There is a potential association between depression and policies that restrict social interaction, as demonstrated during the COVID-19 pandemic, according to the results of a study published in JAMA Network Open.1
Key Takeaways
1. Policies restricting social interaction during the COVID-19 pandemic may be linked to an increase in depression rates.
2. An increase in the proportion of individuals staying home due to policy restrictions was associated with higher depression scores, even after the widespread availability of vaccinations, with mandatory mask-wearing and event cancellations being significant contributing factors.
3. While causation could not be established, the results underscore the need for interventions promoting social engagement during periods of limited mobility in future pandemics or long-lasting disasters to address the correlation between mobility restrictions and depressive symptoms.
The World Health Organization found that in the first year of the COVID-19 pandemic, anxiety and depression rates increased by 25% globally. One potential cause, the agency said, could be due to the social isolation restrictions.2
In the current study, investigators sought to determine the extent to which the limitations around in-person social interactions were associated with depression. They posited that understanding this association could help public health planning for future global disasters and pandemics.2
The study was conducted with 18 waves of internet surveys conducted in the United States between May 2020 and April 2022, including individuals who were aged 18 years and older and lived in any of the 50 states or the District of Columbia. Individuals’ symptoms of depression were measured by the Patient Health Questionnaire-9 (PHQ-9). The study investigators also used country-level community mobility estimates from mobile apps and the Oxford stringency index for COVID-19 at the state level.1
In total, 192,271 individuals responded to the survey, with a mean age of 43.1 years. Approximately 0.4% were American Indian or Alaska Natives, 6% were Asian, 10.5% were Black, 7.8% were Hispanic, 1% were Pacific Islander, 72.1% were White, and 2.1% identified as another race. Also, approximately 65.7% of individuals identified as female. The study authors reported that the mean depression severity was 7.2.1
Investigators found that the mean county-level proportion of those who did not leave their house was associated with a greater level of depression symptoms after adjustment for individual sociodemographic data. Additionally, the results were similar after inclusion of local COVID-19 activity, weather, and county-level economic features.1
The findings showed a 10% increase in the proportion of individuals staying home due to policy restrictions being associated with a 0.27 increase in PHQ-9 scores.1
The study authors also found that the association continued even after widespread availability of vaccinations. Furthermore, the independent associations that had the greatest contribution to increased depressive symptoms were mandatory mask-wearing in public and policies that canceled public events.1
Furthermore, investigators sought to determine whether there was an association between mobility and depression. After accounting for population density, employment, and poverty measures, they found that there was no change in the association on community mobility and mood. They also found that this was true when political affiliation was added to the model for mobility and mood.1
The study authors said they could not determine causation, but there is a need for interventions at increasing social engagements when mobility is limited during future pandemics or long-lasting disasters due to the correlation of mobility and depressive symptoms.1
Limitations of the study included a lack of evidence showing causation. The authors also emphasized that there are possible unobserved causes for the association, which could include economic deprivation. Lastly, they determined that the survey may not be generalizable due to individuals’ willingness to participate in internet-based surveys.1
References
- Perlis RH, Lunz Trujillo K, Safarpour A, Quintana A, et al. Community mobility and depressive symptoms during the COVID-19 pandemic in the United States. JAMA Netw Open. 2023;6(9):e2334945. doi:10.1001/jamanetworkopen.2023.34945
- COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide. News release. World Health Organization. March 2, 2022. Accessed September 27, 2023. https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide
