Associations between local COVID-19 policies and anxiety in the USA: a longitudinal digital cohort study
Introduction A lack of coordinated federal guidance led to substantial heterogeneity in local COVID-19 policies across US states and counties. Local government policies may have contributed to increases in anxiety and mental health disparities during the COVID-19 pandemic.Methods We analysed associa...
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Public Health |
| Online Access: | https://bmjpublichealth.bmj.com/content/3/1/e001135.full |
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| author | Jeffrey E Olgin Gregory M Marcus Rita Hamad John Kornak Carmen R Isasi Ana Sanchez-Birkhead Mark Pletcher Soo Park Natasha Williams Thomas Carton Aaron E Cozen Madelaine Faulkner Modrow Amy Chiang Matthew Brandner Jaime H Orozco Kristen Azar Sylvia E K Sudat Pelin Ozluk Heather Kitzman Sara J Knight |
| author_facet | Jeffrey E Olgin Gregory M Marcus Rita Hamad John Kornak Carmen R Isasi Ana Sanchez-Birkhead Mark Pletcher Soo Park Natasha Williams Thomas Carton Aaron E Cozen Madelaine Faulkner Modrow Amy Chiang Matthew Brandner Jaime H Orozco Kristen Azar Sylvia E K Sudat Pelin Ozluk Heather Kitzman Sara J Knight |
| author_sort | Jeffrey E Olgin |
| collection | DOAJ |
| description | Introduction A lack of coordinated federal guidance led to substantial heterogeneity in local COVID-19 policies across US states and counties. Local government policies may have contributed to increases in anxiety and mental health disparities during the COVID-19 pandemic.Methods We analysed associations between composite policy scores for containment and closure, public health or economic support from the US COVID-19 County Policy Database and self-reported anxiety scores (Generalised Anxiety Disorder-7) from COVID-19 Citizen Science participants between 22 April 2020 and 31 December 2021.Results In 188 976 surveys from 36 711 participants in 100 counties across 28 states, associations between anxiety and containment and closure policy differed by employment (p<0.0001), with elevated anxiety under maximal policy for people working in hospitality and food services (+1.05 vs no policy; 95% CI: 0.45, 1.64) or arts and entertainment (+0.56; 95% CI 0.15, 0.97) and lower anxiety for people working in healthcare (−0.43; 95% CI −0.66 to –0.20) after adjusting for calendar time, county-specific effects and COVID-19 case rates and death rates. For public health policy, associations differed by race and ethnicity (p=0.0016), with elevated anxiety under maximal policy among participants identifying as non-Hispanic Black (+1.71; 95% CI 0.26, 3.16) or non-Hispanic Asian (+0.74; 95% CI 0.05, 1.43) and lower anxiety among Hispanic participants (−0.63, 95% CI −1.26 to –0.006). Associations with public health policy also differed by gender (p<0.0001), with higher anxiety scores under maximal policy for male participants (+0.42, 95% CI 0.09, 0.75) and lower anxiety for female participants (−0.40, 95% CI −0.67 to –0.13). There were no significant differential associations between economic support policy and sociodemographic subgroups.Conclusions Associations between local COVID-19 policies and anxiety varied substantially by sociodemographic characteristics. More comprehensive containment policies were associated with elevated anxiety among people working in strongly affected sectors, and more comprehensive public health policies were associated with elevated anxiety among people vulnerable to racial discrimination. |
| format | Article |
| id | doaj-art-889e774ad0da4b78aa3691b1174d3e94 |
| institution | Kabale University |
| issn | 2753-4294 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
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| spelling | doaj-art-889e774ad0da4b78aa3691b1174d3e942025-01-17T09:10:11ZengBMJ Publishing GroupBMJ Public Health2753-42942025-01-013110.1136/bmjph-2024-001135Associations between local COVID-19 policies and anxiety in the USA: a longitudinal digital cohort studyJeffrey E Olgin0Gregory M Marcus1Rita Hamad2John Kornak3Carmen R Isasi4Ana Sanchez-Birkhead5Mark Pletcher6Soo Park7Natasha Williams8Thomas Carton9Aaron E Cozen10Madelaine Faulkner Modrow11Amy Chiang12Matthew Brandner13Jaime H Orozco14Kristen Azar15Sylvia E K Sudat16Pelin Ozluk17Heather Kitzman18Sara J Knight19Department of Medicine, UCSF, San Francisco, California, USA3 Department of Cardiac Electrophysiology, Division of Cardiology, University of California San Francisco, San Francisco, California, USAFamily Community Medicine, University of California San Francisco, San Francisco, California, USADept of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA7 Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA2College of Nursing, University of Utah, Salt Lake City, Utah, USAEpidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA3UC San Diego, La Jolla, CA, USAFaculty of Health Sciences, Health Systems Enablement and Innovation, University of the Witwatersrand, Johannesburg, South AfricaLouisiana Public Health Institute, New Orleans, Louisiana, USADept of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USADept of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USADivision of General Internal Medicine, University of California San Francisco, San Francisco, California, USADept of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USADept of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USADept of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USACenter for Health Systems Research, Sutter Health, Walnut Creek, California, USAElevance Health Inc, Indianapolis, Indiana, USAUniversity of Texas Southwestern Medical Center, Dallas, Texas, USADivision of Epidemiology, University of Utah, VA Salt Lake City Healthcare System, Salt Lake City, Utah, USAIntroduction A lack of coordinated federal guidance led to substantial heterogeneity in local COVID-19 policies across US states and counties. Local government policies may have contributed to increases in anxiety and mental health disparities during the COVID-19 pandemic.Methods We analysed associations between composite policy scores for containment and closure, public health or economic support from the US COVID-19 County Policy Database and self-reported anxiety scores (Generalised Anxiety Disorder-7) from COVID-19 Citizen Science participants between 22 April 2020 and 31 December 2021.Results In 188 976 surveys from 36 711 participants in 100 counties across 28 states, associations between anxiety and containment and closure policy differed by employment (p<0.0001), with elevated anxiety under maximal policy for people working in hospitality and food services (+1.05 vs no policy; 95% CI: 0.45, 1.64) or arts and entertainment (+0.56; 95% CI 0.15, 0.97) and lower anxiety for people working in healthcare (−0.43; 95% CI −0.66 to –0.20) after adjusting for calendar time, county-specific effects and COVID-19 case rates and death rates. For public health policy, associations differed by race and ethnicity (p=0.0016), with elevated anxiety under maximal policy among participants identifying as non-Hispanic Black (+1.71; 95% CI 0.26, 3.16) or non-Hispanic Asian (+0.74; 95% CI 0.05, 1.43) and lower anxiety among Hispanic participants (−0.63, 95% CI −1.26 to –0.006). Associations with public health policy also differed by gender (p<0.0001), with higher anxiety scores under maximal policy for male participants (+0.42, 95% CI 0.09, 0.75) and lower anxiety for female participants (−0.40, 95% CI −0.67 to –0.13). There were no significant differential associations between economic support policy and sociodemographic subgroups.Conclusions Associations between local COVID-19 policies and anxiety varied substantially by sociodemographic characteristics. More comprehensive containment policies were associated with elevated anxiety among people working in strongly affected sectors, and more comprehensive public health policies were associated with elevated anxiety among people vulnerable to racial discrimination.https://bmjpublichealth.bmj.com/content/3/1/e001135.full |
| spellingShingle | Jeffrey E Olgin Gregory M Marcus Rita Hamad John Kornak Carmen R Isasi Ana Sanchez-Birkhead Mark Pletcher Soo Park Natasha Williams Thomas Carton Aaron E Cozen Madelaine Faulkner Modrow Amy Chiang Matthew Brandner Jaime H Orozco Kristen Azar Sylvia E K Sudat Pelin Ozluk Heather Kitzman Sara J Knight Associations between local COVID-19 policies and anxiety in the USA: a longitudinal digital cohort study BMJ Public Health |
| title | Associations between local COVID-19 policies and anxiety in the USA: a longitudinal digital cohort study |
| title_full | Associations between local COVID-19 policies and anxiety in the USA: a longitudinal digital cohort study |
| title_fullStr | Associations between local COVID-19 policies and anxiety in the USA: a longitudinal digital cohort study |
| title_full_unstemmed | Associations between local COVID-19 policies and anxiety in the USA: a longitudinal digital cohort study |
| title_short | Associations between local COVID-19 policies and anxiety in the USA: a longitudinal digital cohort study |
| title_sort | associations between local covid 19 policies and anxiety in the usa a longitudinal digital cohort study |
| url | https://bmjpublichealth.bmj.com/content/3/1/e001135.full |
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