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Depression in the U.S. Before and After COVID: Risk of Increased Co-Occurring Disorders


Decades of research and documentation show the relationship between alcohol/substance use disorder (AUD/SUD) and mental health disorders such as anxiety, post-traumatic stress disorder (PTSD), bipolar disorder (BPD), and depression. When an individual receives a diagnosis for more than one mental health disorder, clinicians use the terms co-occurring disorders or dual diagnosis. Both these phrases mean exactly what they sound like: co-occurring disorders means that two disorders occur in one individual at the same time, and dual diagnosis means one individual has received a diagnosis for two different disorders.

Data from the National Survey on Drug Use and Health (NSDUH) published in 2020 show the following:

  • 4.1 million adolescents (12-17) in the U.S. had a major depressive episode (MDE)
    • 664,000 adolescents (12-17) with a MDE also had SUD
  • 108 million adults in the U.S. had depressive symptoms
    •  17.0 million adults with a mental health disorder also had SUD

The mental health disorders that most commonly co-occur with SUD are:

  • Major depressive disorder (MDE)
  • Anxiety
  • Bipolar disorder (BPD)
  • Post-traumatic stress disorder

Additional research shows that people with depression are twice as likely to develop SUD than people with no depression, and people with bipolar disorder are seven times as likely to develop SUD than people without bipolar disorder.

This article discusses a recent study published by researchers at Boston University that asked a question many people around the country – both clinicians and regular citizens alike – are curious about:

Has COVID caused an increase in depression in people in the U.S.?

What we mean, of course, is not COVID itself, but COVID lockdown and everything associated with it, such as isolation, social distance, income insecurity, and anxiety about schools reopening – to name a few.

COVID and Depression: The Results

The research team at Boston University took their cue from studies in China that showed a fifty percent increase in depressive symptoms among healthcare workers, increased levels of anxiety among medical students, and increased levels of anxiety and stress related to loss of sleep during the height of the coronavirus pandemic.

They suspected similar trends in the U.S. and designed a study to assess the situation and confirm or deny their suspicions. They used two surveys designed to accurately reflect the U.S. population: before COVID data comes from the National Health and Nutrition Examination Survey (NHANES), while after COVID data comes from the AmeriSpeak panel. In total, they analyzed data from over five thousand people before the coronavirus pandemic and over fourteen hundred people after the pandemic began.

Here’s what they found:

Depression in the U.S. Before and After COVID

  • 8.5% of participants had depressive symptoms before COVID
    • 10.1% of women
    • 6.9% of men
  • 27.8% of participants had depressive symptoms after COVID
    • 33.3% of women
    • 21.9% of men

As we can see, those differences are not small. Overall prevalence increased about three times – and that increase was roughly the same for both women and men. Researchers also analyzed rates of depression as related to household savings. Here’s what they found:

  • 19.3 % of People in households with more than $5,000 in savings reported depressive symptoms
  • 40.4% of people in households with less than $5,000 in savings reported depressive symptoms

That’s also significant. More than twice as many people from households with less than $5,000 in savings reported depressive symptoms, compared to people from households with over $5,000 in savings.

Finally, researchers analyzed the before/after COVID data by severity of depressive symptoms. Here’s what they found:

  • Mild symptoms: 52% increase
  • Moderate symptoms: 160% increase
  • Moderately severe symptoms: 276% increase
  • Severe symptoms: 628% increase

That’s another important set of data: people with mild depressive symptoms experienced the smallest increase in symptoms, while people with severe symptoms experienced the largest increase in symptoms. In plain language, that means that for people with depression, those with the most severe cases were hit the hardest by COVID.

What This Means for Us

We know that people with mental health disorders experience alcohol and substance use disorders at a greater rate than people without mental health disorders. We also know that people with mood disorders, such as depression, experience co-occurring SUD at greater rates than people with anxiety disorders, such as PTSD. This new data from Boston University offers evidence to support what most people in the U.S. thought might be true: rates of depression and depressive symptoms measured after the coronavirus pandemic began are greater than rates of depression and depressive symptoms measured before the coronavirus pandemic began.

What this means for us is that we need to pay closer attention to our patients with co-occurring SUD and depression. We were already doing that, because it seemed logical. But now we have evidence to show us our instincts were on track. This also means, for us, that we may see an increase in SUD correlated to an increase in severe depressive symptoms. This potential increase in SUD prevalence means that we may see an increase in people seeking treatment and support. With the knowledge gained from this study, we can ask questions in our initial assessments about preexisting depression and substance use. This will help us design a custom treatment program based on specific biopsychosocial needs.

What This Means for Parents of Teens with Depression

What this means for you is that if your teen has depression, their symptoms may have gotten worse during the past year and a half. The data tells us that people with severe depression experienced the greatest increase in symptoms. Therefore, if your teen has severe depression, we encourage you to watch for signs of alcohol or substance use. If your teen has mild depression, the same is true. Check on them and keep your eyes open for signs of alcohol or substance use. Their depression may have increased in severity. This may have, in turn, led to self-medication and disordered use of alcohol or substances, a.k.a. addiction.

The same goes for you, yourself. If you have depression and your symptoms have increased in severity since the beginning of the pandemic, that’s a concern. Have you also increased your alcohol or substance use in order to mitigate the increase in symptoms? If the answer is yes, then we recommend discussing your situation with a therapist of your own. Be honest, be prudent, and be careful with yourself. A trained mental health professional can help you work through your symptoms and help prevent you from developing a co-occurring alcohol or substance use disorder.

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