The Experience of COVID-19 Among People with Depression: Impact on Daily Life and Coping Strategies

Background: The prevalence of depression symptoms among U.S. adults increased dramatically during the early months of the COVID-19 pandemic. The early disruption of routines and access to mental health care was associated with increased symptoms of depression and anxiety later in the pandemic. We sought to understand the unique experience of the COVID-19 pandemic on the daily activities, access to basic needs, coping strategies, and symptomatology for people with a history of depression.

We sought to understand the impact of the pandemic on people with a history of depression.

Methods: In June 2020, a national sample of 5,023 U.S. adults, including 760 reporting past/current diagnoses of depression, completed survey measures related to the COVID experience, COVID-19 Fear Scale, Brief-COPE, Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-8 (PHQ-8), and Posttraumatic Diagnostic Scale for DSM-5 (PDS-5). Demographic information collected included age, BMI, sex, race, ethnicity, marital status, education, current work status, occupation, number of people supported by household income, employment status before COVID 19, current living situation, current smoking status, and current diagnosis of a comorbid condition. Continuous variables were summarized with means and standard deviations and categorical variables with counts and percentages. Significant differences in means and counts/percentages were assessed using t-tests and chi-square tests, respectively. To adjust for differing demographic profiles, a propensity score for a reported history of depression was calculated using all the demographics. Multivariable logistic regression was performed to determine whether depression status was significantly associated with COVID experience measures and mental health measures (PHQ-8, GAD-7, and PDS-5) while adjusting for participant characteristics. Coping strategies (adaptive and maladaptive) were introduced into the multivariable linear and logistic regressions to determine their association with the mental health outcomes. These models were repeated in the participants reporting a history of depression only to further examine the association between coping and the mental health measures in this group.

Results: After adjusting for sociodemographic characteristics, a history of depression increased the odds of negative effects of the COVID-19 pandemic on multiple aspects of life including: routines, access to mental health treatment, alcohol use, prescription painkiller use, and other drug use. Those with a history of depression also scored significantly higher on the PHQ-8, GAD-7, and PDS-5 (all ps < 0.0001). In all respondents (regardless of depression history), greater use of adaptive coping strategies was significantly associated with lower scores, and greater use of maladaptive strategies with higher scores, on these scales. Individuals reporting a history of depression reported greater use of both adaptive and maladaptive strategies.

Conclusions: Individuals reporting a history of depression showed a significantly greater negative psychological impact during the early months of the pandemic. Adaptive coping strategies appear to be protective and help regulate symptomatology, suggesting that particular focus during the clinical encounter on developing tools to promote well-being, alleviate stress, and decrease perceptions of helplessness could mitigate the effects.