JMIR Publications

ABSTRACT

Background:

The onset of the COVID-19 pandemic in the United States (US) in March 2020 caused a dramatic change to the way many people lived. Few aspects of daily life were left undisrupted by the pandemic’s onset as well as accompanying policies to control the spread of the disease. Previous research has found that the pandemic may have significantly impacted the mental health of LGBTQ individuals—potentially more so than other individuals. However, the pandemic did not affect all areas of the US at the same time and there may be regional variation in the impact of the onset of the pandemic on depressive symptoms among LGBTQ individuals.

Objective:

To assess regional variation of the impact of the pandemic, we used time series analysis stratified by U.S. geographic region to examine symptoms of depression and anxiety among a sample of primarily cisgender gay and bisexual men before and after the onset of the COVID-19 pandemic in the United States.

Methods:

5,007 participants completed assessments as part of the Together 5000 study, an ongoing prospective cohort study. Depressive and anxiety symptoms were measured using the Patient Health Questionnaire-4 (PHQ-4). PHQ-4 scores were graphed as a function of days from March 15th, 2020. Locally estimated scatterplot smoothing trendlines were applied. Sieve-bootstrap Mann-Kendall’s test for monotonic trend was conducted to assess the presence and direction of trends in the scatterplots. We then compared the observed trends to those observed for one year prior (2018-2019) to the pandemic onset using data collected from the same sample.

Results:

Symptoms of anxiety and depression increased among the study population in the Northeast and Midwest during the beginning months of the COVID-19 pandemic, but similar increases were not observed in the South and West regions. These trends were also not found for any region in the 2018-2019 assessment window. This may indicate region-specific trends in anxiety and depression, potentially driven by the burden of the pandemic and policies which varied from region-to-region. Future studies should consider geographic variation in COVID-19 spread and policies as well as explore potential mechanisms by which this could influence the mental health of LGBTQ individuals.

Conclusions:

Symptoms of anxiety and depression increased among the study population in the Northeast and Midwest. This may indicate region-specific trends in anxiety and depression, potentially driven by the burden of the pandemic and policies.