One Nation, Under Stress

Eighteen months into the pandemic, many Americans are sick and tired of being sick and tired. In the early months of the pandemic, many experts recognized that, along with the serious health risks of the coronavirus, the steps required to control the pandemic such as school and business closures and social distancing were posing their own risks to Americans’ mental health and wellbeing.

The added mental health burden from the pandemic impacts people’s physical and financial health. Worse mental health increases the need to seek health care and exacerbates other health conditions such as high blood pressure. It also makes it harder for people to focus on their jobs and handle their finances. Ensuring good mental health improves people’s quality of life in a number of ways then.

The good news is that mental health indicators have improved as pandemic restrictions have gradually eased and vaccinations have gone up. The bad news is that the population’s mental health is still well above levels recorded prior to the pandemic. Mental health care needs to remain a high national priority.

Since the early weeks of the pandemic, the Census Bureau’s Household Pulse Survey (HPS) has asked U.S. households whether and how often they are bothered by things like: feeling nervous, anxious, or on edge; not being able to stop or control worrying; having little interest or pleasure in doing things; and/or feeling down, depressed, or hopeless? These survey questions were explicitly designed to mirror those used by clinicians in diagnosing anxiety and depression in patients.

The early responses to these questions were shocking – in the summer of 2020, four in ten respondents had symptoms of anxiety or depression – almost a fourfold increase from pre-pandemic levels.


Since that time, mental health indicators have surged and eased, in response to trends in the pandemic, the economy, and our overall national mood. The share of households reporting mental health conditions came roaring back in late 2020, hitting another peak in mid-winter 2021. Since that time, levels have gradually come down, but they remain at elevated levels. In September, one-in-three respondents had clinically-relevant symptoms of anxiety disorder or depressive disorder (see figure below). 

By way of comparison, in 2019, “8.1% of adults aged 18 and over had symptoms of anxiety disorder, 6.5% had symptoms of depressive disorder, and 10.8% had symptoms of anxiety disorder or depressive disorder,” according to CDC. In other words, the incidence of anxiety and depression is still close to triple pre-pandemic levels, despite all the progress seen with vaccines, schools reopening, businesses stabilizing, and pandemic restrictions easing.

The HPS also asks all respondents on whether they needed counseling or therapy from a mental health professional, but did not get it. More than one fourth of those, who indicated that they suffered from anxiety or depression in the late summer and early fall, also said that they did not get the help that they needed.

 It’s clear that as much as Americans are ready to be “# done with the pandemic,” when it comes to their collective mental health, the impact of the pandemic is not so easily erased. Ensuring people’s mental health in schools, workplaces, and communities must remain a high priority. Government at all levels, employers, insurers, and health care providers all need to take steps to ensure that care gaps are closed and unmet mental health care needs become a thing of the past, before society can truly heal from the pandemic.

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