Full access
Articles
Published Online: 12 April 2023

Anxiety and Depression Symptoms Among Young U.S. Essential Workers During the COVID-19 Pandemic

Doron Amsalem, M.D. [email protected], Chana T. Fisch, B.A., Melanie Wall, Ph.D., C. Jean Choi, M.S., Amit Lazarov, Ph.D., John C. Markowitz, M.D., Mariah LeBeau, B.A., … Show All … , Melissa Hinds, R.N., M.S.N., Kip Thompson, Ph.D., Prudence W. Fisher, Ph.D., Thomas E. Smith, M.D., Sidney H. Hankerson, M.D., Roberto Lewis-Fernández, M.D., Lisa B. Dixon, M.D., M.P.H., and Yuval Neria, Ph.D.Authors Info & Affiliations
Publication: Psychiatric Services
Volume 74, Number 10
https://doi.org/10.1176/appi.ps.20220530
Track CitationsAdd to favorites
PDF/EPUB

Abstract

Objective:

Emerging cross-sectional data indicate that essential workers in the COVID-19 era face increased mental health risks. This study longitudinally examined clinical symptoms of generalized anxiety disorder, depression, and posttraumatic stress disorder (PTSD) among U.S. essential workers, including health care workers and workers in indispensable occupations such as manufacturing, food industry, construction, transportation, hospitality, and emergency services, during the COVID-19 pandemic. The authors anticipated high symptom levels and greater symptom severity among women versus men and among younger adults compared with older adults. Analyses also explored the association between COVID-19 vaccination status and clinical symptoms.

Methods:

This four-wave online survey study assessed clinical symptoms in a convenience sample of 4,136 essential workers at baseline and 14, 30, and 90 days between August and December 2021. Symptoms of anxiety, depression, and PTSD were measured with the Generalized Anxiety Disorder–7, Patient Health Questionnaire–9, and Primary Care PTSD Screen instruments, respectively.

Results:

At every time point, 74%–78% of respondents reported symptoms of anxiety and depression, which were highest among younger adults (ages 18–22 years), females, and transgender respondents. Vaccinated participants had slightly higher symptom levels than unvaccinated respondents. Rates of clinical symptoms did not change significantly over time.

Conclusions:

Essential workers consistently reported symptoms of generalized anxiety, depression, or PTSD, especially younger adult, female, and transgender participants. The overwhelming and unprecedented nature of the COVID-19 pandemic underscores the need to offer mental health care to essential workers, especially those in these subgroups. Employers and administrators should support and proactively encourage employees to access care when needed.

HIGHLIGHTS

•
Essential workers work in a variety of sectors critical to sustaining societal infrastructure and were affected by the COVID-19 pandemic, yet have been studied less frequently than workers in other sectors.
•
In a large sample (N=4,136) of essential workers, 74%–78% reported elevated levels of persistently endorsed symptoms of depression, anxiety, and posttraumatic stress disorder during the COVID-19 pandemic.
•
Higher rates of clinical symptoms were reported by female, transgender, young adult, and vaccinated essential workers.
The COVID-19 pandemic has elevated rates of mental distress in the United States (1). Fear of infection or of losing loved ones, imposed social distance from friends and family, and increased financial burdens have resulted in high rates of anxiety and depression (2–4). The mental health impacts of COVID-19 include fears of infection, work burnout, prolonged grief, and clinical symptoms, including anxiety, depression, and acute posttraumatic stress (5). Symptom severity varies across groups and differs by age, gender, race-ethnicity, and occupation (6).
Essential workers—that is, those in occupations deemed indispensable for daily community life and whose jobs usually require direct interpersonal contact—have been particularly affected by pandemic-related mental health conditions (7). Despite laboring in diverse industries (e.g., health care, food service, transport, or construction) and varying widely in perceived social status (8), these workers have greater daily COVID-19 exposure risk than nonessential workers (7). Therefore, anxiety and depression symptoms among essential workers have increased since the pandemic began, especially as a result of fear of contracting COVID-19 or of infecting a loved one (7, 9–11). However, research documenting the prepandemic mental health of essential workers has studied only subsets of essential workers, namely health care workers, first responders, and police. For example, several studies have focused on the impact of stress, grief, and burnout on health care workers’ mental health, especially among more junior providers and those exposed to patient death (12–14). Research on first responders and law enforcement personnel revealed significant job-related stressors before the pandemic (15). A recent review (16) of mental health effects on nonessential health care workers during six pandemics (2000–2020) found 32 studies documenting increases in depression, anxiety, stress, and other mental health issues among these workers.
In the decade before COVID-19, the prevalence of anxiety and depression in the United States had already been slowly but significantly increasing among adults, especially young adults. The prevalence of past-year depression increased between 2005 and 2015, especially among younger people (ages 12–17 and 18–25 years) (17). COVID-19 has accelerated these trends: studies have shown drastically increased levels of depression specifically among adolescents (45%) and 18- to 25-year-olds (37%) (18, 19). Among young U.S. adults, COVID-19–era prevalence estimates are 43% for anxiety and 40% for depression, more than double the rates for older adults (20).
Gender and race-ethnicity also influence mental health outcomes (21). Several COVID-19 studies have found that women and transgender and nonbinary people were more likely to develop depression, anxiety, and posttraumatic stress disorder (PTSD) during the pandemic (21–25). Moreover, women contribute a higher percentage of the health care, culinary, and retail workforce industries adversely affected by the pandemic (26). Other studies (27, 28) have shown that Hispanic and non-Hispanic Black people are more likely than non-Hispanic White people to experience COVID-19–related symptoms of mental disorders. However, no study to date has addressed the association of demographic variables with mental health outcomes among essential workers during COVID-19.
Finally, vaccination status may also be associated with mental health outcomes, although pertinent research is sparse. One Dutch study found that low COVID-19 vaccination rates were associated with chronic psychiatric diagnoses, including self-reported depression and anxiety (29). Similarly, in a sample of European and Asian neurosurgeons (N=534), those who were vaccinated reported a lower rate of depression (30).
In this study, we sought to understand the longitudinal trajectory of clinical symptoms in a sample of adult essential workers during the COVID-19 pandemic. Data on anxiety, depression, and PTSD symptoms were collected online at four time points between August and December 2021. We hypothesized that we would find high rates of clinical symptoms among essential workers, with minimal changes over time; greater symptom severity among women than men and among younger than older adults; and lower rates of clinical symptoms among those with COVID-19 vaccination than among unvaccinated individuals.

Methods

Participants and Recruitment

Participants were recruited through Prolific, an online crowdsourcing tool frequently used in psychiatric research (31). Prolific constantly screens the platform population to ensure response consistency in demographic and other characteristics (e.g., occupation) (32). It facilitates longitudinal studies by creating anonymous respondent IDs. To enhance participant verification and data quality, we excluded participants who repeated the assessment more than once and added a timer to ensure that respondents had properly read the instructions. We excluded respondents who failed attention-verification questions (e.g., “please mark the fourth answer”).
Participants were English-speaking, U.S.-residing essential workers ages 18–80 years who replied to a mental health study request. Essential worker was defined as follows: as health care workers, including nurses, physicians, mental health professionals, health care administrators, and emergency medical technicians, and as workers in indispensable occupations such as manufacturing, food industry, construction, transportation, hospitality, and emergency services. We recruited essential workers who commuted daily during the pandemic. Participants received $3 compensation at each of the four time points, for a total of up to $12. The New York State Psychiatric Institute Institutional Review Board approved this study (IRB protocol 8128).
The resulting nonprobability sample may not have been statistically representative of U.S. essential workers. Nonetheless, the large and demographically diverse sample allowed for comparisons between respondent subgroups and within subjects across time, providing insights into broader population trends.

Procedure

Before study entry and at each time point, participants reviewed an informed consent form and directions to complete study procedures via Qualtrics.com, a secure online data collection platform. Demographic information, clinical symptoms, and COVID-19–related characteristics were first assessed in August 2021. Follow-up assessments occurred 14, 30, and 90 days after the initial assessment, with data collection completed by December 28, 2021.

Instruments

The Generalized Anxiety Disorder–7 (GAD-7) instrument assesses the presence of seven generalized anxiety symptoms during the past 2 weeks, each rated on a scale ranging from 0 (“not at all”) to 3 (“nearly every day”), with an overall score range of 0–21 (33). Higher scores indicate greater self-reported anxiety: a GAD-7 total score of 5–9 indicates mild anxiety; 10–14, moderate anxiety; and 15–21, severe anxiety. Previous studies have reported high sensitivity (89%) and specificity (82%) of the GAD-7 screen for a cutoff score of 10 (33). In this study, the baseline Cronbach’s α (indicating internal validity for the GAD-7 items) was 0.92.
The nine-item Patient Health Questionnaire–9 (PHQ-9), a screening instrument based on the DSM-5 diagnostic criteria for major depression, assesses depressive symptoms during the past 2 weeks (34). Response options range from 0 (“not at all”) to 3 (“nearly every day”), yielding an overall range of 0–27. A total PHQ-9 score of 5–9 indicates mild depression; 10–14, moderate depression; 15–19, moderate to severe depression; and 20–27, severe depression. Previous studies have shown high sensitivity (88%) and specificity (85%) of the PHQ-9 for a cutoff score of 10 (35). In this study, the baseline Cronbach’s α was 0.90.
The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) is a five-item yes-or-no self-report instrument that identifies probable PTSD (36). It reflects DSM-5 diagnostic criteria for PTSD; three positive items constitute the screening threshold for probably PTSD. The PC-PTSD has good reliability and operating characteristics compared with a PTSD diagnosis based on clinician interview (37). To focus on COVID-19–related events, we adjusted PC-PTSD-5 items for the pandemic (e.g., “In the past month, have you felt guilty or unable to stop blaming yourself or others for COVID-19–related events?”) In this study, the baseline Cronbach’s α was 0.67.

Data Analysis

Sociodemographic, clinical, and COVID-19–related characteristics were summarized by using frequencies and proportions. To analyze mean scores on the GAD-7 and PHQ-9 instruments over time, longitudinal mixed-effect models were used with a random intercept to account for between-subject variances, a random effect of time point, and missing data with an unstructured covariance structure. All analyses included effects of time (baseline and 14, 30, and 90 days), age group (18–22, 23–30, 31–40, and ≥41 years), race-ethnicity (non-Hispanic White, non-Hispanic African American or Black, non-Hispanic Asian, Hispanic, non-Hispanic Native American or Pacific Islander, and non-Hispanic other or prefer not to answer), gender (male; female; and transgender, other, or prefer not to answer). To test for sociodemographic differences (age, gender, race-ethnicity, and occupation) and other COVID-19–related factors, the model included an additional interaction effect of moderator and time point. For models with significant interactions, contrasts were performed to examine whether clinical symptoms changed differentially by moderator between baseline and 90 days. To examine differences in GAD-7 and PHQ-9 scores by vaccination status, baseline vaccination status (received or not) was included in the main-effects model.
Attrition occurred at follow-ups. Pearson chi-square and t tests were used to examine differences between follow-up survey completers and noncompleters. Participants’ age and race-ethnicity differed significantly between 90-day completers and noncompleters; however, the mixed-effects model used all available data, not just those of completers, remaining unbiased under the missing-at-random assumption. All analyses were conducted with SAS, version 9.4, and all statistical tests were two-sided, using α<0.05.

Results

Demographic Characteristics

Essential workers (N=4,136) completed the baseline evaluation after we had excluded 310 (7%) individuals who had failed validity tests. Of the 4,136 participants, 3,346 (81%) completed the 14-day assessment, 2,995 (72%) the 30-day assessment, and 2,545 (62%) the 90-day assessment. Mean±SD participant age was 27.7±9.3 years (range 18–73). Most respondents were women (69%). Table 1 presents age, race-ethnicity, gender, and occupation data. Sociodemographic characteristics differed significantly between 90-day completers (N=2,545) and non-completers (N=1,591) for age (26.1±7.7 vs. 28.7±10.0 years), female gender (68% vs. 71%), and race-ethnicity (White 69% vs. 67%; Black 6% vs. 12%) but not in clinical symptom severity. Figure 1 illustrates participants’ geographic distribution.
TABLE 1. Demographic characteristics of essential workers in this study (N=4,136), by survey completion status
 TotalCompleters (N=2,545)Noncompletersa (N=1,591)  
CharacteristicN%N%N%Statisticp
Age (M±SD years)27.7±9.3 26.1±7.7 28.7±10.0 8.9b<.001
Age in years      84.1c<.001
 18–221,512378453366742  
 23–301,477369133656435  
 31–40741184591828218  
 ≥414061032813785  
Gender       .156
 Female2,854691,721681,13371  
 Male1,203297733043027  
 Transgender, other, or prefer not to answer792512282  
Race-ethnicity      42.8c<.001
 Hispanic556133561420013  
 Non-Hispanic White2,833681,760691,07367  
 Non-Hispanic African American or Black3468163618312  
 Non-Hispanic Asian27471938815  
 Non-Hispanic Native American or Pacific Islander341181161  
 Non-Hispanic other or prefer not to answerd932552382  
Occupation      32.1c<.001
 Health care1,402348593454334  
 Food industry819204721934722  
 Retail or sales512123401317211  
 Manufacturing42610279111479  
 Construction232612451087  
 Transportation14331024413  
 Education1423843584  
 Emergency services1353813543  
 Veterinary and animal care531271262  
 Hospitality361211151  
 Other23661576795  
Geographical regione      2.9c.413
 Midwest1,035256452539025  
 Northeast784194801930419  
 South1,441359003554134  
 West867215132035422  
a
Noncompleters at 90 days.
b
Assessed with independent t tests.
c
Assessed with Pearson chi-square tests.
d
Non-Hispanic other: multiracial (N=73), Middle Eastern (N=4), and unspecified (N=28).
e
Geographical data were missing for nine participants.
FIGURE 1. Geographic distribution of essential workers surveyed for this study (August–December 2021)

COVID-19–Related Characteristics and Clinical Symptoms

Table 2 presents COVID-19–related characteristics and baseline clinical symptoms. Of the 4,136 participating essential workers, 78% (N=3,208 and 2,608) reported anxiety, depression, or PTSD symptoms at baseline and day 14, respectively, and 74% (N=2,208 and 1,884) reported these symptoms at days 30 and 90, respectively. Rates of symptom endorsement did not change significantly over time. On the GAD-7 screen, 69% exceeded the mild threshold (GAD-7 scores 5–21), and 37% exceeded the moderate threshold (GAD-7 scores 10–21) at baseline; 71% (N=2,361) and 37% (N=1,242), respectively, exceeded these two thresholds on day 14; 65% (N=1,951) and 31% (N=923), respectively, exceeded these thresholds on day 30; and 66% (N=1,678) and 32% (N=824), respectively, exceeded these thresholds on day 90. For depressive symptoms, 66% reached the mild threshold (PHQ-9 scores 5–27), and 39% exceeded the moderate threshold (PHQ-9 scores 10–27) at baseline; 63% (N=2,123) and 35% (N=1,183), respectively, exceeded these two thresholds on day 14; 64% (N=1,909) and 34% (N=1,032), respectively, exceeded these thresholds on day 30; and 65% (N=1,644) and 37% (N=953), respectively, exceeded these thresholds on day 90. Overall, 27% of the respondents reported symptoms suggesting probable PTSD (PC-PTSD score ≥3) at baseline; 30% (N=1,004), 26% (N=780), and 20% (N=514) reported such symptoms on days 14, 30, and 90, respectively.
TABLE 2. COVID-19–related and baseline clinical characteristics of the study participants (N=4,136), by survey completion status
 TotalCompleters (N=2,545)Noncompletersa (N=1,591)  
CharacteristicN%N%N%Statisticp
Tested positive for COVID-197241842717297192.57b.11
Relative or friend tested positive for COVID-193,069741,909751,160733.31b.34
Exposed to COVID-19–infected people at work2,470601,54461926582.45b.12
Received the COVID-19 vaccine3,314802,053811,261791.84b.40
GAD-7 total score (M±SD)c8.1±5.8 8.1±5.7 8.2±5.8 .44d.65
GAD-7 score        
 5–91,332328223251032  
 ≥101,517379333758437  
PHQ-9 total score (M±SD)e8.6±6.5 8.4±6.5 8.8±6.5 1.66d.10
PHQ-9 score        
 5–91,122276952742727  
 ≥101,619399793964040  
PC-PTSD total score (M±SD)f1.6±1.5 1.6±1.5 1.7±1.4 1.54d.12
PC-PTSD score ≥31,112276702644228  
a
Noncompleters at 90 days.
b
Assessed with Pearson chi-square tests.
c
GAD-7, Generalized Anxiety Disorder–7. Scores range from 5 to 9 for mild anxiety, 10 to 14 for moderate anxiety, and 15 to 21 for severe anxiety.
d
Assessed with independent t tests.
e
PHQ-9, Patient Health Questionnaire–9. Scores range from 5 to 9 for mild depression, 10 to 14 for moderate depression, 15 to 19 for moderate to severe depression, and 20 to 27 for severe depression.
f
PC-PTSD, Primary Care PTSD Screen for DSM-5. Scores range from 0 to 5, with a score of ≥3 indicating probable posttraumatic stress disorder.
Both age (F=2.87, df=9 and 8,884, p=0.002) and gender (F=2.18, df=6 and 8,887, p=0.042) significantly moderated GAD-7 scores over time after adjustment for race-ethnicity. Figure 2 presents the adjusted mean GAD-7 scores over time by age and gender. At every time point, adjusted mean GAD-7 scores were consistently inversely related to age group: the scores were highest among the youngest age group (ages 18–22, range 8.8–9.4), followed by the 23–30 age group (range 8.0–9.0) and the 31–40 age group (range 6.9–7.3), and were lowest among the oldest age group (≥41; range 5.5–6.2). Compared with baseline scores, 90-day GAD-7 scores significantly decreased in the 23–30 (t=−7.11, df=8,884, p<0.001) and ≥41 (t=−2.30, df=8,884, p=0.02) age groups but remained stable in the other age groups. These changes reached statistical significance but did not appear to be clinically significant.
FIGURE 2. Adjusted mean±SE for Generalized Anxiety Disorder–7 (GAD-7) scores by (A) age and (B) gender of essential workers included in the surveya
aPossible scores range from 0 to 21, with higher scores indicating greater self-reported anxiety.
For gender, at every time point, adjusted mean GAD-7 scores were consistently highest among transgender respondents (range 9.2–10.5), followed by women (range 7.4–8.1), and were lowest among men (range 5.3–5.7). Compared with baseline, the decrease in GAD-7 scores at 90 days among women was statistically significant by −0.70 points (t=−6.95, df=8,887, p<0.001) but, as with age, appeared to be clinically insignificant.
Similarly, both age (F=3.81, df=9 and 8,884, p<0.001) and gender (F=3.45, df=6 and 8,887, p=0.002) significantly moderated depressive symptoms over time, with adjustment for race-ethnicity. Figure 3 presents adjusted mean PHQ-9 scores over time by age and gender. At each time point, adjusted mean PHQ-9 scores were consistently highest among the youngest (18–22; range 8.8–9.4) and lowest among the oldest (≥41; range 5.5–6.2) respondents. Depressive symptom scores were significantly lower at 90 days compared with baseline only for participants ages ≥41 years, which does not appear to be clinically significant. For gender, at every time point, adjusted mean PHQ-9 scores were consistently highest among transgender respondents (range 10.5–11.1) and lowest among men (range 6.5–6.7). We found no significant association between symptom level and racial-ethnic group, occupation, or geographical region.
FIGURE 3. Adjusted mean mean±SE for Patient Health Questionnaire–9 (PHQ-9) scores by (A) age and (B) gender of essential workers included in the surveya
aPossible scores range from 0 to 27, with higher scores indicating greater self-reported depression.
COVID-19 vaccination status was statistically significantly associated with mental health symptoms. Baseline vaccination status significantly moderated GAD-7 scores (F=4.98, df=3 and 8,808, p=0.002) over time, with adjustment for age, gender, and race-ethnicity. At 90 days, GAD-7 scores were 0.50 points higher (t=2.03, df=8,808, p=0.04) among vaccinated participants (mean=7.5, 95% CI=7.0–8.0) than among nonvaccinated participants (mean=6.7, 95% CI=6.1–7.4). For depressive symptoms, adjusted PHQ-9 scores were 0.63 points higher (F=10.47, df=18 and 811, p=0.001) among vaccinated participants (mean=7.7, 95% CI=7.2–8.2) than among nonvaccinated participants (mean=7.1, 95% CI=6.5–7.7).

Discussion

Our study assessed essential workers’ self-reported anxiety, depression, and PTSD symptoms over 90 days in the latter half of 2021. As hypothesized, we found above-threshold clinical symptoms among >70% of the participants, with higher symptom rates among female than male, transgender than cisgender, and younger than older adult participants. Contradicting our hypothesis, COVID-19 vaccination was associated with slightly higher rates of clinical symptoms compared with nonvaccinated status. Clinical symptom levels remained stable over time in the absence of significant pandemic-related health developments (e.g., no new COVID-19 vaccine). We note that to our knowledge and although the United States ranks first in number of COVID-19–related infections and deaths, this is the first study to report on a longitudinal course of mental health symptoms during the COVID-19 pandemic across a wide range of essential workers.
Between 74% and 78% of the participants reported anxiety, depression, or PTSD symptoms across the four study time points. Research on COVID-19–related psychological outcomes among essential workers in the general population is scant. Although we cannot compare our sample with population-based representative samples, other Web-based opportunity samples have shown similarly high symptom rates in specific occupations. A survey of 5,077 U.K. residents showed reduced well-being and greater psychological distress among construction, manufacturing, food and retail, and transport sector employees than among individuals working from home (38). A study from China showed that non–patient-facing essential employees reported a high rate of probable depression of 50%, as assessed with the PHQ-9 (39). Among 637 Italian workers, those in public health emergency roles (e.g., police and emergency personnel) self-reported more anxiety symptoms and fear than did Italian students (40).
Our results support previous findings of greater depression and anxiety symptoms among young adults (18–20). Several explanations may account for these increases. First, young adults endorsed increased stress levels during the pandemic resulting from events such as job loss or reduced hours, financial strains, and separation from loved ones (18). Second, transition-age youths may be especially vulnerable to mental health problems during the developmental period of identity consolidation, characterized by powerful needs for a sense of competence, social acceptance, and autonomy (41). Third, young adults report greater COVID-19–related loneliness, distress, and worry, which predict psychiatric symptoms (42).
Our findings emphasize the need for early detection and treatment of mental health difficulties among young essential workers. Such workers are often reluctant to seek mental health care, which increases the need for interventions to facilitate greater openness to treatment seeking. Among barriers to care, treatment-related stigma is a significant obstacle; some essential workers perceive receiving treatment as a weakness or failure to meet social or personal expectations (43, 44). Long after the pandemic eventually fades, psychiatric sequelae among these young essential workers may persist, leaving them vulnerable and needing assistance (45–47). Stigma and treatment avoidance are not the only obstacles to care. Limited availability of services and inadequate insurance also pose barriers to care. Research needs to examine the need for policy changes and how to increase the likelihood of care seeking among essential workers.
Our findings of higher symptomatology among female than male essential workers corroborate results from the literature (21–24). Although the subsample of transgender or other participants was relatively small (N=79), they reported the highest PHQ-9 (range 10.5–11.1) and GAD-7 (range 9.2–10.5) scores of any group. Usually marginalized, transgender individuals face unprecedented difficulties with mental health and social well-being and challenges accessing mental health care (25). These disparities are worsened by policies based on binary gender norms that can impede transgender individuals’ access to mental health care and increase the risk for psychopathology during the COVID-19 pandemic (48). Surprisingly, we found no significant association between racial-ethnic group and symptomatology. Future studies should explore psychiatric symptoms, ways to increase access to care, and policy changes for in-need groups.
COVID-19 vaccines were freely available to essential workers beginning in early 2021, months before this study took place. Accordingly, 80% of the participants reported receiving at least one COVID-19 vaccination at baseline, increasing to 86% at day 90 (data not shown). The most frequent reasons for declining a COVID-19 vaccine were “I don’t trust its efficacy” (50%), “Because of the side effects” (47%), and “It is not needed” (20%) (data not shown). A U.S. study on hesitancy regarding a future vaccine, with sampling designed to reflect national census data, reported similar explanations, that is, unknown efficacy and adverse effects (63%) (49). A recent review identified the following vaccine hesitancy factors: perceived risk, concerns about safety and effectiveness, lack of doctors’ recommendations, and history of influenza vaccination (50).
We found that receiving a COVID-19 vaccination was associated with slightly higher rates of clinical symptoms of anxiety and depression than not having received a vaccination. It is possible that people with higher baseline anxiety levels tend to have higher vaccine acceptance. We cannot, however, draw conclusions about causality given the cross-sectional nature of the assessment. Our interpretation of this result concurs with some of the current literature. For example, a German study of 1,779 adults found that COVID-19–related anxiety and health-related fears were associated with higher vaccine acceptance (51), as did a French study of 2,047 health care workers (52). Our data replicate existing literature, extending findings to essential workers in the United States.
Our study had several limitations. First, its findings are limited to a convenience sample of Prolific participants, who may not fully represent the population of essential workers. This restriction precludes comparison of our prevalence findings with those of the general population. The material used to recruit participants mentioned mental health, which may have encouraged enrollment of people with psychological difficulties. Ethnoracially, our sample fairly closely resembled the 2020 U.S. census distribution: 13% versus 16% Hispanic or Latino, 68% versus 72% non-Hispanic White, and 8% versus 13% non-Hispanic African American or Black in this study versus in the United States, respectively. However, at the 90-day follow-up assessment, non-Hispanic African American or Black participation had decreased to 7%. Second, we did not collect data on socioeconomic status or education level, which both are associated with mental health outcomes. Third, clinical assessments based on self-report questionnaires rather than formal diagnostic interview are subject to over- or underreporting (53). The PC-PTSD had borderline internal reliability (Cronbach’s α=0.67). Last, the cross-sectional nature of the data precluded addressing causality, and absence of pre–COVID-19 information limited comparison with the prepandemic era.

Conclusions

More than 70% of essential workers surveyed in this study consistently reported symptoms of generalized anxiety, depression, or PTSD over the course of 3 months in late 2021. Younger adult, female, transgender, and COVID-19–vaccinated participants reported greater distress. The overwhelming, unprecedented nature of the COVID-19 pandemic underscores the mental health care needs of essential workers, especially in these subgroups. Employers and administrators should support and proactively encourage employees to access care when needed.

Acknowledgments

The authors thank the essential workers who participated in this study.

Footnote

ClinicalTrials.gov identifier: NCT04964570.

REFERENCES

1.
Twenge JM, Joiner TE: US Census Bureau–assessed prevalence of anxiety and depressive symptoms in 2019 and during the 2020 COVID‐19 pandemic. Depress Anxiety 2020; 37:954–956
Crossref
PubMed
Google Scholar
2.
Vahratian A, Blumberg SJ, Terlizzi EP, et al: Symptoms of anxiety or depressive disorder and use of mental health care among adults during the COVID-19 pandemic— United States, August 2020–February 2021. MMWR Morb Mortal Wkly Rep 2021; 70:490–494
Crossref
PubMed
Google Scholar
3.
Marroquín B, Vine V, Morgan R: Mental health during the COVID-19 pandemic: effects of stay-at-home policies, social distancing behavior, and social resources. Psychiatry Res 2020; 293:113419
Crossref
PubMed
Google Scholar
4.
Brooks SK, Webster RK, Smith LE, et al: The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 2020; 395:912–920
Crossref
PubMed
Google Scholar
5.
Boden M, Zimmerman L, Azevedo KJ, et al: Addressing the mental health impact of COVID-19 through population health. Clin Psychol Rev 2021; 85:102006
Crossref
PubMed
Google Scholar
6.
García‐Fernández L, Romero‐Ferreiro V, Padilla S, et al: Gender differences in emotional response to the COVID‐19 outbreak in Spain. Brain Behav 2021; 11:e01934
Crossref
PubMed
Google Scholar
7.
Bell C, Williman J, Beaglehole B, et al: Challenges facing essential workers: a cross-sectional survey of the subjective mental health and well-being of New Zealand healthcare and “other” essential workers during the COVID-19 lockdown. BMJ Open 2021; 11:e048107
Crossref
PubMed
Google Scholar
8.
Guidance on the Essential Critical Infrastructure Workforce: Ensuring Community and National Resilience in COVID-19 Response. Washington, DC, US Department of Homeland Security, Cybersecurity and Infrastructure Security Agency, 2020. https://www.cisa.gov/sites/default/files/publications/ECIW_4.0_Guidance_on_Essential_Critical_Infrastructure_Workers_Final3_508_0.pdf
Google Scholar
9.
Grooms J, Ortega A, Rubalcaba JAA, et al: Racial and ethnic disparities: essential workers, mental health, and the coronavirus pandemic. Rev Black Polit Econ 2022; 49:363–380
Crossref
PubMed
Google Scholar
10.
Mayer B, Arora M, Helm S, Barnett M: Essential but ill-prepared: how the COVID-19 pandemic affects the mental health of the grocery store workforce. Public Health Rep 2022; 137:120–127
Crossref
PubMed
Google Scholar
11.
Toh WL, Meyer D, Phillipou A, et al: Mental health status of healthcare versus other essential workers in Australia amidst the COVID-19 pandemic: initial results from the collate project. Psychiatry Res 2021; 298:113822
Crossref
PubMed
Google Scholar
12.
McCullough JH, van Hamel C: Anxiety among newly-qualified doctors: an eight-year analysis. Med Teach 2020; 42:52–57
Crossref
PubMed
Google Scholar
13.
Hannan E, Breslin N, Doherty E, et al: Burnout and stress amongst interns in Irish hospitals: contributing factors and potential solutions. Ir J Med Sci 2018; 187:301–307
Crossref
PubMed
Google Scholar
14.
Laposa JM, Alden LE: Posttraumatic stress disorder in the emergency room: exploration of a cognitive model. Behav Res Ther 2003; 41:49–65
Crossref
PubMed
Google Scholar
15.
Stanley IH, Hom MA, Joiner TE: A systematic review of suicidal thoughts and behaviors among police officers, firefighters, EMTs, and paramedics. Clin Psychol Rev 2016; 44:25–44
Crossref
PubMed
Google Scholar
16.
Chowdhury N, Kainth A, Godlu A, et al: Mental health and well-being needs among non-health essential workers during recent epidemics and pandemics. Int J Environ Res Public Health 2022; 19:5961
Crossref
PubMed
Google Scholar
17.
Weinberger AH, Gbedemah M, Martinez AM, et al: Trends in depression prevalence in the USA from 2005 to 2015: widening disparities in vulnerable groups. Psychol Med 2018; 48:1308–1315
Crossref
PubMed
Google Scholar
18.
Kujawa A, Green H, Compas BE, et al: Exposure to COVID‐19 pandemic stress: associations with depression and anxiety in emerging adults in the United States. Depress Anxiety 2020; 37:1280–1288
Crossref
PubMed
Google Scholar
19.
Hawes MT, Szenczy AK, Klein DN, et al: Increases in depression and anxiety symptoms in adolescents and young adults during the COVID-19 pandemic. Psychol Med 2021; 52:3222–3230
Crossref
PubMed
Google Scholar
20.
Zhang W, Walkover M, Wu YY: The challenge of COVID-19 for adult men and women in the United States: disparities of psychological distress by gender and age. Public Health 2021; 198:218–222
Crossref
PubMed
Google Scholar
21.
Xiong J, Lipsitz O, Nasri F, et al: Impact of COVID-19 pandemic on mental health in the general population: a systematic review. J Affect Disord 2020; 277:55–64
Crossref
PubMed
Google Scholar
22.
Ahmed MZ, Ahmed O, Aibao Z, et al: Epidemic of COVID-19 in China and associated psychological problems. Asian J Psychiatr 2020; 51:102092
Crossref
PubMed
Google Scholar
23.
Gao J, Zheng P, Jia Y, et al: Mental health problems and social media exposure during COVID-19 outbreak. PLoS ONE 2020; 15:e0231924
PubMed
Google Scholar
24.
Lei L, Huang X, Zhang S, et al: Comparison of prevalence and associated factors of anxiety and depression among people affected by versus people unaffected by quarantine during the COVID-19 epidemic in southwestern China. Med Sci Monit 2020; 26:e924609
Crossref
PubMed
Google Scholar
25.
Zhu X, Gao Y, Gillespie A, et al: Health care and mental wellbeing in the transgender and gender-diverse Chinese population. Lancet Diabetes Endocrinol 2019; 7:339–341
Crossref
PubMed
Google Scholar
26.
Rho HJ, Brown H, Fremstad S: A Basic Demographic Profile of Workers in Frontline Industries. Washington, DC, Center for Economic and Policy Research 2020
Google Scholar
27.
Ettman CK, Abdalla SM, Cohen GH, et al: Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic. JAMA Netw Open 2020; 3:e2019686
Crossref
PubMed
Google Scholar
28.
Coley RL, Baum CF: Trends in mental health symptoms, service use, and unmet need for services among US adults through the first 8 months of the COVID-19 pandemic. Transl Behav Med 2022; 12:273–283
Crossref
PubMed
Google Scholar
29.
Pan KY, Kok AAL, Penninx BWJH, et al: Attitudes towards COVID‐19 vaccination: a comparison between persons with different chronicity of pre‐pandemic depressive, anxiety or obsessive–compulsive disorders. Acta Psychiatr Scand 2022; 145:412–415
Crossref
PubMed
Google Scholar
30.
Sharif S, Amin F, Hafiz M, et al: A year of pandemic—comparison of depression among neurosurgeons after the advent of the COVID-19 vaccine. World Neurosurg 2022; 159:e466–e478
Crossref
PubMed
Google Scholar
31.
Peer E, Brandimarte L, Samat S, et al: Beyond the Turk: alternative platforms for crowdsourcing behavioral research. J Exp Soc Psychol 2017; 70:153–163
Crossref
Google Scholar
32.
Palan S, Schitter C: Prolific.ac—a subject pool for online experiments. J Behav Exp Finance 2018; 17:22–27
Crossref
Google Scholar
33.
Spitzer RL, Kroenke K, Williams JBW, et al: A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006; 166:1092–1097
Crossref
PubMed
Google Scholar
34.
Kroenke K, Spitzer RL, Williams JBW: The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16:606–613
Crossref
PubMed
Google Scholar
35.
Levis B, Benedetti A, Thombs BD, et al: Accuracy of Patient Health Questionnaire–9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ 2019; 365:l1476
Crossref
PubMed
Google Scholar
36.
Prins A, Bovin MJ, Smolenski DJ, et al: The primary care PTSD screen for DSM-5 (PC-PTSD-5): development and evaluation within a veteran primary care sample. J Gen Intern Med 2016; 31:1206–1211
Crossref
PubMed
Google Scholar
37.
Ouimette P, Wade M, Prins A, et al: Identifying PTSD in primary care: comparison of the Primary Care-PTSD screen (PC-PTSD) and the General Health Questionnaire–12 (GHQ). J Anxiety Disord 2008; 22:337–343
Crossref
PubMed
Google Scholar
38.
Chen DTH, Wang YJ: Inequality-related health and social factors and their impact on well-being during the COVID-19 pandemic: findings from a national survey in the UK. Int J Environ Res Public Health 2021; 18:1014
Crossref
PubMed
Google Scholar
39.
Fang X, Zhang J, Teng C, et al: Depressive symptoms in the front-line non-medical workers during the COVID-19 outbreak in Wuhan. J Affect Disord 2020; 276:441–445
Crossref
PubMed
Google Scholar
40.
Mazza M, Attanasio M, Pino MC, et al: Moral decision-making, stress, and social cognition in frontline workers vs population groups during the COVID-19 pandemic: an explorative study. Front Psychol 2020; 11:588159
Crossref
PubMed
Google Scholar
41.
Leavey JE: Youth experiences of living with mental health problems: emergence, loss, adaptation and recovery (ELAR). Can J Commun Ment Health 2005; 24:109–126
Crossref
PubMed
Google Scholar
42.
Loades ME, Chatburn E, Higson-Sweeney N, et al: Rapid systematic review: the impact of social isolation and loneliness on the mental health of children and adolescents in the context of COVID-19. J Am Acad Child Adolesc Psychiatry 2020; 59:1218–1239
Crossref
PubMed
Google Scholar
43.
Liu CH, Zhang E, Wong GTF, et al: Factors associated with depression, anxiety, and PTSD symptomatology during the COVID-19 pandemic: clinical implications for US young adult mental health. Psychiatry Res 2020; 290:113172
Crossref
PubMed
Google Scholar
44.
Clement S, Schauman O, Graham T, et al: What is the impact of mental health–related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychol Med 2015; 45:11–27
Crossref
PubMed
Google Scholar
45.
Shultz JM, Baingana F, Neria Y: The 2014 Ebola outbreak and mental health: current status and recommended response. JAMA 2015; 313:567–568
Crossref
PubMed
Google Scholar
46.
Amsalem D, Dixon LB, Neria Y: The coronavirus disease 2019 (COVID-19) outbreak and mental health: current risks and recommended actions. JAMA Psychiatry 2021; 78:9–10
Crossref
PubMed
Google Scholar
47.
Markowitz JC: In the Aftermath of the Pandemic: Interpersonal Psychotherapy for Anxiety, Depression, and PTSD. New York, Oxford University Press, 2021
Crossref
Google Scholar
48.
Perez-Brumer A, Silva-Santisteban A: COVID-19 policies can perpetuate violence against transgender communities: insights from Peru. AIDS Behav 2020; 24:2477–2479
Crossref
PubMed
Google Scholar
49.
Pogue K, Jensen JL, Stancil CK, et al: Influences on attitudes regarding potential COVID-19 vaccination in the United States. Vaccines 2020; 8:582
Crossref
Google Scholar
50.
Lin C, Tu P, Beitsch LM: Confidence and receptivity for COVID-19 vaccines: a rapid systematic review. Vaccines 2020; 9:16
Crossref
Google Scholar
51.
Bendau A, Plag J, Petzold MB, et al: COVID-19 vaccine hesitancy and related fears and anxiety. Int Immunopharmacol 2021; 97:107724
Crossref
PubMed
Google Scholar
52.
Gagneux-Brunon A, Detoc M, Bruel S, et al: Intention to get vaccinations against COVID-19 in French healthcare workers during the first pandemic wave: a cross-sectional survey. J Hosp Infect 2021; 108:168–173
Crossref
PubMed
Google Scholar
53.
Schwarz N: Self-reports: how the questions shape the answers. Am Psychol 1999; 54:93–105
Crossref
Google Scholar

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Volume 74 • Number 10 • October 01, 2023
Pages: 1010 - 1018
PubMed: 37042105

History

Received: 14 October 2022
Revision received: 25 January 2023
Accepted: 1 February 2023
Published online: 12 April 2023
Published in print: October 01, 2023

Keywords

  1. Essential workers
  2. COVID-19
  3. Depression
  4. Young Adults
  5. Anxiety disorders

Authors

Details

Doron Amsalem, M.D. [email protected]
New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson).
View all articles by this author
Chana T. Fisch, B.A.
New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson).
View all articles by this author
Melanie Wall, Ph.D.
New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson).
View all articles by this author
C. Jean Choi, M.S.
New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson).
View all articles by this author
Amit Lazarov, Ph.D.
New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson).
View all articles by this author
John C. Markowitz, M.D.
New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson).
View all articles by this author
Mariah LeBeau, B.A.
New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson).
View all articles by this author
Melissa Hinds, R.N., M.S.N.
New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson).
View all articles by this author
Kip Thompson, Ph.D.
New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson).
View all articles by this author
Prudence W. Fisher, Ph.D.
New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson).
View all articles by this author
Thomas E. Smith, M.D.
New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson).
View all articles by this author
Sidney H. Hankerson, M.D.
New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson).
View all articles by this author
Roberto Lewis-Fernández, M.D.
New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson).
View all articles by this author
Lisa B. Dixon, M.D., M.P.H.
New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson).
View all articles by this author
Yuval Neria, Ph.D.
New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson).
View all articles by this author

Notes

Send correspondence to Dr. Amsalem ([email protected]). Dr. Dixon is editor of the journal. Benjamin Druss, M.D., M.P.H., served as decision editor on the manuscript.

Author Contributions

Drs. Dixon and Neria share senior authorship.

Competing Interests

Dr. Fisher has received funding support from the NVLD Project and from TeleSage, Inc., has received donor support for the Man O’ War Project for equine-assisted psychotherapy projects (including the Earl I. Mack Foundation, the David and Julia Koch Foundation, the Jockey Club, the Mary and Daniel Loughran Foundation, the Gulfstream Park Racing Association, Meta Aerospace Capital, Ltd., and Tactical Air Support), and has received royalties from the Research Foundation for Mental Hygiene. Dr. Lewis-Fernández had common stock ownership in Vistagen Therapeutics, sold November 2021, and received an honorarium for a training presentation from AbbVie. The other authors report no financial relationships with commercial interests.

Metrics & Citations

Metrics

Citations

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.

Format
Citation style
Style
Copy to clipboard
Tips for downloading citations

View Options

View options

PDF/EPUB

View PDF/EPUB

Login options

Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.

Personal login Institutional Login Open Athens login
Item saved, go to cart
Purchase Options

Purchase this article to access the full text.

PPV Articles - Psychiatric Services

PPV Articles - Psychiatric Services

Not a subscriber?

Subscribe Now / Learn More

PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Media

Figures

Other

Tables

Share

Share

Share article link

Share

×

As described within the American Psychiatric Association (APA)'s Privacy Policy and Terms of Use, this website utilizes cookies, including for the purpose of offering an optimal online experience and services tailored to your preferences. Please read the entire Privacy Policy and Terms of Use. By closing this message, browsing this website, continuing the navigation, or otherwise continuing to use the APA's websites, you confirm that you understand and accept the terms of the Privacy Policy and Terms of Use, including the utilization of cookies.