{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T22:53:44Z","timestamp":1793919224166,"version":"4.8.0"},"reference-count":34,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2021,8,8]],"date-time":"2021-08-08T00:00:00Z","timestamp":1628380800000},"content-version":"unspecified","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000877","name":"Rockefeller Foundation","doi-asserted-by":"publisher","award":["2019 HTH 024"],"award-info":[{"award-number":["2019 HTH 024"]}],"id":[{"id":"10.13039\/100000877","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,7,15]]},"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To document the prevalence of anxiety disorders in the USA during the COVID-19 pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A cross-sectional analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>A nationally representative sample in the USA between 31 March and 13 April 2020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>1450 English-speaking adult participants in the AmeriSpeak Panel. AmeriSpeak is a probability-based panel designed to be representative of households in the USA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Prevalence of probable generalised anxiety disorder (GAD) using the GAD-7 and post-traumatic stress symptoms (PTSS) using the four-item PTSD (post-traumatic stress disorder) checklist. Both outcomes were stratified by demographics and COVID-19-related stressors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The majority of participants were female (51.8%), non-Hispanic white (62.9%) and reported a household saving of $5000 or more. Those between 18 and 29 years old were the largest age group (38.1%) compared with 40\u201359 years (32.0%) and 60 years or more (29.9%). The prevalence of probable GAD was 10.9% (95% CI 9.1% to 13.2%) and the prevalence of PTSS was 21.7% (95% CI 19.1% to 24.6%). Among participants reporting five or more COVID-19-related stressors, the prevalence of probable GAD was 20.5% (95% CI 16.1% to 25.8%) and the prevalence of PTSS was 35.7% (95% CI 30.2% to 41.6%). Experiencing five or more COVID-19-related stressors was a predictor of both probable GAD (OR=4.5, 95%\u2009CI 2.3 to 8.8) and PTSS (OR=3.3, 95%\u2009CI 2.1 to 5.1).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The prevalence of probable anxiety disorders in the USA, as the COVID-19 pandemic and policies implemented to tackle it unfolded, is higher than estimates reported prior to the pandemic and estimates reported following other mass traumatic events. Exposure to COVID-19-related stressors is associated with higher prevalence of both probable GAD and PTSS, highlighting the role these stressors play in increasing the risk of developing anxiety disorders in the USA. Mitigation and recovery policies should take into account the mental health toll the pandemic had on the USA population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-044125","type":"journal-article","created":{"date-parts":[[2021,8,9]],"date-time":"2021-08-09T13:42:03Z","timestamp":1628516523000},"page":"e044125","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":64,"title":["Mental health consequences of COVID-19: a nationally representative cross-sectional study of pandemic-related stressors and anxiety disorders in the USA"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5474-4521","authenticated-orcid":false,"given":"Salma M","family":"Abdalla","sequence":"first","affiliation":[{"name":"Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine K","family":"Ettman","sequence":"additional","affiliation":[{"name":"Boston University School of Public Health, Boston, Massachusetts, USA"},{"name":"Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory H","family":"Cohen","sequence":"additional","affiliation":[{"name":"Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandro","family":"Galea","sequence":"additional","affiliation":[{"name":"Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA"},{"name":"Boston University School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,8,9]]},"reference":[{"key":"2025121407240313000_11.8.e044125.1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-032013-182435"},{"key":"2025121407240313000_11.8.e044125.2","doi-asserted-by":"publisher","DOI":"10.1177\/0004867419899165"},{"key":"2025121407240313000_11.8.e044125.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0929-6646(10)60087-3"},{"key":"2025121407240313000_11.8.e044125.4","doi-asserted-by":"publisher","DOI":"10.1007\/BF02103669"},{"key":"2025121407240313000_11.8.e044125.5","doi-asserted-by":"publisher","DOI":"10.4178\/epih.e2016048"},{"key":"2025121407240313000_11.8.e044125.6","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.psychres.2018.07.008","article-title":"Relationship between economic stress factors and stress, anxiety, and depression: moderating role of social support","volume":"268","author":"Viseu","year":"2018","journal-title":"Psychiatry Res"},{"key":"2025121407240313000_11.8.e044125.7","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2017-000471"},{"key":"2025121407240313000_11.8.e044125.8","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.64.12.1427"},{"key":"2025121407240313000_11.8.e044125.9","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.153.5.705"},{"key":"2025121407240313000_11.8.e044125.10","doi-asserted-by":"crossref","DOI":"10.1016\/j.psychres.2020.112934","article-title":"The psychological impact of the COVID-19 epidemic on college students in China","volume":"287","author":"Cao","year":"2020","journal-title":"Psychiatry Res"},{"key":"2025121407240313000_11.8.e044125.11","doi-asserted-by":"crossref","DOI":"10.1001\/jamainternmed.2020.1369","article-title":"US public concerns about the COVID-19 pandemic from results of a survey given via social media","volume":"180","author":"Nelson","year":"2020","journal-title":"JAMA Intern Med"},{"key":"2025121407240313000_11.8.e044125.12","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph18010210","article-title":"Change in physical activity, sleep quality, and psychosocial variables during COVID-19 lockdown: evidence from the Lothian birth cohort 1936","volume":"18","author":"Okely","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"2025121407240313000_11.8.e044125.13","doi-asserted-by":"publisher","DOI":"10.1002\/brb3.1934"},{"key":"2025121407240313000_11.8.e044125.14","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20758"},{"key":"2025121407240313000_11.8.e044125.15","article-title":"Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China","volume":"17","author":"Wang","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"2025121407240313000_11.8.e044125.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2020.113172"},{"key":"2025121407240313000_11.8.e044125.17","doi-asserted-by":"publisher","DOI":"10.2307\/3090175"},{"key":"2025121407240313000_11.8.e044125.18","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1002\/da.23077","article-title":"U.S. census Bureau-assessed prevalence of anxiety and depressive symptoms in 2019 and during the 2020 COVID-19 pandemic","volume":"37","author":"Twenge","year":"2020","journal-title":"Depress Anxiety"},{"key":"2025121407240313000_11.8.e044125.19","doi-asserted-by":"crossref","DOI":"10.1186\/s12960-020-00544-1","article-title":"The prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients: a systematic review and meta-regression","volume":"18","author":"Salari","year":"2020","journal-title":"Hum Resour Health"},{"key":"2025121407240313000_11.8.e044125.20","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17186603"},{"key":"2025121407240313000_11.8.e044125.21","doi-asserted-by":"publisher","DOI":"10.1186\/s12992-020-00589-w"},{"key":"2025121407240313000_11.8.e044125.22","doi-asserted-by":"publisher","DOI":"10.1192\/j.eurpsy.2020.89"},{"key":"2025121407240313000_11.8.e044125.23","doi-asserted-by":"publisher","DOI":"10.1002\/jts.20355"},{"key":"2025121407240313000_11.8.e044125.24","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092"},{"key":"2025121407240313000_11.8.e044125.25","doi-asserted-by":"publisher","DOI":"10.1037\/0022-006X.76.2.272"},{"key":"2025121407240313000_11.8.e044125.26","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.62.6.617"},{"key":"2025121407240313000_11.8.e044125.27","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1001\/jamapsychiatry.2017.0056","article-title":"Cross-sectional comparison of the epidemiology of DSM-5 generalized anxiety disorder across the globe","volume":"74","author":"Ruscio","year":"2017","journal-title":"JAMA Psychiatry"},{"key":"2025121407240313000_11.8.e044125.28","doi-asserted-by":"publisher","DOI":"10.1037\/tra0000924"},{"key":"2025121407240313000_11.8.e044125.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijchp.2020.07.007"},{"key":"2025121407240313000_11.8.e044125.30","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.19686","article-title":"Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic","volume":"3","author":"Ettman","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2025121407240313000_11.8.e044125.31","doi-asserted-by":"crossref","first-page":"345","DOI":"10.3389\/fpsyt.2018.00345","article-title":"Prevalence rates and predictors of generalized anxiety disorder symptoms in residents of Fort mcmurray six months after a wildfire","volume":"9","author":"Agyapong","year":"2018","journal-title":"Front Psychiatry"},{"key":"2025121407240313000_11.8.e044125.32","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.10.1235"},{"key":"2025121407240313000_11.8.e044125.33","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.3976"},{"key":"2025121407240313000_11.8.e044125.34","unstructured":"NORC.org . AmeriSpeak: NORC\u2019s Breakthrough Panel-Based Research Platform. Available: https:\/\/www.norc.org\/Research\/Capabilities\/Pages\/amerispeak.aspx [Accessed 18 May 2020]."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-044125","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T15:24:08Z","timestamp":1765725848000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-044125"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8]]},"references-count":34,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8,9]]},"published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1136\/bmjopen-2020-044125"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-044125","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8]]}}}