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.