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The proportion of New Yorkers reporting poor mental health peaked at 40% in February 2021, and has declined since, down to a rate of 32% in May 2021. See an @nys_health brief on the mental health impact of the pandemic in New York State.
Using @uscensusbureau data, @nys_health report finds that in May 2021, more than half of New Yorkers in households that lost employment income in the last 4 weeks reported poor mental health in the prior week.
In May 2021, twice as many food-scarce New Yorkers reported poor mental health as food-secure New Yorkers (57% vs. 29%). @nys_health brief:

Introduction

New York State has made significant progress against the coronavirus pandemic in recent months. New daily infections and deaths are well below peak pandemic levels and more than 70% of adults have received at least one dose of a COVID-19 vaccine.[1] Nearly all remaining restrictions on businesses and social gatherings have been eliminated.

But as the State begins to return to life as it once was, many New Yorkers will not. More than 53,000 New Yorkers have died from COVID-19, leaving friends and family members mourning.[2] Millions of New Yorkers have lost employment or income over the course of the pandemic, plunging families into food insecurity and housing instability.[3],[4] The impact of this loss of life, prolonged economic hardship, and societal upheaval has had—and will continue to have—a profound impact on the mental health of New Yorkers.

This report examines the mental health of New Yorkers during the coronavirus pandemic. It analyzes self-reported symptoms of anxiety and depression by race and ethnicity, age, and household income. It also examines how mental health is associated with income loss, food scarcity, and vaccination. Unmet need for mental health services among New Yorkers is also studied. Data in this report come from the COVID-19 Household Pulse Survey, an experimental data product designed by the U.S. Census Bureau in collaboration with multiple federal agencies. The survey data analyzed for this report were collected from May 7, 2020 until May 24, 2021. See Methods for more details on the survey and how rates were developed for this report.


[1] The New York Times, “Tracking Coronavirus in New York: Latest Map and Case Count,” The New York Times, July 12, 2021, https://www.nytimes.com/interactive/2021/us/new-york-covid-cases.html
[2] The New York Times, “Tracking Coronavirus in New York: Latest Map and Case Count.”
[3] New York State Department of Labor, “NYS Economy Added 9,800 Private Sector Jobs in June 2021,” July 15, 2021, https://dol.ny.gov/system/files/documents/2021/07/nys-economy-added-9800-private-sector-jobs-in-june-2021.pdf
[4] New York State Department of Labor, “NYS Economy Added 11,200 Private Sector Jobs in February 2020,” March 26, 2020, https://dol.ny.gov/system/files/documents/2021/03/press-release-1-february-2020-final.pdf

Key Findings

  • In May 2020, shortly after the start of the pandemic, more than one-third (35%) of adult New Yorkers reported symptoms of anxiety and/or depression in the prior week (referred to in this report as experiencing poor mental health). That rate is generally two to three times higher than what was reported in the pre-pandemic period by a separate data source.
  • The proportion of New Yorkers reporting poor mental health peaked at 40% in February 2021, and has declined since, down to a rate of 32% in May 2021. This was the first sustained decrease in reported symptoms of poor mental health during the pandemic.
  • Over the course of the pandemic, Hispanic New Yorkers tended to have the largest proportion of reported symptoms of anxiety and/or depression compared with other racial or ethnic groups.
  • Nearly half of New Yorkers in households making less than $25,000 reported symptoms of anxiety and/or depression in the prior week, compared with approximately one-quarter of New Yorkers in households making more than $50,000.
  • Although all age groups were affected, young adult New Yorkers (ages 18–34 years) had the largest proportion (45%) of reported symptoms of poor mental health in May 2021.
  • In May 2021, more than half of New Yorkers (51%) in households that lost employment income in the last 4 weeks reported poor mental health in the prior week. This rate is nearly twice as high as among households that did not experience income loss.
  • In May 2021, twice as many food-scarce New Yorkers reported poor mental health as food-secure New Yorkers (57% compared with 29%). Food-scarce New Yorkers were more likely to report poor mental health, compared with food-secure New Yorkers, across all races and ethnicities, age groups, and income groups.
  • Compared with unvaccinated New Yorkers, those who received at least one dose of a COVID-19 vaccine were 20% less likely to report poor mental health in May 2021.
  • In May 2021, more than 1 in 5 adult New Yorkers who reported symptoms of anxiety and/or depression also reported that they needed counseling or therapy from a mental health professional during the prior 4 weeks, but did not get it. This proportion generally increased from November 2020 to April 2021.

Anxiety and Depression Among New Yorkers

Overall

Shortly after the start of the COVID-19 pandemic in May 2020, 30% of adult New Yorkers reported symptoms of an anxiety disorder, 25% reported symptoms of depressive disorder, and 35% reported symptoms of anxiety and/or depressive disorder in the prior week (Figure 1). See the Methods section for details on how the Household Pulse Survey measures symptoms of anxiety and depression. The proportion of New Yorkers reporting these symptoms stayed high over the course of 2020 and into the start of 2021. However, beginning in March 2021, rates of reported symptoms appeared to be trending downward, reaching the lowest levels of the pandemic in May 2021. In May 2021, 27% of adult New Yorkers reported symptoms of an anxiety disorder, 22% reported symptoms of depressive disorder, and 32% reported symptoms of anxiety and/or depressive disorder in the prior week.

New York State’s significant progress in recovering from the COVID-19 pandemic may be influencing this recent improvement in mental health. More than 70% of adult New Yorkers have received at least one COVID-19 vaccine dose.[1] New daily coronavirus infections and deaths from COVID-19 are well below peak pandemic levels. The State has regained more than 1 million jobs since April 2020 (although the number of jobs remains more than 730,000 below pre-pandemic numbers).[2],[3],[4] Society is increasingly reverting to a pre-pandemic normal with the lifting of restrictions on businesses and social gatherings. Many New Yorkers are seeing family and friends for the first time after more than a year of isolation, in settings that resemble what life was like before the pandemic. The subsiding of the COVID-19 pandemic and these downstream effects appear to be improving the mental health of New Yorkers.

Despite these encouraging developments, rates of poor mental health remain high compared with pre-pandemic periods. Before the pandemic (January–June 2019), 8.2% of adults nationwide had symptoms of anxiety disorder, 6.6% had symptoms of depressive disorder, and 11.0% had symptoms of either or both disorders.[5] Using a broader measure of mental health, prior to the pandemic (2018–2019), 19.5% of New Yorkers reported any mental illness in the previous year.[6]

[1] New York State Department of Health, “COVID-19 Vaccine Tracker,” accessed July 12, 2021, https://covid19vaccine.health.ny.gov/covid-19-vaccine-tracker
[2] New York State Department of Labor, “NYS Economy Added 9,800 Private Sector Jobs in June 2021,” July 15, 2021, https://dol.ny.gov/system/files/documents/2021/07/nys-economy-added-9800-private-sector-jobs-in-june-2021.pdf
[3] New York State Department of Labor, “NYS Economy Loses More than 1.7 Million Private Sector Jobs in April 2021,” May 21, 2020, https://dol.ny.gov/system/files/documents/2021/03/press-release-1-april-2020-final_2.pdf
[4] New York State Department of Labor, “NYS Economy Added 11,200 Private Sector Jobs in February 2020,” March 26, 2020, https://dol.ny.gov/system/files/documents/2021/03/press-release-1-february-2020-final.pdf
[5] National Center for Health Statistics, “Early Release of Selected Mental Health Estimates Based on Data from the January–June 2019 National Health Interview Survey,” May 2020, https://www.cdc.gov/nchs/data/nhis/earlyrelease/ERmentalhealth-508.pdf
[6] Substance Abuse and Mental Health Services Administration, “2018-2019 National Survey On Drug Use And Health: Model-Based Prevalence Estimates (50 States And The District Of Columbia),” December 15, 2020, https://www.samhsa.gov/data/report/2018-2019-nsduh-state-prevalence-estimates

Anxiety and Depression Among New Yorkers

By Race and Ethnicity

Over the course of the pandemic, Hispanic New Yorkers were most likely to report symptoms of anxiety and/or depression relative to all racial or ethnic groups, with a rate of 35% in May 2021 (Figure 2). All races and ethnicities have experienced a decline in reported symptoms of poor mental health since March 2021.

Asian New Yorkers experienced notable spikes in symptoms of anxiety and/or depression in May 2020 and February 2021. One possible explanation for this trend is racist and biased coverage of the virus, which has precipitated surges of hate crimes, violence, and other negative responses against Asian Americans.[1] In New York City alone, the number of Anti-Asian hate crimes reported to the police soared by more than 220% when comparing the first quarter of 2021 with the same period in 2020.[2]

Several high-profile attacks in New York City occurred in February 2021, coinciding with the increase in symptoms of anxiety and/or depression that month among Asian New Yorkers.[3] These attacks need not be experienced firsthand to have a serious mental health impact. Research has found that both Asian Americans who have experienced direct discrimination and those who have experienced vicarious racism (e.g., hearing about racist acts committed against other members of one’s racial group) during the pandemic reported higher levels of symptoms of anxiety and depression.[4],[5]

[1] Hannah Tessler, Meera Choi, and Grace Kao, “The Anxiety of Being Asian American: Hate Crimes and Negative Biases During the COVID-19 Pandemic,” American Journal of Criminal Justice, June 10, 2020, 1–11, https://doi.org/10.1007/s12103-020-09541-5
[2] Center for the Study of Hate & Extremism, California State University, San Bernardino, “Report to the Nation: Anti-Asian Prejudice & Hate Crime,” 2021, https://www.csusb.edu/sites/default/files/Report%20to%20the%20Nation%20-%20Anti-Asian%20Hate%202020%20Final%20Draft%20-%20As%20of%20Apr%2030%202021%206%20PM%20corrected.pdf
[3] Alexandra E. Petri and Daniel E. Slotnik, “Attacks on Asian-Americans in New York Stoke Fear, Anxiety and Anger,” The New York Times, February 26, 2021, sec. New York, https://www.nytimes.com/2021/02/26/nyregion/asian-hate-crimes-attacks-ny.html
[4] Anne Saw, Aggie J. Yellow Horse, and Russell Jeung, “Stop AAPI Hate Mental Health Report” (Stop AAPI Hate, May 2021), https://stopaapihate.org/wp-content/uploads/2021/05/Stop-AAPI-Hate-Mental-Health-Report-210527.pdf
[5] David H. Chae et al., “Vicarious Racism and Vigilance During the COVID-19 Pandemic: Mental Health Implications Among Asian and Black Americans,” Public Health Reports 136, no. 4 (July 1, 2021): 508–17, https://doi.org/10.1177/00333549211018675

Anxiety and Depression Among New Yorkers

By Age

Younger New Yorkers were the most likely of any age group to have reported symptoms of anxiety and/or depression over the course of the pandemic (Figure 3). In May 2021, 45% of adults aged 18–34 years reported symptoms in the prior week.

In the early months of the pandemic, there was widespread concern that older adults would experience poor mental health, owing to their increased risk for COVID-19 mortality and the impact of social distancing on seniors’ loneliness. However, research has found that older adults have reported lower rates of poor mental health than younger people during the pandemic.[1] Older adults may be more resilient to disasters in part because of the wisdom they have gained through life experience.[2],[3] There are also fewer older adults in the workforce, so their income over the course of the pandemic was less likely to be disrupted by job loss, an experience which is associated with anxiety and depression.[4],[5]

[1] Ipsit V. Vahia, Dilip V. Jeste, and Charles F. Reynolds, “Older Adults and the Mental Health Effects of COVID-19,” JAMA 324, no. 22 (December 8, 2020): 2253, https://doi.org/10.1001/jama.2020.21753
[2] Vahia, Jeste, and Reynolds, “Older Adults and the Mental Health Effects of COVID-19.”
[3] Ellen E. Lee et al., “Outcomes of Randomized Clinical Trials of Interventions to Enhance Social, Emotional, and Spiritual Components of Wisdom: A Systematic Review and Meta-Analysis,” JAMA Psychiatry 77, no. 9 (September 1, 2020): 925–35, https://doi.org/10.1001/jamapsychiatry.2020.0821
[4]Jessamyn Schaller and Ann Huff Stevens, “Short-Run Effects of Job Loss on Health Conditions, Health Insurance, and Health Care Utilization,” Journal of Health Economics 43 (September 2015): 190–203, https://doi.org/10.1016/j.jhealeco.2015.07.003
[5] Stephanie Pappas, “The Toll of Job Loss,” Monitor on Psychology 51, no. 7 (October 1, 2020), https://www.apa.org/monitor/2020/10/toll-job-loss

Anxiety and Depression Among New Yorkers

By Household Income

Over the course of the pandemic, the lower a New Yorker’s household income, the higher their likelihood of reporting symptoms of anxiety and/or depression (Figure 4). In May 2021, nearly half of New Yorkers in households making less than $25,000 reported symptoms of anxiety and/or depression in the prior week, compared with approximately one-quarter of New Yorkers in households making more than $50,000. And although the proportion of New Yorkers with household incomes of more than $50,000 reporting poor mental health has declined since February 2021, New Yorkers in households making less than $50,000 have not experienced sustained improvements over the same time period.

Anxiety and Depression Among New Yorkers

By Household Employment Income Loss

In May 2021, New Yorkers in households that experienced a loss of employment income in the prior 4 weeks were nearly twice as likely to report symptoms of anxiety and/or depression in the prior week as New Yorkers in households that had not lost employment income (51% compared with 27%) (Figure 5). Since February 2021, the proportion of New Yorkers who maintained household employment income during the pandemic reporting poor mental health has decreased. In contrast, the proportion of New Yorkers who lost household employment income during the pandemic reporting poor mental health appears to be increasing.

Anxiety and Depression Among New Yorkers

By Food Security Status

Throughout the pandemic, New Yorkers who reported that their household sometimes or often did not have enough to eat in the prior week were more likely to report symptoms of anxiety and/or depression (Figure 6). In May 2021, twice as many food-scarce New Yorkers reported poor mental health as food-secure New Yorkers (57% compared with 29%).

Food-scarce New Yorkers were more likely to report poor mental health, compared with food-secure New Yorkers, across all races and ethnicities, age groups, and income groups (see tabs within Figure 6). Other national-level research has found that experiencing food scarcity during the COVID-19 pandemic was associated with symptoms of poor mental health, even after adjusting for socioeconomic and demographic factors.[1] Additional studies of low-income adults during the pandemic have also found that food scarcity is associated with increased risk of anxiety and depression.[2],[3] This research is consistent with the observed mental health disparity between food-scarce and food-secure New Yorkers during the pandemic across various sociodemographic characteristics.

[1] Jason M. Nagata et al., “Food Insufficiency and Mental Health in the U.S. During the COVID-19 Pandemic,” American Journal of Preventive Medicine 60, no. 4 (April 1, 2021): 453–61, https://doi.org/10.1016/j.amepre.2020.12.004
[2] Di Fang, Michael R. Thomsen, and Rodolfo M. Nayga, “The Association between Food Insecurity and Mental Health during the COVID-19 Pandemic,” BMC Public Health 21, no. 1 (March 29, 2021): 607, https://doi.org/10.1186/s12889-021-10631-0
[3] Julia A Wolfson, Travertine Garcia, and Cindy W Leung, “Food Insecurity Is Associated with Depression, Anxiety, and Stress: Evidence from the Early Days of the COVID-19 Pandemic in the United States,” Health Equity, 2021, 8, https://www.liebertpub.com/doi/pdfplus/10.1089/heq.2020.0059

Anxiety and Depression Among New Yorkers

By Vaccination Status

Since January 2021 (when data collection on vaccination status began), a larger proportion of New Yorkers who have not received a COVID-19 vaccine have reported symptoms of anxiety and/or depression, compared with vaccinated New Yorkers (Figure 7). In May 2021, the proportion was 1.2 times higher for unvaccinated New Yorkers (38%) compared with those who were vaccinated (30%). Unvaccinated New Yorkers were more likely to report poor mental health, compared with vaccinated New Yorkers, across all races and ethnicities, income groups, and most age groups (see tabs within Figure 7).

Unmet Need for Mental Health Services Among New Yorkers During the Pandemic

In May 2021, more than 1 in 5 adult New Yorkers who reported symptoms of anxiety and/or depression also reported that they needed counseling or therapy from a mental health professional during the prior 4 weeks, but did not get it (Figure 8).[1] The proportion of New Yorkers with symptoms of anxiety and/or depression reporting they needed counseling or therapy but did not get it generally increased from November 2020 to March 2021. Many barriers posed by the pandemic could be preventing New Yorkers from accessing mental health care, including: lack of insurance coverage; cancellation of in-person appointments because of COVID-19; lack of mental health providers offering telemedicine services; lack of internet or technology to use telemedicine; and lack of privacy accessing telemedicine services while isolating at home. Many New Yorkers may also be experiencing symptoms of mental health disorders for the first time, or with greater severity than ever before, and may not have the knowledge, resources, or support to establish care.

[1] NYSHealth analysis of U.S. Census Bureau Household Pulse Survey.

Methods

Data

The data used for the analysis are part of the COVID-19 Household Pulse Survey, an experimental data product designed by the U.S. Census Bureau in collaboration with multiple federal agencies. The data are available from:

U.S. Census Bureau. “Household Pulse Survey Public Use File.” Accessed July 2021. https://www.census.gov/programs-surveys/household-pulse-survey/datasets.html

The survey is designed to provide near real-time data on household experiences during the coronavirus pandemic across all states to inform federal and state recovery planning. Households were contacted via e-mail and/or a mobile phone number to complete an internet questionnaire. The survey phases are described in Table 1.

Only adults were surveyed. The Census Bureau drew the sampling frame from the Census Bureau Master Address File, supplemented by the Census Bureau Contact Frame. The Census Bureau weighted the survey responses to account for nonresponse. This weighting also adjusted the survey responses to be more representative of demographic distributions—including by educational attainment, sex, age, and race and ethnicity—in each state. Weighted data were used in this analysis based on the weights provided by the Census Bureau.

The unweighted counts of weekly responses in New York State are displayed in Table 2 below. More information on the survey design, including the survey instruments, are available from:

U.S. Census Bureau. “Household Pulse Survey Technical Documentation.” Accessed July 2021. https://www.census.gov/programs-surveys/household-pulse-survey/technical-documentation.html

Methods

Calculation of Rates

Throughout the report, rates are calculated as the percentage of the applicable (weighted) population that self-reported a certain attribute (e.g., symptoms of anxiety and/or depression). As recommended by the Census Bureau, rates exclude individuals who did not respond to the question. Although the survey was conducted on a weekly (during Phase 1) or biweekly (during Phases 2–3.1) basis, and results were reported as such by the Census Bureau, we reported results that combined multiple time periods of the survey. That is, we created monthly estimates by averaging the weekly or biweekly data approximately corresponding to each month (see Table 3 for the survey weeks assigned to each month). This was done to increase the sample size associated with each estimate and smooth out weekly or biweekly variation in estimates that may be a result of small sample sizes, particularly when reporting results on subgroups of the population.

Responses for each of the month periods were combined and averaged without any additional weighting. That is, aside from the application of the survey weights supplied by the Census Bureau to make the results more generalizable to the full New York State population, no additional weighting was applied in the development of the rates for this analysis. More information on the weighting methodology used by the Census Bureau is available from:

U.S. Census Bureau. “Household Pulse Survey Technical Documentation.” Accessed July 2021. https://www.census.gov/programs-surveys/household-pulse-survey/technical-documentation.html

Methods

Categorizations

The Household Pulse Survey included questions to measure the frequency of anxiety and depression symptoms. These questions were developed based on the Patient Health Questionnaire (PHQ-2) and the Generalized Anxiety Disorder (GAD-2) scale. One difference is that the Household Pulse Survey measured symptoms over the last 7 days, as opposed to the typical 14 days.

Adapted PHQ-2 questions:

  • Over the last 7 days, how often have you been bothered by having little interest or pleasure in doing things? Would you say not at all, several days, more than half the days, or nearly every day?
  • Over the last 7 days, how often have you been bothered by feeling down, depressed, or hopeless? Would you say not at all, several days, more than half the days, or nearly every day?

Adapted GAD-2 questions:

  • Over the last 7 days, how often have you been bothered by the following problems: Feeling nervous, anxious, or on edge? Would you say not at all, several days, more than half the days, or nearly every day?
  • Over the last 7 days, how often have you been bothered by the following problems: Not being able to stop or control worrying? Would you say not at all, several days, more than half the days, or nearly every day?

The answers to each scale were assigned a numerical value (not at all = 0, several days = 1, more than half the days = 2, and nearly every day = 3). The answers for each scale (for PHQ-2 and GAD-2) were summed together. A sum of three or greater on the PHQ-2 score is associated with diagnoses of major depressive disorder, while a sum of three or greater on the GAD-2 scale is associated with diagnoses of generalized anxiety disorder. The proportion of adults with symptoms in this report is based on the composite scores. Only adults who responded to both questions were included in each scale’s calculation. For more information, see:

National Center for Health Statistics. “Anxiety and Depression: Household Pulse Survey.” Accessed July 2021. https://www.cdc.gov/nchs/covid19/pulse/mental-health.htm

It should be noted that certain responses to these scales are associated with diagnoses of major depressive disorder or generalized anxiety disorder. The results from the Household Pulse Survey indicate symptoms of anxiety and depression, but do not represent clinical diagnoses. Even if they do not meet the diagnostic criteria for a mental illness, New Yorkers who experience symptoms of anxiety and depression during the pandemic still require support, as these symptoms negatively impact emotional wellbeing.[1]

To analyze adults by race/ethnicity, we categorized adults with an ethnicity of Hispanic identified in the data as Hispanic. We categorized adults with an ethnicity of Non-Hispanic as Black, Asian, or white, according to their race code identified in the data. Adults with a race identified in the data as “Other or two or more races” were excluded from analyses by race/ethnicity as a result of low counts.

Adults were categorized into age groups based on the birth year provided in the data. Because month and date of birth were not collected from survey respondents, ages were treated as the respondent’s age as of December 31, 2020, for data collected in 2020 and as of December 31, 2021, for data collected in 2021.

Household income is defined in the survey as total 2019 household income before taxes. From May 2020 through March 2021, an adult was considered to have lost household employment income if they or anyone in their household experienced a loss of employment income since March 13, 2020. Starting in May 2021, an adult was considered to have lost household employment income if they or anyone in their household experienced a loss of employment income in the last 4 weeks.

Adults who responded that their household “sometimes” did not have enough to eat or “often” did not have enough to eat in the prior seven days were categorized as food scarce. Adults who responded that their household had enough of the kinds of food wanted, or had enough food, but not always the kind wanted, in the prior seven days were categorized as food secure.


[1] Emily Esterwood and Sy Atezaz Saeed, “Past Epidemics, Natural Disasters, COVID19, and Mental Health: Learning from History as We Deal with the Present and Prepare for the Future,” The Psychiatric Quarterly, August 16, 2020, 1–13, https://doi.org/10.1007/s11126-020-09808-4

Limitations

Confidence intervals are not provided with the estimates. Although we attempted to improve the reliability of estimates by developing estimates based on multiple time frames of the survey, readers should interpret the precision of the estimates with caution, particularly those for subgroups of the New York State population. Rather than focusing on specific point estimates, these data are most useful for understanding the persistence of patterns over time, including the identification of changes in the direction of trends (e.g., persistent increases followed by persistent decreases), and the relativeness of estimates of one group in comparison with another (e.g., persistent patterns of differences in estimates by race).

As with most surveys, biases can occur in the survey estimates. The Census Bureau has identified certain biases as a result of measurement error, coverage error, nonresponse error, and processing errors that could have occurred in the administration of the COVID-19 Household Pulse Survey. For more details, see the Limitations section at:

National Center for Health Statistics. “Anxiety and Depression: Household Pulse Survey.” Accessed July 2021. https://www.cdc.gov/nchs/covid19/pulse/mental-health.htm

Some of the errors may have been more likely to occur because the COVID-19 Household Pulse Survey was meant to provide near real-time information during the pandemic. This meant there was limited time for testing questions to help ensure that survey questions were consistently clear to respondents. However, the questions used to measure depression and anxiety are based on well-established research. Processing errors (e.g., incorrect coding of data) may have also been more likely because of the rapid timeline.

Coverage error may have occurred as households were invited to participate in the survey via cellphone and e-mail. New Yorkers without cellphones, computers, or internet access therefore may have been underrepresented. Also, the response rate for the Household Pulse Survey was substantially lower than many other federally sponsored surveys, which would make it more susceptible to nonresponse error. Although the federal government employs quality-control procedures to minimize certain biases, the extent of such biases has not yet been evaluated for the COVID-19 Household Pulse Survey.