Income Differences and COVID-19: Impact on Daily Life and Mental Health

Introduction: The COVID-19 pandemic has caused disproportionate suffering among vulnerable and socio-economically disadvantaged portions of the population. Low-income and minority populations are likely to experience disparate disease and mental health burdens. Currently, there is little evidence regarding how the experience of the early months of the U.S. COVID-19 outbreak differed by income level, and how that related to mental health symptoms.

Methods: The present study utilized data from a national sample of U.S. adults (n=5,023) who completed measures related to the COVID experience, COVID-19 Fear Scale (FCV-19S), the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-8 (PHQ-8). 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 diagnosis of a mental health condition, current smoking status, and current diagnosis of a comorbid condition. Continuous variables are 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 income level was calculated using the demographic variables and was included in the multivariable models. Multivariable logistic regression was performed to determine whether income level (low: <$45,000 vs high: $75,000+) was significantly associated with COVID experience measures and PHQ-8 and GAD-7 scores. Multivariable regression was performed to determine whether income level (low: <$45,000 vs high: $75,000+) was significantly associated with COVID experience measures, PHQ-8, GAD-7, and COVID fear scores.

Results: Among the low-income group, COVID-19 had a significantly greater negative impact on: family income/employment, access to food, access to mental health treatment, and stress and discord in the family. Participants in the low-income group also had greater odds of a PHQ-8 score ≥ 10 (OR=1.38, 95% CI 1.08, 1.77) and a GAD-7 score ≥ 10 (OR=1.65, 95% CI 1.27, 2.14) compared to those in the high-income group.

Conclusion: Our findings suggest substantial differences in how COVID-19 impacted daily life and mental health between adults living in low-income households compared to high earning households during the early months of the pandemic. Specifically, the early experience of the COVID pandemic differed dramatically between income groups, with lower income individuals experiencing substantial negative impact concerning their finances and access to basic needs such as food and mental health treatment. By contrast, the higher income individuals experienced changing routines and difficulty accessing social support. Essentially, these results show that the COVID-19 pandemic has further amplified the role of the social determinants of health, a select array of conditions in which people are born, live, work, and age that significantly affect all aspects of health.