The novel coronavirus disease (COVID-19) outbreak that emerged in Wuhan, China, in 2019 soon spread to the remainder of the world, causing greater than 4.2 million infections and about 85 thousand deaths throughout the first yr in 2020. Consequently, the World Health Organization (WHO) declared COVID-19 a world pandemic in March 2020. After that, many countries began adopting data collection protocols from municipalities and native counties to assist them make informed decisions to curb the spread of the causative agent severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2). Nevertheless, limited information availability led many countries to implement large-scale control measures equivalent to lockdowns.

The state and federal governments in the USA implemented several mandates to administer the spread of SARS‑CoV‑2. The federal government, nonetheless, opted for a hands-off approach allowing individual states to make your mind up the best way to limit the spread of the disease. There have been quite a lot of mandates, starting from school and work closures to stay-at-home orders. Furthermore, the rise in COVID-19 cases and deaths led to increased pandemic-related worry amongst people. Policies determining pandemic-related decisions can adversely affect mental health resulting in depression and anxiety. Consequently, a jump in mental health conditions was reported within the second quarter of 2020 in comparison with the last quarter of 2019.

Study: Understanding mental health trends during COVID-19 pandemic in the USA using network evaluation. Image Credit: rudall30 / Shutterstock

Several studies indicated that lockdowns and lots of COVID-19-related policies could increase mental health burdens, especially for vulnerable groups. Nevertheless, some policies were shown to positively impact each psychological and physical health. Furthermore, vaccines were also reported to cut back mental health issues following their initial roll-out in late 2020. Nevertheless, a big proportion of the population was hesitant to receive vaccination and continued to experience similar mental distress levels. Subsequently, dynamic interpretation of knowledge is significant across time concisely and clearly.

One previous study by Bulai and Amico implemented a network evaluation to find out COVID-19 interactions amongst various regions of Italy and the impact of the Italian government policies to manage the spread of the disease. They used six indicators to form a correlation network often called “Covidome,” which showed the north-south clustering of the regions in Italy. Furthermore, additionally they observed a major difference in Covidome fluctuations between the primary and second pandemic waves based on political decisions between different regions.

A latest study posted within the pre-print server medRxiv* aimed to use clustering and network evaluation to find out the connectivity between the states and used COVID-19-related mental health indicators to grasp how COVID-19 impacts mental health across the USA.

In regards to the study

The study was based on survey results from Carnegie Mellon University’s Delphi Group. Survey questions varied from the economic impact of COVID-19 and physical health to behavioral prompts and mental health. The participants’ responses were aggregated, collected, and made available publicly. Three indicators that indicated the impact of COVID-19 on mental health were the share of participants who experienced feelings of hysteria throughout the past seven days, the share of participants who felt nervous about their funds for the subsequent month, and the share of participants who felt depressed throughout the past seven days. Information on day by day confirmed COVID-19 cases and deaths was also obtained.

The outcomes collected from the survey were categorized into two-time frames, the primary starting from eighth September 2020 to 2nd March 2021 and the second from 2nd March 2021 to tenth January 2022. The plotting of day by day COVID-19 cases, hospitalizations, and deaths indicated three waves. Based on them, the info was split into three different periods, 1st April to 1st July 2021, 2nd July to eleventh November 2021, and 2nd November 2021 to tenth January 2022. Along with the person states, 4 realms (south, west, northeast, and midwest) of the USA and political party reference were used to find out any mental health trends among the many states clustered consequently of comparable politically or geographically established communities. Moreover, the survey results on mental health indicators were plotted based on political preference and realms.

The policies implemented to manage the COVID-19 outbreak were categorized as nervous about funds or related to depression and anxiety. Clustering and correlation networks were used to find out the connectivity of states. Finally, dynamic connectome evaluation was used to grasp the link between government policy, mental health indicators, and their relationship across political parties and realms. Each correlation values and eigenvector centrality values were analyzed for mental health indicators. The minimum and maximum correlation values were determined for every period and verified using the eigenvector centrality values.

Study findings

The outcomes indicated no clear community distinction for the three mental health indicators apart from a slight South region clustering. An allegiance matrix constructed using the three mental health indicators showed three principal clusters, out of which the south geographic region was most interesting. Nevertheless, the south region didn’t include Arkansas, West Virginia, and Virginia, while it included Nevada, North Carolina, and California, that are non-southern states.

The bottom minimum and highest maximum correlation values were observed from the northeastern region in the primary period for the sensation anxious variable. Within the second period, the northeast showed the bottom correlation values, while the south showed the best. The west had the bottom correlation values, while the midwest had the best.

In the primary period, the minimum and maximum correlation values for feeling depressed were observed within the midwest region. Within the second period, the utmost value was observed within the south and the minimum within the northeast. Through the final period, northeastern states had the best correlation, and western states had the bottom.

The nervous about funds variable had the next maximum correlation in the primary period and a decreasing correlation in subsequent periods. In the primary period, the midwest region had the bottom correlation values while the south had the best values. Through the second period, the south had the best values, and the northeast had the bottom values. Finally, third-period values were observed to be lowest within the northeast and highest within the west.

On the sensation anxious variable, the midwest exhibited minimal eigenvector centrality and northeast maximum values. Within the second period, maximum values were observed within the south and minimum values within the northeast. The south had the bottom values in the course of the third period, while the northeast had the best.

There have been only two regions with minimum and maximum eigenvector centrality values for the sensation depressed variable. The midwest was observed to have maximum values for the primary period and minimum and maximum values for the second period. Maximum values were observed within the northeast in the course of the third and second periods, while minimum values were observed in the course of the third period.

For the nervous about funds variable, the midwest was observed to have the utmost values and the south because the minimum values in the primary period. For the second period, the south was observed to have each minimum and maximum values. Finally, the west had maximum values for the third period, and the midwest had minimum values.

Moreover, the correlation values increased for the Democratic states but not for Republican states. For the sensation anxious variable, each the utmost and minimum correlation values were observed within the Democratic states for the primary period. For the second period, the utmost values were observed within the Republican states and minimum values within the Democratic states. For the third period, the minimum values were observed within the Republican states and the utmost within the Democratic states.

The Republican states were observed to have minimum values for all three periods for the sensation depressed variable. The utmost correlation values were observed within the Democratic states for the primary and third periods while within the Republican states for the second period. Furthermore, for the nervous about funds variable, all maximum and minimum values were observed within the Republican states for all of the periods.

For the sensation anxious variable, minimum eigenvector centrality values were observed within the Republican states, and the utmost values were observed within the Democratic states in the course of the first wave. Each maximum and minimum values were observed within the Republican states for the second wave while within the Democratic states for the third wave.

For the sensation depressed variable, minimum eigenvector centrality values were observed within the Republican states in the primary and second periods and the Democratic states within the third period. Then again, the utmost eigenvector centrality values were observed within the Democratic states in the primary and second periods and Republican states within the second period. For the nervous about funds variable, all maximum and minimum eigenvector centrality values were observed within the Republican states.

Subsequently, the present study demonstrated the same trend for nervous about funds and feeling anxious among the many Republican and southern states between third March 2021, and tenth January 2022. Nevertheless, no identifiable communities that resembled political parties or realms were reported for the sensation depressed indicator. Moreover, the depressed and anxious feelings variables overlapped with the increased COVID-19 cases, hospitalizations, and deaths and the spread of the Delta variant.

Limitations

The study has certain limitations. First, anxiety might be brought on by other sources, equivalent to media exposure and negative COVID-19 experience. Second, most lockdown measures had ended during this study’s data collection. Third, certain states were loosening restrictions which could influence the participants’ response to the survey. Fourth, the closeness of specific policies makes it difficult to find out their impact on mental health. Fifth, the study may not be sensitive to short-term changes in correlation. Finally, the interpretation of the sentiments of depression variable is difficult.

*Essential notice

medRxiv publishes preliminary scientific reports that are usually not peer-reviewed and, due to this fact, mustn’t be thought to be conclusive, guide clinical practice/health-related behavior, or treated as established information.