Acute and longer-term psychological distress associated with testing positive for COVID-19: longitudinal evidence from a population-based study of US adults

Background The novel coronavirus (SARS-CoV-2) has produced a considerable public health burden but the impact that contracting the disease has on mental health is unclear. In this observational population-based cohort study, we examined longitudinal changes in psychological distress associated with testing positive for COVID-19. Methods Participants (N = 8,002; Observations = 139,035) were drawn from 23 waves of the Understanding America Study, a nationally representative survey of American adults followed-up every two weeks from April 1 2020 to February 15 2021. Psychological distress was assessed using the standardized total score on the Patient Health Questionnaire-4 (PHQ-4). Results Over the course of the study 576 participants reported testing positive for COVID-19. Using regression analysis including individual and time fixed effects we found that psychological distress increased by 0.29 standard deviations ( p <.001) during the two-week period when participants first tested positive for COVID-19. Distress levels remained significantly elevated ( d = 0.16, p <.01) for a further two weeks, before returning to baseline levels. Coronavirus symptom severity explained changes in distress attributable to COVID-19, whereby distress was more pronounced among those whose symptoms were more severe and were slower to subside. Conclusions This study indicates that testing positive for COVID-19 is associated with an initial increase in psychological distress that diminishes quickly as symptoms subside. While COVID-19 may not produce lasting psychological distress among the majority of the general population it remains possible that a minority may suffer longer-term mental health consequences.