Trends in psychological distress among US adults before, during, and after the COVID-19 pandemic: a repeated cross-sectional analysis, 2017-2024.

Objective: Psychological distress among United States (US) adults following the COVID-19 pandemic remains incompletely characterized. To address this gap, we compared the prevalence of psychological distress during and after the pandemic with pre-pandemic levels using nationally representative data. Methods: We analyzed six iterations of the Health Information National Trends Survey. Psychological distress was measured using the Patient Health Questionnaire-4. Adjusted prevalence ratios (aPRs) comparing early, late, and post-pandemic periods with the pre-pandemic period were estimated using weighted logistic regression models accounting for key demographic and geographic characteristics. The data were collected January 2018 to September 2024 in the US. Results: Among 25,459 respondents, the prevalence of clinically meaningful psychological distress was 12.8% during the pre-pandemic period, 14.7% during the early pandemic period, 14.0% during the late pandemic period, and 14.9% during the post-pandemic period. Compared with pre-pandemic levels, distress prevalence was similar during the early pandemic (aPR = 1.06; 95%CI = 0.83,1.36) and late pandemic (aPR = 1.09; 95%CI = 0.94,1.27) but higher post-pandemic (aPR = 1.16; 95%CI = 1.02,1.32). Increases were most evident for anxiety-related symptoms and among males, younger adults, and college graduates. Conclusions: Psychological distress among US adults was higher in 2024 than before the pandemic, underscoring the need for sustained mental health surveillance, prevention strategies, and resource allocation.