SURE Education Research Group, Department of Smart City, Chung-Ang University, Seoul, South Korea.
Department of Urban Planning and Spatial Analysis, Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA.
Soc Psychiatry Psychiatr Epidemiol. 2022 Aug;57(8):1557-1570. doi: 10.1007/s00127-022-02265-3. Epub 2022 Mar 29.
We examined the associations of statewide COVID-19 conditions (i.e., state-level case and death rates) with individual-level Generalized Anxiety Disorder (GAD) and Major Depression Disorder (MDD) focusing on the salient mediating roles of individual-level cognitive concerns and behavioral changes.
Using a national representative sample of adults in the United States (n = 585,073), we fitted logistic regressions to examine the overall associations between the COVID-19 pandemic and GAD/MDD. We employed a causal mediation analysis with two mediators: cognitive concerns (i.e., concerns on going to the public, loss of income, food insufficiency, housing payment, and the economy) and behavioral changes (i.e., taking fewer trips, avoiding eating-out, more online-purchase, more curbside pick-up, and cancelling doctor's appointments).
We found relationships of statewide COVID-19 cases with GAD (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 1.05, 1.07) and MDD (OR = 1.08; 95% CI = 1.07, 1.09). The ORs were mediated by cognitive concerns for GAD (OR = 1.02, proportion mediated: 29%) and MDD (OR = 1.01, 17%). Another salient mediator was behavioral changes for GAD (OR = 1.02, 31%) and MDD (OR = 1.01, 15%). Similar associations were found with statewide COVID-19 death.
Our mediation analyses suggest that cognitive concerns and behavioral changes are important mediators of the relationships between statewide COVID-19 case/death rates and GAD/MDD. COVID-19 pandemic may involve individual-level concerns and behavior changes, and such experiences are likely to affect mental health outcomes. Public health approaches to alleviate adverse mental health consequences should take into account the mediating factors.
我们研究了州级 COVID-19 状况（即州级病例和死亡率）与个体层面的广泛性焦虑症（GAD）和重度抑郁症（MDD）之间的关联，重点关注个体层面的认知问题和行为变化的显著中介作用。
我们使用美国全国代表性成年人样本（n=585,073），通过逻辑回归分析检验 COVID-19 大流行与 GAD/MDD 之间的总体关联。我们采用了因果中介分析，使用两个中介变量：认知问题（即对去公共场所、收入损失、食物不足、住房支付和经济的担忧）和行为变化（即减少旅行、避免外出就餐、更多网上购物、更多路边取货和取消医生预约）。
我们发现州级 COVID-19 病例与 GAD（比值比[OR] = 1.06；95%置信区间[CI] = 1.05，1.07）和 MDD（OR = 1.08；95% CI = 1.07，1.09）有关。对于 GAD（OR = 1.02，中介比例：29%）和 MDD（OR = 1.01，17%），这些 OR 可由认知问题来解释。对于 GAD（OR = 1.02，31%）和 MDD（OR = 1.01，15%），另一个重要的中介变量是行为变化。对于 GAD 和 MDD，州级 COVID-19 死亡也存在类似的关联。
我们的中介分析表明，认知问题和行为变化是州级 COVID-19 病例/死亡率与 GAD/MDD 之间关系的重要中介因素。COVID-19 大流行可能涉及个体层面的问题和行为变化，这些经历可能会影响心理健康结果。减轻不良心理健康后果的公共卫生措施应考虑到这些中介因素。
