The Effect of Cumulative Risk on Older Minority Adult Psychosocial Health during the Covid-19 Pandemic

Background/Purpose: The COVID-19 pandemic disparately affected the physical and mental health of older minority adults in the United States. Biological and socio-economic risk of morbidity and mortality follow a demographic gradient that disproportionally threatens older adult and minority racial/ethnic communities. Pathways to increased psychosocial vulnerability are complex, with factors like race, socio-economic status, gender, and age contributing to individualized profiles of vulnerability. The purpose of this study was to create a novel index that could quantify cumulative risk created by the COVID-19 pandemic in order to understand the impact these added risks have on older adult minority psychosocial health so that more focused attention and resources can be provided during times of pandemic crisis.

Methods: The sample for this study consisted of n=14,812 older adult respondents to the 2020 Household Pulse Survey (HPS), a weekly cross-sectional survey conducted by the US Census Bureau. The primary goal of the HPS is to produce data on the social and economic impacts of the coronavirus in America. A cumulative risk index (CRI) was created to assess the presence and quantity of risk factors across four major domains directly affected by conditions of the COVID-19 pandemic, including: food sufficiency, housing sufficiency, employment/income sufficiency, and healthcare access. Hierarchical linear regression models were then created to determine the effect gender, race, and cumulative pandemic-induced risk have on older adult feelings of anxiety, worry, anhedonia, and depression, along with any interaction effects between gender and race.

Results: Around 54% of the older adult sample (65 years of age and over) identified as female, with only around 13% belonging to a racial or ethnic group other than non-Hispanic white. The most common risk factor experienced was food insecurity (29.6%), followed by health care access (27.1%), employment/income insecurity (26.2%), and housing insecurity (10.1%). Regression models were then created for each of the four psychosocial factors, with each model including race, gender, and the cumulative risk index score. The cumulative risk index was a significant predictor for increased feelings of anxiety (β= 0.32, SE=0.01, CI= 0.30 – 0.33, p < 0.01), worry (β= 0.31, SE=0.01, CI= 0.30 – 0.32, p < 0.01), anhedonia (β= 0.30, SE=0.01, CI= 0.28 – 0.31, p < 0.01), and depression (β= 0.28, SE=0.01, CI= 0.27 – 0.29, p < 0.01). Additionally, significant interaction effects were observed between gender and race for anhedonia (β= -0.13, CI= -0.22 – -0.05, p < 0.01) and anxiety (β= -0.12, CI= -0.22 – -0.01, p < 0.01).

Conclusions and Implications: Findings from this study demonstrate that as exposure to adverse events increases, so too does the likelihood of experiencing mental health symptoms of anxiety, depression, anhedonia, and worry. The ramifications of the COVID-19 pandemic on the mental health of older adults in racial/ethnic minorities is significant and will likely be long-lasting. Greater study of the continuously evolving factors that impinge dissimilarly and disproportionately on the outcomes of distinct demographic groups is necessary in order to develop and provide effective resources to those most severely impacted