COVID-19 Pandemic
The association between county-level COVID-19 policy and self-reported depression among the Citizen Science Study participants Hyelee Kim* Hyelee Kim Aaron Cozen Thomas Carton Madelaine Modrow Soo Park Sylvia Sudat Heather Kitzman Carmen Isasi Scott Zimmerman Jingxuan Wang Maria Glymour Jeffrey Olgin Gregory Marcus Mark Pletcher
Aim
We investigated the association between county-level COVID-19 policies and depression in a large digital cohort.
Method
We analyzed county-level policy data from the U.S. COVID-19 County Policy Database and individual depression scores from the COVID-19 Citizen Science Study between April 2020 and December 2021. County-level policies were combined and transformed into weekly indexes for 3 domains: containment and closure (n=13, ranges 0-13), public health (n=8, 0-8), and economic support (n=5, 0-5). Depression was measured by self-report using the Patient Health Questionnaire-8 (PHQ-8). We used a linear mixed model to estimate the association between each 4-week rolling averaged policy index and outcomes of PHQ-8 scores and major depressive disorder (MDD=1 [vs. 0] if PHQ-8≥10) with random intercepts for counties and individuals, adjusting for individual sociodemographic factors and county-level averaged COVID-19 cases and deaths.
Results
A total of 34,102 participants from 183 counties were included (mean age 51.2, 31.9% male, 7.4% Hispanic, 6.2% Asian, and 1.7% Black). A 1-unit increase in the containment and closure index over the previous 4 weeks was associated with a 0.07-unit higher PHQ-8 score (95% CI 0.06, 0.07) and 0.3% higher MDD RD (95% CI 0.2%, 0.3%). Increases in the public health index were associated with decreases in PHQ-8 (β -0.13; 95% CI -0.14, -0.12) and MDD risk (RD -0.4%; 95% CI -0.6%, -0.3%). The economic support index was not associated with PHQ-8 scores (β -0.01; 95% CI -0.04, 0.01) or MDD risk (RD 0.0%; 95% CI -0.2%, 0.2%). An increase in county-level COVID-19 deaths was associated with higher PHQ-8 scores (β 0.15; 95% CI 0.10, 0.20) and MDD risk (RD 0.7%; 95% CI 0.3%, 1.2%).
Conclusion
Containment and closure policies may have contributed to depressive symptoms in the short term, whereas active public health policies may have reduced depression risk. This study showed a promising opportunity for digital cohorts for better policy implementation.