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Follow-up Survey of US Adult Reports of Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic, September 2020

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

Adverse mental health symptoms among US adults were more prevalent during the early phase (April-June 2020) of the coronavirus disease 2019 (COVID-19) pandemic compared with prepandemic estimates (eg, 3-fold increased prevalences of anxiety and depression symptoms, 2-fold increased prevalence of suicidal ideation).1,2 In June 2020, 2238 (40.9%) of 5470 US adults reported adverse mental or behavioral health symptoms. During this time, the prevalence of symptoms was lower in adults aged 65 years or older (141 of 933 [15.1%]) than in young adults aged 18 to 24 years (547 of 731 [74.9%]; P < .001).1 Given suggestions that acute increases in the prevalence of adverse mental health symptoms may represent a transient response to mass trauma,3 we sought to determine whether these patterns persisted in September 2020 and to examine disproportionately affected demographic groups.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: December 27, 2020.

Published: February 19, 2021. doi:10.1001/jamanetworkopen.2020.37665

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Czeisler MÉ et al. JAMA Network Open.

Corresponding Author: Mark É. Czeisler, AB, Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Clayton Campus, Level 5, Clayton, VIC 3800, Australia (mark.czeisler@fulbrightmail.org).

Author Contributions: Mr Czeisler had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: M. É. Czeisler, Lane, C. A. Czeisler, Howard, Rajaratnam.

Acquisition, analysis, or interpretation of data: M. É. Czeisler, Wiley, C. A. Czeisler, Howard, Rajaratnam.

Drafting of the manuscript: M. É. Czeisler, Lane.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: M. É. Czeisler, Wiley.

Obtained funding: M. É. Czeisler, Lane, C. A. Czeisler, Howard, Rajaratnam.

Administrative, technical, or material support: Lane, C. A. Czeisler, Rajaratnam.

Supervision: Howard, Rajaratnam.

Conflict of Interest Disclosures: Mr Czeisler reported receiving grants from the Australian-American Fulbright Commission administered through a 2020 Fulbright Future Scholarship funded by The Kinghorn Foundation during the conduct of the study and receiving personal fees from Vanda Pharmaceuticals outside the submitted work. Dr Czeisler reported receiving grants to support The COVID-19 Outbreak Public Evaluation (COPE) Initiative and grants from Brigham and Women's Physician's Organization during the conduct of the study; being a paid consultant to or speaker for Ganésco, Institute of Digital Media and Child Development, Klarman Family Foundation, M. Davis and Co, Physician's Seal, Samsung Group, State of Washington Board of Pilotage Commissioners, Tencent Holdings, Teva Pharma Australia, and Vanda Pharmaceuticals, in which Dr. Czeisler holds an equity interest; receiving travel support from Aspen Brain Institute, Bloomage International Investment Group, UK Biotechnology and Biological Sciences Research Council, Bouley Botanical, Dr Stanley Ho Medical Development Foundation, Illuminating Engineering Society, National Safety Council, Tencent Holdings, and The Wonderful Co; receiving institutional research and/or education support from Cephalon, Mary Ann and Stanley Snider via Combined Jewish Philanthropies, Harmony Biosciences, Jazz Pharmaceuticals PLC, Johnson and Johnson, Neurocare, Peter Brown and Margaret Hamburg, Philips Respironics, Regeneron Pharmaceuticals, Regional Home Care, Teva Pharmaceuticals Industries, Sanofi S.A., Optum, ResMed, San Francisco Bar Pilots, Schneider National, Serta, Simmons Betting, Sysco, Vanda Pharmaceuticals; being or having been an expert witness in legal cases, including those involving Advanced Power Technologies; Aegis Chemical Solutions; Amtrak; Casper Sleep; C and J Energy Services; Complete General Construction; Dallas Police Association; Enterprise Rent-A-Car; Steel Warehouse Co; FedEx; Greyhound Lines; Palomar Health District; PAR Electrical, Product, and Logistics Services; Puckett Emergency Medical Services; South Carolina Central Railroad Co; Union Pacific Railroad; UPS; and Vanda Pharmaceuticals; serving as the incumbent of an endowed professorship provided to Harvard University by Cephalon; and receiving royalties from McGraw Hill and Philips Respironics for the Actiwatch-2 and Actiwatch Spectrum devices. Dr Czeisler's interests were reviewed and are managed by the Brigham and Women's Hospital and Mass General Brigham in accordance with their conflict of interest policies. Dr Rajaratnam reported receiving institutional consulting fees from CRC for Alertness, Safety, and Productivity; Teva Pharmaceuticals; Vanda Pharmaceuticals; Circadian Therapeutics; BHP Billiton; and Herbert Smith Freehills; receiving grants from Teva Pharmaceuticals and Vanda Pharmaceuticals; and serving as chair for the Sleep Health Foundation outside the submitted work. No other disclosures were reported.

Funding/Support: Funding for survey data collection was supported in part by research grants from the US Centers for Disease Control and Prevention Foundation, with funding from BNY Mellon and from WHOOP, to Monash University acting through its Faculty of Medicine, Nursingy, and Health Sciences, and by institutional support from Philips Respironics and Alexandra Dane to Brigham and Women’s Hospital, the Turner Institute for Brain and Mental Health, Monash University, and Institute for Breathing and Sleep, Austin Hospital.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Additional Contributions: We gratefully acknowledge all survey respondents, as well as Laura K. Barger, PhD (Brigham and Women’s Hospital), Rebecca Robbins, PhD (Brigham and Women’s Hospital), and Elise R. Facer-Childs, PhD (Monash University) for their contributions to the survey instrument and study design, and Matthew D. Weaver, PhD (Brigham and Women’s Hospital) for his analytic advice. None of these individuals received compensation for their help. We also thank Mallory Colys, BSc (Qualtrics); Sneha Baste, BIndDes (Hons), (Qualtrics); Daniel Chong, BSc (Qualtrics); and Rebecca Toll, BMedSc, (Qualtrics), who were compensated as Qualtrics employees, for support in survey data collection.

References
1.
Czeisler  MÉ , Lane  RI , Petrosky  E ,  et al.  Mental health, substance use, and suicidal ideation during the COVID-19 pandemic: United States, June 24-30, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(32):1049-1057. doi:10.15585/mmwr.mm6932a1 PubMedGoogle ScholarCrossref
2.
Ettman  CK , Abdalla  SM , Cohen  GH , Sampson  L , Vivier  PM , Galea  S .  Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic.   JAMA Netw Open. 2020;3(9):e2019686. doi:10.1001/jamanetworkopen.2020.19686 PubMedGoogle Scholar
3.
Fancourt  D , Steptoe  A , Bu  F .  Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19 in England: a longitudinal observational study.   Lancet Psychiatry. Published online December 9, 2020. doi:10.1016/S2215-0366(20)30482-XPubMedGoogle Scholar
4.
Wortham  JM , Lee  JT , Althomsons  S ,  et al.  Characteristics of persons who died with COVID-19: United States, February 12-May 18, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(28):923-929. doi:10.15585/mmwr.mm6928e1 PubMedGoogle ScholarCrossref
5.
Vahia  IV , Jeste  DV , Reynolds  CF  III .  Older adults and the mental health effects of COVID-19.   JAMA. 2020;324(22):2253-2254. doi:10.1001/jama.2020.21753 PubMedGoogle ScholarCrossref
6.
Bauchner  H , Vahia  I . Older adults and the mental health effects of COVID-19. Published November 20, 2020. Accessed November 25, 2020. https://edhub.ama-assn.org/jn-learning/audio-player/18561943
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