3 or more on the GAD-2 to be indicative of generalized anxiety disorder. For the present study, we create binary measures for depression and anxiety using these cutoffs. Covariates Models control for individual covariates that are likely associated with mental health. Covariates include age, gender, race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, Asian (reference), "other" race/ ethnicity), marital status, educational attainment and income levels. Analytical Model: We use a difference-in-differences approach to compare changes in outcomes between the treatment group and a comparison group. We first compare mental health outcomes in respondents who had COVID-19 against those who did not. Then, among those who had COVID-19 we compare the group that had long-COVID against those who did not have symptoms of long-COVID (had mild/asymptomatic COVID-19). We fit linear logistical regression models with our mental health measures as the outcomes. We estimate the following equation: Y it = β 0 + β 1 long_COVID it + β 2 X it + γ s + α t + ε it (1) Where the subscripts i represents individual respondents, t represents the time period measured in survey waves, and s represents states. Y it represents the mental health outcome of interest, coded using a binary indicator of anxiety and depression for each individual. Long-Covid it is our primary variable of interest, which measures the differential effect of having COVID-19 symptoms lasting longer than 3 months on mental health outcomes. X it controls for individual-level characteristics like age, race/ethnicity, gender, marital status, education, and income. We also include controls (also called fixed effects) for state of residence γ s , and for each survey wave α t to control for any confounding factors like unmeasured state-specific and time-specific conditions and policies. 3. Results Table 1 provides descriptive statistics for the Household Pulse Survey data waves #46-#63. Column 1 reports the values for all respondents and column 2 reports the values for the subset of respondents who responded “yes” for long-COVID. About half (51.8%) of all respondents reported testing positive for COVID-19 and about 27.3% of this group reported having long-COVID. Adults who had long-COVID were more likely to be younger, Hispanic, less educated, and lower income. Indicators of mental health, anxiety and depression, were worse in this group. Our primary results are presented in Table 2 . Column (1) reports the results of the difference-in-differences estimates for the full sample of 1,069,931 observations, which includes our treatment group, those who tested positive for COVID-19, and the control group, which is everyone else. Column (2) includes the results from the COVID-19 group (542,845 observations), which is roughly half the total number. We compare the group that had long-COVID against those who had mild/asymptomatic COVID-19 symptoms. Our estimates show that anxiety levels and depression levels were dramatically higher in the long-COVID group. The group that had COVID-19 had higher odds of reporting anxiety symptoms compared to everyone else [1.04, p < 0.001], but there were no significant difference in depression symptoms between this group and the rest of the population. By comparison, the odds of experiencing anxiety and depression symptoms were twice as high in the group that had long-COVID (OR: 2.253, p < 0.001 and OR: 2.263, p < 0.001 respectively). Figures 1 and 2 plot the odds-ratios with a 95% confidence intervals by subgroups based on age, gender, marital status, race/ethnicity, education and income. Our estimates suggest that anxiety and depression decreased slightly with age for both the COVID-19 (OR: 0.969, p < 0.001) and long-COVID (OR: 0.969, p < 0.001) groups. A recent analysis of 78,252 health insurance claims in the U.S. found that two-thirds of patients with long-COVID were between the ages of 36 and 64, and nearly 11% were younger than age 22. In general in the larger COVID-19 cohort a higher proportion of females reported symptoms of anxiety (OR: 1.349, p < 0.001) and somewhat higher odds of depression (OR: 1.02, p < 0.001) as compared to males. Interestingly however, a higher proportion of males with long-COVID appear to report symptoms of anxiety and depression than females (OR: 0.905, p < 0.001 and OR: 0.925, p < 0.001, respectively). According to another study men reported higher rates of depressive symptoms and suicidal ideation. Studies have shown that there is gender disparity in the mortality rates from COVID-19. Death rates from COVID-19 were significantly higher among males in every age group. Some of the potential male bias in COVID-19 outcomes is ascribed to gender-linked health behaviors and occupational exposure. Compared with the reference group Asians, anxiety symptoms were highest among Whites followed by Hispanics and Blacks. The differences were less significant for depression. The odds of experiencing anxiety and depression symptoms were higher at lower levels of education. Similarly, the income effect is significantly negative. Those at the lower end of the income scale had a higher odds experiencing anxiety and depression. Table 3 reports the results by severity of COVID-19 symptoms. In the larger COVID-19 cohort the odds of reporting anxiety and depression were significantly higher for those with severe symptoms (OR: 1.84, p < 0.001 for anxiety, and OR: 1.74, p < 0.001 for depression) compared to those with mild/asymptomatic COVID-19. The odds were twice as high for those with severe symptoms in the long-COVID group (OR: 1.972, p < 0.001 for anxiety, OR: 1.878, p < 0.001 for depression). 4. Discussion Thiis study uses a population based nationally representative Household Pulse Survey data to study the impact of COVID-19, especially long-COVID on mental health. We use difference-in-differences analysis with appropriate control groups to analyze the effect of COVID-19 on anxiety and depression. Our results indicate that those with long-COVID were twice as likely to report anxiety (GAD-2) and depression (PHQ-2) symptoms vis-a-vis those with mild/asymptomatic COVID-19. The differences between the mild COVID-19 and the rest of the population (control group) is insignificant. Our sub-group analysis reveals that for the larger COVID-19 cohort, in general anxiety and depression rates are higher among younger adults and females, and lower among the married. Further, respondents at the lower end of the education and income scale reported higher odds of anxiety and depression symptoms. Interestingly however, for the group with long_COVID, the odds of anxiety and depression symptoms were higher among males. This could be linked to higher mortality rate in this group. Analysis based on race/ethnicity shows that Whites, Blacks, and Hispanics were more likely to report symptoms of anxiety and depression than the reference group (Asians). Finally, those with severe COVID-19 symptoms were nearly twice as likely to report mental health problems vis-à-vis those with mild symptoms. This study has several limitations. First, although our measures of anxiety (GAD-2) and depression (PHQ-2), are based on widely used screening tools for anxiety and depression symptoms, our data is self-reported, and thus is subject to bias. Secondly, the Household Pulse Survey is a repeated cross-sectional data, thus we cannot observe changes in mental health symptoms at the individual level over-time. Finally, the Pulse survey only started collecting data on the incidence of long-COVID in June 2022. We have no counter-factual data for comparison to a period before the actual onset of long-COVID. 5. Conclusion This study fills a significant gap in the literature on the mental health effects of COVID-19. It uses the first nationally representative data on the prevalence of long-COVID to estimate its implications for anxiety and depression in the U.S. Our results, based population level data, point to a significant association between COVID-19, especially long-COVID, and cognitive impairment and mental health problems. Nearly 51.8% of the sample reported testing positive for COVID-19 and of these 27.3% reported suffering from long-COVID. Anxiety and depression rates were twice as high in those with long-COVID.. Interestingly the study finds long-COVID was associated with more negative mental health outcomes among males, where reported mortality rates were higher. Abbreviations SAMHSA Substance Abuse and Mental Health Services Administration GAO Government Accountability Office GAD-2 Two-item Generalized Anxiety Disorder scale PHQ-2 wo-item Patient Health Questionnaire Declarations Ethical Approval : Not applicable Consent for Publication: Not applicable Availability of data and materials : The datasets used and/or analyzed during the current study are available from the corresponding author AD on request. Funding: No external funding was received for this research Competing Interests: The authors declare no competing interests Achknowledgemens: Not applicable Author contributions: The entire research - data collection, statistical analysis, writing, and review of the manuscript was done by A.D. References SAMHSA (2023). Overview of the Impacts of Long COVID on Behavioral Health. Report, January 2023. U.S. Government Accountability Office. (2022). Science & Tech Spotlight: Long COVID. Retrieved from: https://www.gao.gov/products/gao-22-105666. U.S. Department of Health and Human Services (June, 2023). HHS Issues Advisory on Mental Health Symptoms and Conditions Related to Long COVID. Retrieved from https://www.hhs.gov/about/news/2023/06/21/hhs-issues-advisory-mental-health-symptoms-and-conditions-related-long-covid.html. Rooksby M., Furuhashi T., McLeod H.J. Hikikomori: A hidden mental health need following the COVID-19 pandemic. World Psychiatry. 2020;19:399–400. doi: 10.1002/wps.20804. Williamson, L. (August, 2023). Understanding the link between long COVID and mental health conditions, American Heart Association News. Retrieved from https://www.heart.org/en/news/2023/08/17/understanding-the-link-between-long-covid-and-mental-health-conditions Kennelly CE, Nguyen ATP, Sheikhan NY, Strudwick G, Ski CF, Thompson DR, et al. (2023) The lived experience of long COVID: A qualitative study of mental health, quality of life, and coping. PLoS ONE 18(10). Deng, J., Zhou, F., Hou, W., et al. (2020). The prevalence of depression, anxiety, and sleep disturbances in COVID19 patients: a meta-analysis. Annals of the New York Academy of Sciences 2021;1486(1):90-111. Retrieved from: https://doi.org/10.1111/nyas.14506. Groff, D., Sun, A., Ssentongo AE, et al. (2021). Short-term and Long-term Rates of Postacute Sequelae of SARSCoV-2 Infection: A Systematic Review. JAMA Network Open 2021;4(10). 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Tables Table 1: Sample Characteristics of respondents in the Household Pulse Survey, June 2022-October 2023 Descriptive Statistics Sample=All Respondents (n=1,069,931) Sample = Had COVID-19 (n=542,845) Sample= Had Long COVID (n=146,000) Characteristics Mean Mean Mean Age, years (SD) 50.35 (16.01) 47.57 (15.35) 47.15 (14.68) Female, % 56.8 58.3 68.6 Married, % 56.4 59.9 53.8 Race/Ethnicity, % White 73.2 73.4 70.7 Black 8.1 7.0 7.7 Asian 4.8 4.6 3.1 Hispanic 8.8 9.6 11.5 Other 5.2 5.4 7.0 Education, % Less than high school or high school 14.6 14.4 15.7 Income, % Less than $25,000 10.2 8.0 12.2 $25,000-$34,999 8.2 7.0 9.6 $35,000-$49,999 10.5 9.6 12.2 $50,000-$74,999 16.6 16.0 18.2 $75,000-$99,999 14.1 14.4 14.4 $100,000-$149,999 18.5 19.9 17.3 $150,000-$199,999 9.6 10.8 7.9 $200,000 or more 12.3 14.5 8.1 COVID-19, % Had COVID-19 51.8 100.0 100.0 Had Long-COVID 27.3 27.3 100.0 Mild 41.0 40.7 22.8 Moderate 42.8 42.5 50.1 Severe 11.4 11.3 25.6 Mental Health Outcomes, % Anxiety symptoms score>1 (1=not at all) 87.0 88.0 100.0 Anxiety symptoms score≥3 23.9 24.9 38.8 Depressive symptoms>1 (1=not at all) 37.7 38.9 53.2 Depressive symptoms score score≥3 25.7 25.5 3351 Source: Author’s analysis of data from the Household Pulse Survey, June 2022 to October 2023. Notes: Data are drawn from waves 46-53 of the Household Pulse Survey and included people with non-missing values. Anxiety symptoms were measured using the Generalized Anxiety Disorder-2 scale, and depressive symptoms were measured using the Patient Health Questionnaire-2 scale; both were dichotomized at the standard cutoff of 3 or more to indicate high risk of mental health problems. Table 2: COVID-19 and Long COVID effects on Anxiety and Depression (1) (2) Had COVID-19 Had Long-COVID Anxiety 1.040 *** 2.253 *** (5.97) (103.51) Depression 1.002 2.263 *** (0.25) (84.55) N 863152 442532 t statistics in parentheses; * p < 0.05, ** p < 0.01, *** p < 0.001 Table 3: Anxiety and Depression by symptoms (1) Had COVID-19 (2) Had Long-COVID anxiety34 depress34 anxiety34 depress34 Moderate 1.141 *** 1.063 *** 1.233 *** 1.159 *** Severe 1.840 *** 1.737 *** 1.972 *** 1.878 *** N 865123 866763 865123 866763 pseudo R 2 0.086 0.090 0.085 0.089 Exponentiated coefficients; t statistics in parentheses * p < 0.05, ** p < 0.01, *** p < 0.001 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4752480","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":333737000,"identity":"0d472353-7694-4e51-898a-4e63f61a2c34","order_by":0,"name":"Anusua Datta","email":"data:image/png;base64,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","orcid":"","institution":"Thomas Jefferson University","correspondingAuthor":true,"prefix":"","firstName":"Anusua","middleName":"","lastName":"Datta","suffix":""}],"badges":[],"createdAt":"2024-07-16 22:26:52","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4752480/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4752480/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62637125,"identity":"a8609cad-19f2-4093-b236-5e72c9d673b1","added_by":"auto","created_at":"2024-08-16 17:22:41","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":37778,"visible":true,"origin":"","legend":"\u003cp\u003eAnxiety by sub-group\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4752480/v1/250092915bacf90590282285.jpg"},{"id":62637126,"identity":"f30be3d1-dacd-4593-8d99-d9946c88abe6","added_by":"auto","created_at":"2024-08-16 17:22:41","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":39375,"visible":true,"origin":"","legend":"\u003cp\u003eDepression by sub-group\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4752480/v1/0a9ee8f8a5e5b212132a40b0.jpg"},{"id":63737826,"identity":"2086304c-c3a4-42b8-a648-1531a2d62ae6","added_by":"auto","created_at":"2024-09-01 18:29:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":569755,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4752480/v1/1a5cb5c0-b057-4c29-b470-ec5268213f3b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessing the Effects of Long-COVID on Mental Health in the United States: A Population Based Study","fulltext":[{"header":"1. Background","content":"\u003cp\u003eThe COVID-19 pandemic profoundly impacted individual health and well-being. According to a report by SAMHSA (2023)\u003ca class=\"FNLink\" href=\"#Fn1\" id=\"#FNLinkFn1\"\u003e\u003c/a\u003e as of May 2022, there were a total of 81.7\u0026nbsp;million reported cases and over one million COVID-19 related deaths in the United States alone. While most people make a full recovery from this disease, nearly 30% of survivors reported protracted symptoms that persisted beyond four weeks, often referred to as post-acute COVID-19 or long-COVID. This translates to 7.7 to 23\u0026nbsp;million people residing in the U.S. who are living with symptoms of long-COVID.\u003ca class=\"FNLink\" href=\"#Fn2\" id=\"#FNLinkFn2\"\u003e\u003c/a\u003e\u003c/p\u003e \u003cp\u003eLong-COVID encompasses a wide range of symptoms that include fatigue, cognitive impairment, loss of smell and taste, brain fog, sleep disturbance, anxiety and depression, among many others. In June 2023, the U.S. Department of Health and Human Services issued an advisory\u003ca class=\"FNLink\" href=\"#Fn3\" id=\"#FNLinkFn3\"\u003e\u003c/a\u003e for the identification and management of mental health symptoms and conditions associated with long-COVID. Long-COVID is increasingly recognized as a potentially chronic health condition, yet mental health and cognitive symptoms associated with it often get dismissed as psychosomatic conditions.\u003c/p\u003e \u003cp\u003eLong-COVID conditions have been associated with reduced quality of life. An emerging issue relates to the effects of long-COVID on mental health. \u003ca class=\"FNLink\" href=\"#Fn4\" id=\"#FNLinkFn4\"\u003e\u003c/a\u003e \u003ca class=\"FNLink\" href=\"#Fn5\" id=\"#FNLinkFn5\"\u003e\u003c/a\u003e \u003ca class=\"FNLink\" href=\"#Fn6\" id=\"#FNLinkFn6\"\u003e\u003c/a\u003e A meta-analysis of studies around the world showed that the overall prevalence of depression, anxiety, and sleep disturbances among COVID-19 survivors was nearly 10\u0026ndash;15% higher than in the general non-COVID population.\u003ca class=\"FNLink\" href=\"#Fn7\" id=\"#FNLinkFn7\"\u003e\u003c/a\u003e A systematic reviews also found indications of cognitive impairment, with difficulty concentrating, generalized anxiety disorder, and depression being among the most prevalent long-COVID consequences. \u003ca class=\"FNLink\" href=\"#Fn8\" id=\"#FNLinkFn8\"\u003e\u003c/a\u003e The incidence of neurologic and psychiatric diagnosis among adults with long-COVID was approximately 34%, and it was highest among for those hospitalized (39%) and critically ill (46%).\u003ca class=\"FNLink\" href=\"#Fn9\" id=\"#FNLinkFn9\"\u003e\u003c/a\u003e A study\u003ca class=\"FNLink\" href=\"#Fn10\" id=\"#FNLinkFn10\"\u003e\u003c/a\u003e using primary data, finds a substantial impact of long COVID on mental health and quality of life.\u003c/p\u003e \u003cp\u003eStudies on long-COVID cognitive impairment have largely focused on hospitalized patients, which are not representative of the population. A limitation of such studies is that they mostly come from cross-sectional or cohort based studies with small sample sizes.\u003ca class=\"FNLink\" href=\"#Fn11\" id=\"#FNLinkFn11\"\u003e\u003c/a\u003e A systematic review\u003ca class=\"FNLink\" href=\"#Fn12\" id=\"#FNLinkFn12\"\u003e\u003c/a\u003e notes that there is marked heterogeneity in the literature about how long-COVID symptoms are investigated and underscores the need for more research with control groups.\u003c/p\u003e \u003cp\u003eThe Household Pulse Survey provides the first population based nationally representative sample on the prevalence of long-COVID, starting with the survey\u0026rsquo;s June 2022 wave. The survey, which also includes questions on mental health status of respondents such as anxiety and depression, allows us to assess the mental health effects of long-COVID in the US. A population-based survey also allows us to conduct counterfactual research using control groups. We use a difference-in-differences analysis to compare mental health outcomes in respondents who had COVID-19 against the population that did not. Then we use the COVID-19 sample to compare the outcomes for those with long-COVID against those with mild or asymptomatic COVID-19..\u003c/p\u003e \u003cp\u003ePrevious studies\u003ca class=\"FNLink\" href=\"#Fn13\" id=\"#FNLinkFn13\"\u003e\u003c/a\u003e \u003ca class=\"FNLink\" href=\"#Fn14\" id=\"#FNLinkFn14\"\u003e\u003c/a\u003e \u003ca class=\"FNLink\" href=\"#Fn15\" id=\"#FNLinkFn15\"\u003e\u003c/a\u003e have shown that financial hardships, and the disruptions to social life caused by the COVID-19 pandemic led to heightened anxiety and depression in this country. Job loss, housing insecurity, loss of childcare, as well as the loss of loved ones due to COVID-19 are just a few ways in which the pandemic affected mental health. The current study focuses on the mental health risks associated with contracting SARS-COV2 disease, specifically long-COVID. We use Household Pulse Survey data from June 2022 to October 2023 (waves 46\u0026ndash;63) to assess the association between long-COVID and the risk of anxiety and depression.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eThe sample for this study is taken from the Census Bureau\u0026rsquo;s Household Pulse Survey, a nationally representative repeated cross-sectional survey that began in April 2020 and continues through the present. The Census Bureau randomly selects addresses to participate in the Pulse from all 50 states and sends an internet based survey to this randomly selected list of participants. The Pulse survey started collecting data on the incidence of long-COVID starting in their June 2022 wave. This study examines adults from ages 18\u0026ndash;65 using survey data from waves 46\u0026ndash;63 (June 1, 2022 \u0026ndash; October 30, 2023).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLong-COVID Measure\u003c/strong\u003e \u003cp\u003eIn the survey the incidence of long-COVID is defined as long term symptoms lasting 3 months or longer, that the respondent did not have, prior to having coronavirus or COVID-19. The survey question identifies a long list of symptoms from physical symptoms like tiredness and fatigue, shortness of breath, heart palpitations and chest pain to cognitive problems like difficulty concentrating, memory problems like forgetfulness and brain fog.\u003ca class=\"FNLink\" href=\"#Fn16\" id=\"#FNLinkFn16\"\u003e\u003c/a\u003e\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eMental Health Measures\u003c/em\u003e: The Household Pulse Survey assesses the frequency of anxiety and depression symptoms. For depression, we use the two-item Patient Health Questionnaire (PHQ-2)\u003ca class=\"FNLink\" href=\"#Fn17\" id=\"#FNLinkFn17\"\u003e\u003c/a\u003e. Respondents report how often they have been bothered by 1) having little interest or pleasure in doing things and 2) feeling down, depressed, or hopeless over the past seven days. For anxiety, we use the two-item Generalized Anxiety Disorder scale (GAD-2).\u003ca class=\"FNLink\" href=\"#Fn18\" id=\"#FNLinkFn18\"\u003e\u003c/a\u003e Respondents report how often they have been bothered by 1) feeling nervous, anxious, or on edge and 2) not being able to stop or control worrying over the past seven days. Each of these questions has four response options: not at all (0), several days (1), more than half the days (2), nearly every day (3). In line with prior research, we consider a score equal to 3 or more on the PHQ-2 to be indicative of major depressive disorder\u003ca class=\"FNLink\" href=\"#Fn19\" id=\"#FNLinkFn19\"\u003e\u003c/a\u003e \u003ca class=\"FNLink\" href=\"#Fn20\" id=\"#FNLinkFn20\"\u003e\u003c/a\u003eand a score equal to 3 or more on the GAD-2 to be indicative of generalized anxiety disorder.\u003ca class=\"FNLink\" href=\"#Fn21\" id=\"#FNLinkFn21\"\u003e\u003c/a\u003e For the present study, we create binary measures for depression and anxiety using these cutoffs.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCovariates\u003c/strong\u003e \u003cp\u003eModels control for individual covariates that are likely associated with mental health. Covariates include age, gender, race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, Asian (reference), \"other\" race/ ethnicity), marital status, educational attainment and income levels.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eAnalytical Model: We use a difference-in-differences approach to compare changes in outcomes between the treatment group and a comparison group. We first compare mental health outcomes in respondents who had COVID-19 against those who did not. Then, among those who had COVID-19 we compare the group that had long-COVID against those who did not have symptoms of long-COVID (had mild/asymptomatic COVID-19). We fit linear logistical regression models with our mental health measures as the outcomes. We estimate the following equation:\u003c/p\u003e \u003cp\u003e \u003cem\u003eY\u003c/em\u003e \u003csub\u003e \u003cem\u003eit\u003c/em\u003e \u003c/sub\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;β\u003c/em\u003e\u003csub\u003e\u003cem\u003e0\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;\u003cem\u003e+\u0026thinsp;β\u003c/em\u003e\u003csub\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sub\u003e \u003cem\u003elong_COVID\u003c/em\u003e\u003csub\u003e\u003cem\u003eit\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;\u003cem\u003e+\u0026thinsp;β\u003c/em\u003e\u003csub\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sub\u003e \u003cem\u003eX\u003c/em\u003e\u003csub\u003e\u003cem\u003eit\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;\u003cem\u003e+\u0026thinsp;γ\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;\u003cem\u003e+\u0026thinsp;α\u003c/em\u003e\u003csub\u003e\u003cem\u003et\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;\u003cem\u003e+\u0026thinsp;ε\u003c/em\u003e\u003csub\u003e\u003cem\u003eit\u003c/em\u003e\u003c/sub\u003e (1)\u003c/p\u003e \u003cp\u003eWhere the subscripts \u003cem\u003ei\u003c/em\u003e represents individual respondents, \u003cem\u003et\u003c/em\u003e represents the time period measured in survey waves, and \u003cem\u003es\u003c/em\u003e represents states. \u003cem\u003eY\u003c/em\u003e\u003csub\u003e\u003cem\u003eit\u003c/em\u003e\u003c/sub\u003e represents the mental health outcome of interest, coded using a binary indicator of anxiety and depression for each individual. \u003cem\u003eLong-Covid\u003c/em\u003e\u003csub\u003e\u003cem\u003eit\u003c/em\u003e\u003c/sub\u003e is our primary variable of interest, which measures the differential effect of having COVID-19 symptoms lasting longer than 3 months on mental health outcomes. \u003cem\u003eX\u003c/em\u003e\u003csub\u003e\u003cem\u003eit\u003c/em\u003e\u003c/sub\u003e controls for individual-level characteristics like age, race/ethnicity, gender, marital status, education, and income. We also include controls (also called fixed effects) for state of residence \u003cem\u003eγ\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e,\u003c/sub\u003e and for each survey wave\u003cem\u003eα\u003c/em\u003e\u003csub\u003e\u003cem\u003et\u003c/em\u003e\u003c/sub\u003e to control for any confounding factors like unmeasured state-specific and time-specific conditions and policies.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e provides descriptive statistics for the Household Pulse Survey data waves #46-#63. Column 1 reports the values for all respondents and column 2 reports the values for the subset of respondents who responded \u0026ldquo;yes\u0026rdquo; for long-COVID. About half (51.8%) of all respondents reported testing positive for COVID-19 and about 27.3% of this group reported having long-COVID. Adults who had long-COVID were more likely to be younger, Hispanic, less educated, and lower income. Indicators of mental health, anxiety and depression, were worse in this group.\u003c/p\u003e \u003cp\u003eOur primary results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Column (1) reports the results of the difference-in-differences estimates for the full sample of 1,069,931 observations, which includes our treatment group, those who tested positive for COVID-19, and the control group, which is everyone else. Column (2) includes the results from the COVID-19 group (542,845 observations), which is roughly half the total number. We compare the group that had long-COVID against those who had mild/asymptomatic COVID-19 symptoms. Our estimates show that anxiety levels and depression levels were dramatically higher in the long-COVID group. The group that had COVID-19 had higher odds of reporting anxiety symptoms compared to everyone else [1.04, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001], but there were no significant difference in depression symptoms between this group and the rest of the population. By comparison, the odds of experiencing anxiety and depression symptoms were twice as high in the group that had long-COVID (OR: 2.253, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and OR: 2.263, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 respectively).\u003c/p\u003e \u003cp\u003eFigures 1 and \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e plot the odds-ratios with a 95% confidence intervals by subgroups based on age, gender, marital status, race/ethnicity, education and income. Our estimates suggest that anxiety and depression decreased slightly with age for both the COVID-19 (OR: 0.969, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and long-COVID (OR: 0.969, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) groups. A recent analysis of 78,252 health insurance claims in the U.S. found that two-thirds of patients with long-COVID were between the ages of 36 and 64, and nearly 11% were younger than age 22.\u003ca class=\"FNLink\" href=\"#Fn22\" id=\"#FNLinkFn22\"\u003e\u003c/a\u003e In general in the larger COVID-19 cohort a higher proportion of females reported symptoms of anxiety (OR: 1.349, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and somewhat higher odds of depression (OR: 1.02, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) as compared to males. Interestingly however, a higher proportion of males with long-COVID appear to report symptoms of anxiety and depression than females (OR: 0.905, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and OR: 0.925, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, respectively). According to another study\u003ca class=\"FNLink\" href=\"#Fn23\" id=\"#FNLinkFn23\"\u003e\u003c/a\u003e men reported higher rates of depressive symptoms and suicidal ideation. Studies\u003ca class=\"FNLink\" href=\"#Fn24\" id=\"#FNLinkFn24\"\u003e\u003c/a\u003e\u003ca class=\"FNLink\" href=\"#Fn25\" id=\"#FNLinkFn25\"\u003e\u003c/a\u003e have shown that there is gender disparity in the mortality rates from COVID-19. Death rates from COVID-19 were significantly higher among males in every age group. Some of the potential male bias in COVID-19 outcomes is ascribed to gender-linked health behaviors and occupational exposure.\u003c/p\u003e \u003cp\u003eCompared with the reference group Asians, anxiety symptoms were highest among Whites followed by Hispanics and Blacks. The differences were less significant for depression. The odds of experiencing anxiety and depression symptoms were higher at lower levels of education. Similarly, the income effect is significantly negative. Those at the lower end of the income scale had a higher odds experiencing anxiety and depression.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e reports the results by severity of COVID-19 symptoms. In the larger COVID-19 cohort the odds of reporting anxiety and depression were significantly higher for those with severe symptoms (OR: 1.84, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for anxiety, and OR: 1.74, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for depression) compared to those with mild/asymptomatic COVID-19. The odds were twice as high for those with severe symptoms in the long-COVID group (OR: 1.972, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for anxiety, OR: 1.878, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for depression).\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThiis study uses a population based nationally representative Household Pulse Survey data to study the impact of COVID-19, especially long-COVID on mental health. We use difference-in-differences analysis with appropriate control groups to analyze the effect of COVID-19 on anxiety and depression. Our results indicate that those with long-COVID were twice as likely to report anxiety (GAD-2) and depression (PHQ-2) symptoms vis-a-vis those with mild/asymptomatic COVID-19. The differences between the mild COVID-19 and the rest of the population (control group) is insignificant.\u003c/p\u003e \u003cp\u003eOur sub-group analysis reveals that for the larger COVID-19 cohort, in general anxiety and depression rates are higher among younger adults and females, and lower among the married. Further, respondents at the lower end of the education and income scale reported higher odds of anxiety and depression symptoms. Interestingly however, for the group with long_COVID, the odds of anxiety and depression symptoms were higher among males. This could be linked to higher mortality rate in this group. Analysis based on race/ethnicity shows that Whites, Blacks, and Hispanics were more likely to report symptoms of anxiety and depression than the reference group (Asians). Finally, those with severe COVID-19 symptoms were nearly twice as likely to report mental health problems vis-\u0026agrave;-vis those with mild symptoms.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, although our measures of anxiety (GAD-2) and depression (PHQ-2), are based on widely used screening tools for anxiety and depression symptoms, our data is self-reported, and thus is subject to bias. Secondly, the Household Pulse Survey is a repeated cross-sectional data, thus we cannot observe changes in mental health symptoms at the individual level over-time. Finally, the Pulse survey only started collecting data on the incidence of long-COVID in June 2022. We have no counter-factual data for comparison to a period before the actual onset of long-COVID.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis study fills a significant gap in the literature on the mental health effects of COVID-19. It uses the first nationally representative data on the prevalence of long-COVID to estimate its implications for anxiety and depression in the U.S. Our results, based population level data, point to a significant association between COVID-19, especially long-COVID, and cognitive impairment and mental health problems. Nearly 51.8% of the sample reported testing positive for COVID-19 and of these 27.3% reported suffering from long-COVID. Anxiety and depression rates were twice as high in those with long-COVID.. Interestingly the study finds long-COVID was associated with more negative mental health outcomes among males, where reported mortality rates were higher.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSAMHSA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSubstance Abuse and Mental Health Services Administration\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eGAO\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGovernment Accountability Office\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cem\u003eGAD-2\u003c/em\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTwo-item Generalized Anxiety Disorder scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cem\u003ePHQ-2\u003c/em\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ewo-item Patient Health Questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e:\u0026nbsp;\u0026nbsp;\u003cbr\u003e\u0026nbsp;Not applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication:\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author AD on request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding: \u0026nbsp;\u003cbr\u003e\u0026nbsp; No external funding was received for this research\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003c/strong\u003eThe authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAchknowledgemens:\u0026nbsp;\u003cbr\u003e\u0026nbsp;Not applicable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003cbr\u003e\u0026nbsp;\u003c/strong\u003eThe entire research - data collection, statistical analysis, writing, and review of the manuscript was done by A.D.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSAMHSA (2023). Overview of the Impacts of Long COVID on Behavioral Health. Report, January 2023.\u003c/li\u003e\n\u003cli\u003eU.S. Government Accountability Office. (2022). Science \u0026amp; Tech Spotlight: Long COVID. Retrieved from: https://www.gao.gov/products/gao-22-105666.\u003c/li\u003e\n\u003cli\u003eU.S. Department of Health and Human Services (June, 2023). HHS Issues Advisory on Mental Health Symptoms and Conditions Related to Long COVID. Retrieved from https://www.hhs.gov/about/news/2023/06/21/hhs-issues-advisory-mental-health-symptoms-and-conditions-related-long-covid.html.\u003c/li\u003e\n\u003cli\u003eRooksby M., Furuhashi T., McLeod H.J. Hikikomori: A hidden mental health need following the COVID-19 pandemic. World Psychiatry. 2020;19:399\u0026ndash;400. doi: 10.1002/wps.20804.\u003c/li\u003e\n\u003cli\u003eWilliamson, L. (August, 2023). Understanding the link between long COVID and mental health conditions, American Heart Association News. Retrieved from https://www.heart.org/en/news/2023/08/17/understanding-the-link-between-long-covid-and-mental-health-conditions\u003c/li\u003e\n\u003cli\u003eKennelly CE, Nguyen ATP, Sheikhan NY, Strudwick G, Ski CF, Thompson DR, et al. (2023) The lived experience of long COVID: A qualitative study of mental health, quality of life, and coping. PLoS ONE 18(10).\u003c/li\u003e\n\u003cli\u003eDeng, J., Zhou, F., Hou, W., et al. (2020). The prevalence of depression, anxiety, and sleep disturbances in COVID19 patients: a meta-analysis. Annals of the New York Academy of Sciences 2021;1486(1):90-111. Retrieved from: https://doi.org/10.1111/nyas.14506.\u003c/li\u003e\n\u003cli\u003eGroff, D., Sun, A., Ssentongo AE, et al. (2021). Short-term and Long-term Rates of Postacute Sequelae of SARSCoV-2 Infection: A Systematic Review. JAMA Network Open 2021;4(10). Retrieved from: https://doi.org/10.1001/jamanetworkopen.2021.28568.\u003c/li\u003e\n\u003cli\u003eMarchi M, Grenzi P, Serafini V, Capoccia F, Rossi F, Marrino P, Pingani L, Galeazzi GM, Ferrari S. (2023). Psychiatric symptoms in Long-COVID patients: a systematic review. Front Psychiatry. 2023, Jun 21;14: 14:1138389. doi: 10.3389/fpsyt.2023.1138389.\u003c/li\u003e\n\u003cli\u003eKennelly CE, Nguyen ATP, Sheikhan NY, Strudwick G, Ski CF, Thompson DR, et al. (2023) The lived experience of long COVID: A qualitative study of mental health, quality of life, and coping. PLoS ONE 18(10).\u003c/li\u003e\n\u003cli\u003eSAMHSA (2023). Overview of the Impacts of Long COVID on Behavioral Health. Report, January 2023.\u003c/li\u003e\n\u003cli\u003eMarchi M, Grenzi P, Serafini V, Capoccia F, Rossi F, Marrino P, Pingani L, Galeazzi GM, Ferrari S. (2023). Psychiatric symptoms in Long-COVID patients: a systematic review. Front Psychiatry. 2023, Jun 21;14: 14:1138389. doi: 10.3389/fpsyt.2023.1138389.\u003c/li\u003e\n\u003cli\u003eDonnelly R, Farina MP. How do state policies shape experiences of household income shocks and mental health during the COVID-19 pandemic? Soc Sci Med. 2021 Jan;269:113557\u003c/li\u003e\n\u003cli\u003eDatta, A. (2023). Longitudinal Study of the Effects of the COVID-19 pandemic on Mental Health in the US. In the Proceedings of the Pennsylvania Economics Association.\u003c/li\u003e\n\u003cli\u003eAlhomsi A, Strassle PD, Ponce S, Mendez I, Quintero SM, Wilkerson M, Stewart AL, Napoles AM. Financial Hardship and Psychological Distress During the Pandemic: A Nationally Representative Survey of Major Racial-Ethnic Groups in the United States. Health Equity. 2023 Jul 20;7(1):395-405. \u003c/li\u003e\n\u003cli\u003eGilbody, S., Richards, D., Brealey, S., Hewitt, C., 2007. Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis. J. Gen. Intern. Med. 22 (11), 1596\u0026ndash;1602.\u003c/li\u003e\n\u003cli\u003eKroenke, K., Spitzer, R.L., Williams, J.B.W., Monahan, P.O., L\u0026uml;owe, B., 2007. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann. Intern. Med. 146, 317\u0026ndash;325.\u003c/li\u003e\n\u003cli\u003eGilbody, S., Richards, D., Brealey, S., Hewitt, C., 2007. Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis. J. Gen. Intern. Med. 22 (11), 1596\u0026ndash;1602.\u003c/li\u003e\n\u003cli\u003eKroenke, K., Spitzer, R.L., Williams, J.B.W., 2003. The patient health questionnaire-2: validity of a two-item depression screener. Med. Care 41 (11), 1284\u0026ndash;1292.\u003c/li\u003e\n\u003cli\u003eKroenke, K., Spitzer, R.L., Williams, J.B.W., Monahan, P.O., L\u0026uml;owe, B., 2007. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann. Intern. Med. 146, 317\u0026ndash;325.\u003c/li\u003e\n\u003cli\u003eFAIR Health. (2022). Patients Diagnosed with Post-COVID Conditions: An Analysis of Private Healthcare Claims Using the Official ICD-10 Diagnostic Code. Retrieved from: https://s3.amazonaws.com/media2.fairhealth.org/whitepaper/asset/Patients%20Diagnosed%20with%20PostCOVID%20Conditions%20-%20A%20FAIR%20Health%20White%20Paper.pdf\u003c/li\u003e\n\u003cli\u003eCzeisler M. \u0026Eacute;., Lane R. I., Petrosky E., Wiley J. F., Christensen A., Njai R., Weaver M.D., Robbins R., Facer-Childs E.R., Barger L. K., Czeisler C.A., Howard M.E., Rajaratnam S.M.W. (2020). Mental health, substance use, and suicidal ideation during the COVID-19 pandemic\u0026mdash;United States, June 24\u0026ndash;30, 2020. \u003cem\u003eMorbidity and Mortality Weekly Report\u003c/em\u003e, 69(32), 1049. 10.15585/mmwr.mm6932a1\u003c/li\u003e\n\u003cli\u003eBetzaida Tejada-Vera, M.S., and Ellen A. Kramarow\u003cstrong\u003e (2022). COVID-19 Mortality in Adults Aged 65 and Over: United States, 2020.\u0026rdquo; NCHS Brief # 446\u003c/strong\u003e\u003c/li\u003e\n\u003cli\u003eKharroubi SA, Diab-El-Harake M. Sex-differences in COVID-19 diagnosis, risk factors and disease comorbidities: A large US-based cohort study. Front Public Health. 2022 Nov 17.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Sample Characteristics of respondents in the Household Pulse Survey, June 2022-October 2023\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDescriptive Statistics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSample=All Respondents\u003c/p\u003e\n \u003cp\u003e(n=1,069,931)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSample = Had COVID-19\u003c/p\u003e\n \u003cp\u003e(n=542,845)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSample= Had Long COVID\u003c/p\u003e\n \u003cp\u003e(n=146,000)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Mean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Mean\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Age, years (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50.35 (16.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47.57 (15.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47.15 (14.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Female, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e56.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e58.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e68.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Married, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e56.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e59.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e53.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Race/Ethnicity, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;White\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e73.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e73.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e70.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Black\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Asian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Hispanic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEducation, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Less than high school or high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eIncome, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Less than $25,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;$25,000-$34,999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;$35,000-$49,999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;$50,000-$74,999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;$75,000-$99,999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;$100,000-$149,999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;$150,000-$199,999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;$200,000 or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;COVID-19, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Had COVID-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Had Long-COVID\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Mild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Moderate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Severe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMental Health Outcomes, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAnxiety symptoms score\u0026gt;1 (1=not at all)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e87.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e88.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAnxiety symptoms score\u0026ge;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDepressive symptoms\u0026gt;1 (1=not at all)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e53.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDepressive symptoms score score\u0026ge;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3351\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSource: Author\u0026rsquo;s analysis of data from the Household Pulse Survey, June 2022 to October 2023.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNotes: Data are drawn from waves 46-53 of the Household Pulse Survey and included people with non-missing values. Anxiety symptoms were measured using the Generalized Anxiety Disorder-2 scale, and depressive symptoms were measured using the Patient Health Questionnaire-2 scale; both were dichotomized at the standard cutoff of 3 or more to indicate high risk of mental health problems.\u003c/p\u003e\n\u003cp\u003eTable 2: COVID-19 and Long COVID effects on Anxiety and Depression\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e(1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.795918367346935%\" valign=\"top\"\u003e\n \u003cp\u003e(2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Had COVID-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.795918367346935%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Had Long-COVID\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.795918367346935%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e1.040\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.795918367346935%\" valign=\"top\"\u003e\n \u003cp\u003e2.253\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e(5.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.795918367346935%\" valign=\"top\"\u003e\n \u003cp\u003e(103.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.795918367346935%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003eDepression\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e1.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.795918367346935%\" valign=\"top\"\u003e\n \u003cp\u003e2.263\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e(0.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.795918367346935%\" valign=\"top\"\u003e\n \u003cp\u003e(84.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.53061224489796%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.673469387755105%\" valign=\"top\"\u003e\n \u003cp\u003e863152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.795918367346935%\" valign=\"top\"\u003e\n \u003cp\u003e442532\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003et\u003c/em\u003e statistics in parentheses; \u003csup\u003e*\u003c/sup\u003e \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, \u003csup\u003e**\u003c/sup\u003e \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01, \u003csup\u003e***\u003c/sup\u003e \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001\u003c/p\u003e\n\u003cp\u003eTable 3: Anxiety and Depression by symptoms\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"648\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.97530864197531%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41.51234567901235%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e(1)\u003c/p\u003e\n \u003cp\u003eHad COVID-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41.51234567901235%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e(2)\u003c/p\u003e\n \u003cp\u003eHad Long-COVID\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.027863777089784%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003eanxiety34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003edepress34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003eanxiety34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003edepress34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.027863777089784%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.027863777089784%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.027863777089784%\" valign=\"top\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e1.141\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e1.063\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e1.233\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e1.159\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.027863777089784%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.027863777089784%\" valign=\"top\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e1.840\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e1.737\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e1.972\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e1.878\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.027863777089784%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.027863777089784%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e865123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e866763\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e865123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e866763\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.027863777089784%\" valign=\"top\"\u003e\n \u003cp\u003epseudo \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.743034055727556%\" valign=\"top\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eExponentiated coefficients; \u003cem\u003et\u003c/em\u003e statistics in parentheses\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e*\u003c/sup\u003e \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, \u003csup\u003e**\u003c/sup\u003e \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01, \u003csup\u003e***\u003c/sup\u003e \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Anxiety, Depression, COVID-19, mental health","lastPublishedDoi":"10.21203/rs.3.rs-4752480/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4752480/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe term long-COVID is commonly used to refer to protracted symptoms following COVID-19 infection that persist beyond four weeks from onset. Long-COVID conditions have been associated with reduced quality of life. This study estimates the impact of long-COVID on anxiety and depression in the US, using survey data from nearly a million Americans.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe Household Pulse Survey, provides the first population based nationally representative data on the prevalence of long-COVID, starting with the survey\u0026rsquo;s June 2022 wave. A population-based survey allows us to conduct counterfactual research using control groups. Difference-in-differences models are applied to predict anxiety and depression in the population that contracted COVID-19 and had symptoms of long-COVID vis-\u0026agrave;-vis control groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eNearly 51.8% of those surveyed reported testing positive for COVID-19 and of these 27.3% reported suffering from long-COVID. Anxiety and depression rates were twice as high in those with long-COVID. Our sub-group analysis reveals that in general COVID-19 is associated with higher rates of anxiety and depression among younger adults and females, and those on the lower income and education scale. Whites, Blacks and Hispanics had higher odds of anxiety and depression symptoms compared to Asians in both the COVID-19 and long-COVID groups. Interestingly, long-COVID was associated with more negative mental health outcomes among males, where reported mortality rates were higher.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study fills a significant gap in the literature on the mental health effects of long-COVID. Our results, based on a large population level data, point to a significant association between COVID-19, especially long-COVID, and cognitive impairment and mental health problems\u003c/p\u003e","manuscriptTitle":"Assessing the Effects of Long-COVID on Mental Health in the United States: A Population Based Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-16 17:22:36","doi":"10.21203/rs.3.rs-4752480/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"45ce76d6-2995-415c-8ff2-877f1b507621","owner":[],"postedDate":"August 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-19T11:39:05+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-16 17:22:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4752480","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4752480","identity":"rs-4752480","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}