Mental health and pre-existing physical illness during the COVID-19 pandemic: Evidence from the Medical Expenditure Panel Survey

Abstract

Background

The COVID-19 pandemic poses substantial health risks, especially for individuals with pre-existing physical illness. While its physical toll is well-documented, its impact on mental health remains less well understood. This study examines mental health changes during the pandemic in U.S. adults with and without pre-existing physical conditions.

Methods

We analyzed data from the Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the U.S. civilian population. Mental health outcomes, including psychological distress (Kessler-6 scale) and depressive symptoms (PHQ-2), were assessed pre-pandemic (typically between July and October 2019) and during the pandemic (between July and October 2020 in most cases). Linear regression models with individual fixed effects evaluated within-person changes in these outcomes.

Results

Overall, depressive symptoms (PHQ-2) increased slightly during the pandemic (B = 0.064, p = .002), with similar effects in individuals with (B = 0.066) and without (B = 0.062) pre-existing conditions. Psychological distress (K6) remained stable overall, but trajectories varied across population subgroups defined by sociodemographic characteristics (e.g., age, education, living arrangements) primarily among individuals with pre-existing illness.

Limitations

The magnitude of change in mental health may have been underestimated due to nonignorable sample attrition.

Conclusions

While depressive symptoms increased modestly across the population, the impact on psychological distress was more nuanced, with certain sociodemographic factors moderating change in psychological distress among individuals with chronic conditions. Findings highlight the need for targeted mental health strategies that consider both medical and sociodemographic factors to better support at-risk populations in future public health emergencies.