eTable 1 presents weighted sample descriptives. Table 2 shows odds ratios (OR), 95% confidence intervals (CI), and predicted prevalence rates (adjusted for cohort, state, and demographic characteristics) for anxiety and depression, with Figure 1 presenting prevalence rates across the sample cohorts. Table 3 and Figure 1 show these results for the prescription, counseling, and unmet need for counseling outcomes. Results for interaction models are presented in eTables 4-8. In describing the results in text, we focus on adjusted prevalence rates for ease of interpretability and practical significance.
Anxiety
Over the entire weighted sample, 44% of respondents met the criteria for anxiety disorder. Results from logistic regressions indicate significant growth in anxiety from early April through November (Table 2 and Figure 1), with prevalence rising from 38% for the first cohort (April 23-May 12, 2020) to 50% in the final cohort (November 11-23, 2020). Prevalence varied significantly by race/ethnicity, with anxiety higher among people identifying as other racial/ethnic groups (51%), Hispanic (50%), and Black (47%) compared to Whites (41%), who were higher than Asians (39%). Interactions between race/ethnicity and wave were significant as a group (eTable 4), with gaps between Hispanics and Whites narrowing, and gaps between Asians and Whites growing across some cohorts.
Rates of anxiety were significantly higher among younger adults, with the prevalence among those age 18-29 (57%) nearly double that of those aged 70 and above (30%). Significant interaction results (eTable 5) found that age disparities grew over the cohorts, with anxiety prevalence rising most quickly for young adults. Females had significantly higher prevalence of anxiety than males (47% vs 40%), and single adults with child(ren) (51%) had higher prevalence than those in adult only households (42%). Nonsignificant interactions showed stable sex and household structure differences over cohorts (eTables 6, 7). Anxiety prevalence declined significantly with greater education, ranging from 47% for those with a high school degree or less to 35% for respondents with a graduate degree. Significant interactions found that educational disparities grew in May and then stabilized (eTable 8).
Depression
Over the entire analytic sample, 38% of respondents met the criteria for depressive disorder. Prevalence of depression grew significantly over the cohorts (Table 2 and Figure 1) from 32% in late April/early May to 44% in mid November. Respondents identifying as other racial/ethnic backgrounds (45%), Hispanics (44%), and Blacks (43%) reported higher prevalence of depression than Whites (35%), with some narrowing of gaps between Hispanics and Whites across cohorts. Depression declined notably with age, with prevalence for 18-29 year olds (52%) nearly twice as high as those for 70+ (27%). Age disparities grew significantly over time: a 20 point gap in the first cohort (42% vs 22% for 18-29 vs 70+) rose to a nearly 30 point gap by the final cohort (61% to 32%). Females reported higher prevalence of depression than males (39% vs 37%), with nonsignificant shifts over cohorts. Prevalence of depression differed across all household structures, with respondents living with other adults reporting the lowest prevalence of depression, and single adults with child(ren) the highest prevalence at 45%, differences which remained stable over cohorts. Depression declined with greater education, with prevalence dropping from 43% for those with a high school degree or less to 25% for respondents with a graduate degree. Education disparities grew over time, with the greatest growth in depression over cohorts among the least educated.
Use of Prescription Medication
Across the entire sample, 21% of respondents reported using prescription medication for emotional, behavioral, or mental health disorders in the prior month. Logistic regression models found that prevalence of medication use grew over time, particularly in late October and through November, ranging from 19% among the first cohort who reported on medication use in late August to 22% in mid November (Table 3 and Figure 1). Medication use varied by race/ethnicity, with prevalence among Whites (23%) significantly higher than Hispanic (16%), Black (15%), and Asian (8%) respondents. Prevalence of medication use varied significantly by age, ranging from a low of 17% among respondents aged 70 and above to a high of 22% among those in their 50s. Females reported significantly higher medication use than males (25% versus 15%). Adults living alone reported higher medication use (23%) than those in multiple adult households (20%), who in turn were higher than those in households with adults and child(ren) (19%). In relation to education, respondents with some college reported significantly higher prevalence of medication use (22%) than those with a high school degree or less (19%). Sets of interactions were all nonsignificant, showing stable demographic differences across cohorts.
Mental Health Counseling
Over the whole sample, 9% of respondents reported accessing mental health counseling in the prior month. Logistic regression results (Table 3, Figure 1) found that prevalence increased over the cohorts, rising to 10% in mid October and November. Prevalence rates of mental health counseling were lower among Asian (6%), Black (9%), and Hispanic (9%) respondents than their White (10%) counterparts. Prevalence varied significantly by age as well, with 13% of 18-29 year olds reporting counseling, more than three times higher than among respondents age 70 and above (4%). Females were more likely than males to receive counseling (11% versus 7%), as were those in single adult (11%) or single adult with child(ren) (13%) households compared to those living with other adults (9%). Prevalence of mental health counseling was significantly lower among those with a high school degree or less (7%) than among their peers with some college (10%) or a bachelors or graduate degree (both 12%). Nonsignificant interactions indicated stable demographic differences across cohorts.
Unmet Need for Mental Health Counseling
Overall, 10% of the sample reported needing but not receiving mental health counseling services in the prior month. Logistic regression results (Table 3 and Figure 1) found increasing prevalence over cohorts, rising from 9% in late August to 11% starting in late October. Prevalence of unmet need for counseling were highest among those identifying as other race/ethnicity (16%) and lowest among Asians (6%), both significantly different than Whites (10%). Unmet needs decreased significantly with age, with prevalence among young adults aged 18-29 (18%) over five times higher than among the oldest respondents age 70 and above (3%). Females were more likely than males to report unmet need for mental health counseling (13% versus 8%). Significant but practically small differences emerged across household structure, while differences across educational strata were larger, with all respondents with higher education reporting greater prevalence of unmet need for mental health services than their peers with a high school degree or less (8%), with the highest predicted rate (13%) among those with some college. Like other measures of mental health services, nonsignificant interactions indicated stable demographic differences across cohorts.
Intersections between Mental Health Disorders and Services
A final set of descriptive analyses assessed intersections between mental health disorders and use of mental health services, using weighted chi square analyses. Of respondents meeting criteria for anxiety disorder, 35% reported use of prescription medication, 17% received counseling, and 24% reported unmet need for counseling versus 13%, 5%, and 3% among those not meeting criteria (all p < .001). Of respondents meeting criteria for depressive disorder, 36% reported using medication, 17% received counseling, and 27% reported unmet need for counseling versus 14%, 6%, and 4% among those not meeting criteria (all p < .001).