Community Mobility and Depressive Symptoms During the COVID-19 Pandemic in the United States

Key Points

Question

Were US adults living in communities with decreased mobility during the COVID-19 pandemic more likely to report a depressed mood?

Findings

In this survey study with 192 271 respondents, individuals who lived in communities where fewer individuals left home on a daily basis during the pandemic reported greater levels of depression on average. These differences were not directly attributable to COVID-19 pandemic restrictions, nor to county-level differences in COVID-19 cases or deaths, weather, or county-level economic features; the association persisted after widespread COVID-19 vaccine availability.

Meaning

These findings suggest that the association of depression and policies that restrict social interaction and movement requires further study to understand potential causal relationships and how to mitigate them.

Abstract

This survey study examines the association of depression and limited mobility during the COVID-19 pandemic in the United States using an internet-based survey of adults in all 50 US states and Washington DC.

Abstract

Importance

Marked elevation in levels of depressive symptoms compared with historical norms have been described during the COVID-19 pandemic, and understanding the extent to which these are associated with diminished in-person social interaction could inform public health planning for future pandemics or other disasters.

Objective

To describe the association between living in a US county with diminished mobility during the COVID-19 pandemic and self-reported depressive symptoms, while accounting for potential local and state-level confounding factors.

Design, Setting, and Participants

This survey study used 18 waves of a nonprobability internet survey conducted in the United States between May 2020 and April 2022. Participants included respondents who were 18 years and older and lived in 1 of the 50 US states or Washington DC.

Main Outcome and Measure

Depressive symptoms measured by the Patient Health Questionnaire-9 (PHQ-9); county-level community mobility estimates from mobile apps; COVID-19 policies at the US state level from the Oxford stringency index.

Results

The 192 271 survey respondents had a mean (SD) of age 43.1 (16.5) years, and 768 (0.4%) were American Indian or Alaska Native individuals, 11 448 (6.0%) were Asian individuals, 20 277 (10.5%) were Black individuals, 15 036 (7.8%) were Hispanic individuals, 1975 (1.0%) were Pacific Islander individuals, 138 702 (72.1%) were White individuals, and 4065 (2.1%) were individuals of another race. Additionally, 126 381 respondents (65.7%) identified as female and 65 890 (34.3%) as male. Mean (SD) depression severity by PHQ-9 was 7.2 (6.8). In a mixed-effects linear regression model, the mean county-level proportion of individuals not leaving home was associated with a greater level of depression symptoms (β, 2.58; 95% CI, 1.57-3.58) after adjustment for individual sociodemographic features. Results were similar after the inclusion in regression models of local COVID-19 activity, weather, and county-level economic features, and persisted after widespread availability of COVID-19 vaccination. They were attenuated by the inclusion of state-level pandemic restrictions. Two restrictions, mandatory mask-wearing in public (β, 0.23; 95% CI, 0.15-0.30) and policies cancelling public events (β, 0.37; 95% CI, 0.22-0.51), demonstrated modest independent associations with depressive symptom severity.

Conclusions and Relevance

In this study, depressive symptoms were greater in locales and times with diminished community mobility. Strategies to understand the potential public health consequences of pandemic responses are needed.