Inequalities in Mental Health During the COVID-19 Pandemic: The Interplay of Individual Pandemic Stressors and State Sociopolitical Contexts

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Project Summary/Abstract The COVID-19 pandemic is a historic crisis that is likely to exacerbate stress and undermine mental health in the United States. Indeed, rates of depression, anxiety, and suicide ideation are shockingly high during the pandemic and the adverse mental health experiences during the pandemic disproportionately burden less educated adults, racial/ethnic minorities, and women. However, the micro- and macro-level factors contributing to mental health disparities during the pandemic are complex and not fully understood. Unequal exposure to pandemic-related stressors (i.e., stress due to work, family, financial circumstances) are likely to result in significant disparities in mental health. Yet, these processes unfold within macro-level state sociopolitical contexts that may influence experiences of pandemic stress and exacerbate or ameliorate disparities in mental health. Thus, the overarching goal of the proposed project is to consider the extent to which individual pandemic stressors and state sociopolitical contexts jointly shape disparities in depression and anxiety. Specifically, this project aims to: 1) determine whether specific pandemic stressors explain disparities in mental health by race/ethnicity, educational attainment, and gender and 2) identify state-level policies and contexts that impact individual-level stress processes and create population disparities in mental health. To do so, the project will rely on a novel, large national dataset (Household Pulse Survey) and state- specific data on existing social policies and policies enacted in response to the pandemic. The proposed project will provide a new way of thinking about mental health disparities during the pandemic by shifting the focus from purely individual-level explanations to a broader framework that considers the interplay of individual-level stressors and state-level policies. By focusing on states as structural drivers of mental health, we will improve understanding of how state policies protect or harm Americans and their mental health during times of crisis, with far-reaching implications beyond the current pandemic. The proposed project has implications for long-term patterns of health and mortality. Because psychological distress can erode physical health and increase mortality risk over time, mental health disparities during the pandemic may exacerbate existing disparities in health and mortality for years to come. Moreover, geographic inequalities in mental health across states may fuel growing geographic inequalities in health and mortality after the pandemic.