Depression and Anxiety Changes Among Sexual and Gender Minority People Coinciding with Onset of COVID-19 Pandemic

Author(s): Flentje, Annesa; Obedin-Maliver, Juno; Lubensky, Micah E; Dastur, Zubin; Neilands, Torsten; Lunn, Mitchell R


INTRODUCTION
With SARS-COV-2 recently sweeping the globe, the population is experiencing a group stressor unlike any phenomenon in this country in the last century. How the pandemic experience is related to mental health challenges including anxiety and depression is unknown. Numerous factors-such as changes in community function; restriction of activities and social contacts; and fearfulness about the virus, the economic downturn, and food access-may contribute to poorer mental health. Marginalized populations, such as sexual and gender minority people (i.e., non-heterosexual people and transgender or gender-expansive people, respectively) may be particularly at risk for adverse impacts of the pandemic due to preexisting economic and health factors. 1 We set out to document changes in depression and anxiety within The PRIDE Study, a longitudinal cohort of sexual and gender minority people, a vulnerable population. 2

Participants in
The PRIDE Study, a longitudinal cohort study of sexual and gender minority people, 2 were included if they completed mental health measures in the 2019 Annual Questionnaire (timepoint 1, June 2019-ongoing at time of data extraction) and in a COVID-19 impact ancillary study (timepoint 2, March 23, 2020, through April 19, 2020). Paired sample t tests examined changes in depression (9-item Patient Health Questionnaire, PHQ-9 3 ) and anxiety (7-item Generalized Anxiety Disorder Scale, GAD-7 4 ) symptoms overall and separately among those who screened positive (PHQ-9 and GAD-7 scores ≥ 10 3, 4 ) and negative (scores < 10) for depression and generalized anxiety disorder at timepoint 1.

RESULTS
In total, 2288 participants were included in this study (see Table 1 for participant characteristics). Depression symptoms increased by a mean PHQ-9 score of 1.21 (t[2280] = 11.35, p < .001, d = .20) from timepoint 1 to 2. Anxiety symptoms increased by a mean GAD-7 score

DISCUSSION
We found increases in anxiety and depression coinciding with the COVID-19 pandemic onset. Increased anxiety and depression symptoms were driven by people who did not have preexisting symptoms consistent with generalized anxiety or depression. While this study was conducted with sexual and gender minority people, the results may be relevant for other vulnerable populations, such as other minority groups.
Health care providers are advised to check in with patients about stress and to screen for mood and anxiety disorders, even among patients who had no prior history of anxiety or depression. Treatment and referrals can include traditional interventions such as individual therapy and medications and may also include COVID-19-specific supports implemented on a larger scale (e.g., supportive peer-led groups, mindfulness practice). This study is observational. Our finding that individuals with preexisting depression had improved mood from timepoint 1 to 2 may represent regression to the mean and should not be interpreted that these individuals have less depressive symptoms, as they already were experiencing symptoms of depression at timepoint 1. Future research will identify who is most at risk for adverse impact. In the interim, we should consider ways to support the mental health of all of our communities during the pandemic, with special care and attention to vulnerable populations.
Acknowledgments: The PRIDE Study is a community-engaged research project that serves and is made possible by LGBTQ+ community involvement at multiple points in the research process, including the dissemination of findings. We acknowledge the courage and dedication of The PRIDE Study participants for sharing their stories; the careful attention of PRIDEnet Participant Advisory Committee (PAC) members for reviewing and improving every study application; and the enthusiastic engagement of PRIDEnet Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons. org/licenses/by/4.0/.  This includes people who were assigned a sex of birth of male or female, and only gender is reported here; thus, gender minority people may be found in all categories c Cisgender is listed here as an identity label. Cisgender people can be found in multiple categories and may not endorse this identity label