Durable Disruption and Compounding Disparities: Pre-pandemic Health Vulnerabilities and COVID-Related Elevation in Depression Trajectories Among U.S. Older Adults

Durable Disruption and Compounding Disparities: Pre-pandemic Health Vulnerabilities and COVID-Related Elevation in Depression Trajectories Among U.S. Older Adults | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Durable Disruption and Compounding Disparities: Pre-pandemic Health Vulnerabilities and COVID-Related Elevation in Depression Trajectories Among U.S. Older Adults Miao Li, Ye Luo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8553749/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Purpose This study examines two questions: (1) How did depressive symptoms among U.S. older adults change during the outbreak (2020) and extended COVID pandemic period (2022)? and (2) How did pre-existing health vulnerabilities ( chronic conditions, functional limitations, self-rated poor health, emotional/psychiatric problems ) predict these changes? Methods We used data from the Health and Retirement Study (2010–2022). Analytic sample (N = 8,284) included respondents with depressive symptoms data in 2010–2022 to model pre- and post-pandemic trajectory change. Latent change score models estimated biennial changes of depressive symptoms, with pre-pandemic health vulnerabilities predicting changes in 2018–2020 and 2020–2022. Results Depressive symptoms remained stable (2010–2018), rose sharply (2018–2020), then plateaued through 2022. Disparities widened at outbreak: poorer self-rated health, greater functional limitations, and psychiatric history predicted disproportionately larger symptom increases. From 2020–2022, disparities tied to functional limitations and psychiatric history stabilized, while poor/fair self-rated health disparities continued to deepen. Conclusion COVID-19 established a higher post-pandemic baseline of depressive symptoms and compounded disadvantage among health-vulnerable older adults. Mental health services for this group should not assume a natural post-pandemic recovery but instead be prepared to address persistently elevated levels of depression in the post-pandemic period. Future research should extend tracking beyond 2022 and identify potential resilience factors. Chronic conditions Depressive symptoms Functional limitations Latent change score model Self-rated Health Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 26 Mar, 2026 Reviewers agreed at journal 27 Feb, 2026 Reviewers invited by journal 24 Feb, 2026 Editor assigned by journal 05 Feb, 2026 Submission checks completed at journal 10 Jan, 2026 First submitted to journal 08 Jan, 2026 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-8553749","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":596263538,"identity":"50daa59d-79cf-4106-8f20-76a97dd601f5","order_by":0,"name":"Miao Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvUlEQVRIiWNgGAWjYDACZiB+UMEgA+MzNhClJeEMAw8JWkAgsY0ULbrtzA8fJM6z4+EXO/7wcQGDjeyGAwS0mB1mMzZI3JbMIzk7x9h4BkOaMRFaGMwkErcd4DG4ncMmzcNwOJEILezfJBLnHOCxv53+DKjlPzFaeIC2NABtkU4wA2o5QJSWYoOEY8k8EreBfuExSDaeSVDL+eMbH3yosZPjn53+8DFPhZ1sHyEtaMCANOWjYBSMglEwCnAAAOnhPZb7SJc8AAAAAElFTkSuQmCC","orcid":"","institution":"Clemson University","correspondingAuthor":true,"prefix":"","firstName":"Miao","middleName":"","lastName":"Li","suffix":""},{"id":596263539,"identity":"5cd8197f-8684-4b6d-bdcf-69296483aea7","order_by":1,"name":"Ye Luo","email":"","orcid":"","institution":"Clemson University","correspondingAuthor":false,"prefix":"","firstName":"Ye","middleName":"","lastName":"Luo","suffix":""}],"badges":[],"createdAt":"2026-01-08 16:39:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8553749/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8553749/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103508119,"identity":"b2f8548b-59c1-4f49-ad63-dc3ea44cb79a","added_by":"auto","created_at":"2026-02-26 13:47:16","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":623564,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscriptsppe.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8553749/v1_covered_59106941-d917-470a-9f33-6cd1c9b4c14e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Durable Disruption and Compounding Disparities: Pre-pandemic Health Vulnerabilities and COVID-Related Elevation in Depression Trajectories Among U.S. Older Adults","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"social-psychiatry-and-psychiatric-epidemiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sppe","sideBox":"Learn more about [Social Psychiatry and Psychiatric Epidemiology](http://link.springer.com/journal/127)","snPcode":"127","submissionUrl":"https://submission.nature.com/new-submission/127/3","title":"Social Psychiatry and Psychiatric Epidemiology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Chronic conditions, Depressive symptoms, Functional limitations, Latent change score model, Self-rated Health","lastPublishedDoi":"10.21203/rs.3.rs-8553749/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8553749/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThis study examines two questions: (1) How did depressive symptoms among U.S. older adults change during the outbreak (2020) and extended COVID pandemic period (2022)? and (2) How did pre-existing health vulnerabilities (\u003cem\u003echronic conditions, functional limitations, self-rated poor health, emotional/psychiatric problems\u003c/em\u003e) predict these changes?\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe used data from the Health and Retirement Study (2010\u0026ndash;2022). Analytic sample (N\u0026thinsp;=\u0026thinsp;8,284) included respondents with depressive symptoms data in 2010\u0026ndash;2022 to model pre- and post-pandemic trajectory change. Latent change score models estimated biennial changes of depressive symptoms, with pre-pandemic health vulnerabilities predicting changes in 2018\u0026ndash;2020 and 2020\u0026ndash;2022.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eDepressive symptoms remained stable (2010\u0026ndash;2018), rose sharply (2018\u0026ndash;2020), then plateaued through 2022. Disparities widened at outbreak: poorer self-rated health, greater functional limitations, and psychiatric history predicted disproportionately larger symptom increases. From 2020\u0026ndash;2022, disparities tied to functional limitations and psychiatric history stabilized, while poor/fair self-rated health disparities continued to deepen.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eCOVID-19 established a higher post-pandemic baseline of depressive symptoms and compounded disadvantage among health-vulnerable older adults. Mental health services for this group should not assume a natural post-pandemic recovery but instead be prepared to address persistently elevated levels of depression in the post-pandemic period. Future research should extend tracking beyond 2022 and identify potential resilience factors.\u003c/p\u003e","manuscriptTitle":"Durable Disruption and Compounding Disparities: Pre-pandemic Health Vulnerabilities and COVID-Related Elevation in Depression Trajectories Among U.S. Older Adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-26 07:50:58","doi":"10.21203/rs.3.rs-8553749/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-03-26T15:48:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"126730119113148900542119903594340577490","date":"2026-02-27T08:57:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-24T11:36:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-05T07:03:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-10T12:36:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"Social Psychiatry and Psychiatric Epidemiology","date":"2026-01-08T16:23:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"social-psychiatry-and-psychiatric-epidemiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sppe","sideBox":"Learn more about [Social Psychiatry and Psychiatric Epidemiology](http://link.springer.com/journal/127)","snPcode":"127","submissionUrl":"https://submission.nature.com/new-submission/127/3","title":"Social Psychiatry and Psychiatric Epidemiology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"a567ab1a-da52-4610-ac7e-143787a85ab9","owner":[],"postedDate":"February 26th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-26T07:50:59+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-26 07:50:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8553749","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8553749","identity":"rs-8553749","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}