Structural
State policy climate and mental distress among working-age US adults during the COVID-19 pandemic: A longitudinal study Ariel Beccia* Ariel Beccia Dougie Zubizarreta Chloe Gao Madina Agénor Jamie Hart Jonggyu Baek S. Bryn Austin
Pandemic mitigation policies (eg, lockdowns) have been linked to adverse mental health outcomes and exacerbated inequities during early waves of COVID-19, yet whether concomitantly implemented economic relief policies (eg, income support) alleviated such harms is unknown. We examined overall and group-specific associations between the US state pandemic policy climate and mental distress among working-age adults in April 2020.
Data came from the COVID-19 Sub-Study of the Nurses’ Health Studies 2/3 and Growing Up Today Study (N=34,843 participants <65 years). Using 2 state-level policy indices (pandemic mitigation, economic relief) from the Oxford COVID-19 Government Response Tracker, we estimated longitudinal associations between participants’ past-month exposure to state policy climate (weak mitigation/weak relief, weak mitigation/strong relief, strong mitigation/weak relief, strong mitigation/strong relief) and subsequent depression (PHQ-2 score >3) via logistic models with state fixed-effects and demographic controls. Secondary models explored effect heterogeneity by gender, sexuality, and race.
The prevalence of depression varied across state policy climates, with the highest prevalence observed among participants living in strong mitigation/weak relief states (20.5%). Economic relief policies buffered against the adverse impacts that pandemic mitigation policies had on depression, such that participants in strong mitigation/strong relief states had reduced odds of depression compared to those in strong mitigation/weak relief states (OR:0.70;95%CI:0.53,0.91). Relative to their non-marginalized counterparts, marginalized groups benefited more from living in states with strong economic relief policies and some (eg, Black and LGB people) experienced attenuated inequities in strong mitigation/strong relief states.
Economic relief policies may have safeguarded against the mental health consequences of necessary pandemic mitigation measures for US adults in April 2020.
