AUTHOR=McDowell Cillian P. , Meyer Jacob D. , Russell Daniel W. , Sue Brower Cassandra , Lansing Jeni , Herring Matthew P. 

TITLE=Bidirectional Associations Between Depressive and Anxiety Symptoms and Loneliness During the COVID-19 Pandemic: Dynamic Panel Models With Fixed Effects

JOURNAL=Frontiers in Psychiatry

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.738892

DOI=10.3389/fpsyt.2021.738892

ISSN=1664-0640

ABSTRACT=<p><bold>Background:</bold> Understanding the direction and magnitude of mental health-loneliness associations across time is important to understand how best to prevent and treat mental health and loneliness. This study used weekly data collected over 8 weeks throughout the COVID-19 pandemic to expand previous findings and using dynamic panel models with fixed effects which account for all time-invariant confounding and reverse causation.</p><p><bold>Methods:</bold> Prospective data on a convenience and snowball sample from all 50 US states and the District of Colombia (<italic>n</italic> = 2,361 with ≥2 responses, 63.8% female; 76% retention rate) were collected weekly <italic>via</italic> online survey at nine consecutive timepoints (April 3–June 3, 2020). Anxiety and depressive symptoms and loneliness were assessed at each timepoint and participants reported the COVID-19 containment strategies they were following. Dynamic panel models with fixed effects examined bidirectional associations between anxiety and depressive symptoms and loneliness, and associations of COVID-19 containment strategies with these outcomes.</p><p><bold>Results:</bold> Depressive symptoms were associated with small increases in both anxiety symptoms (β = 0.065, 95% CI = 0.022–0.109; <italic>p</italic> = 0.004) and loneliness (β = 0.019, 0.008–0.030; <italic>p</italic> = 0.001) at the subsequent timepoint. Anxiety symptoms were associated with a small subsequent increase in loneliness (β = 0.014, 0.003–0.025; <italic>p</italic> = 0.015) but not depressive symptoms (β = 0.025, −0.020–0.070; <italic>p</italic> = 0.281). Loneliness was strongly associated with subsequent increases in both depressive (β = 0.309, 0.159–0.459; <italic>p</italic> &lt; 0.001) and anxiety (β = 0.301, 0.165–0.436; <italic>p</italic> &lt; 0.001) symptoms. Compared to social distancing, adhering to stay-at-home orders or quarantining were not associated with anxiety and depressive symptoms or loneliness (both <italic>p</italic> ≥ 0.095).</p><p><bold>Conclusions:</bold> High loneliness may be a key risk factor for the development of future anxiety or depressive symptoms, underscoring the need to combat or prevent loneliness both throughout and beyond the COVID-19 pandemic. COVID-19 containment strategies were not associated with mental health, indicating that other factors may explain previous reports of mental health deterioration throughout the pandemic.</p>