Generalized anxiety disorder in low-resourced adults: a nationally representative, longitudinal cohort study across the COVID-19 pandemic

The burden of generalized anxiety disorder (GAD) accrued disproportionately over the COVID-19 pandemic to low-resource populations. Using a longitudinal, nationally representative study of US adults, we used generalized estimating equations to estimate the burden of positive screen for GAD (GAD-7 score ≥ 10) over time. The final sample included 1270 adults at least 18 years old who completed the COVID-19 and Life Stressors Impact on Mental Health and Well-being (CLIMB) Study, with data collected in spring 2020, 2021, and 2022. The national prevalence of positive screen for GAD decreased from 24.4% in 2020 to 21.3% in 2022 (P <. 05). Across the COVID-19 pandemic, factors associated with increased odds of positive screen for GAD were lower income (odds ratio (OR) = 2.06 [95% CI, 1.17-3.63] for ≤$19 999 relative to ≥$75 000), younger age (OR = 2.55 [95% CI, 1.67-3.89] for ages 18-39 years relative to ≥60 years), and having contracted COVID-19 (OR = 1.54 [95% CI, 1.12-2.14]). Experiencing stressors was associated with 14% increased odds of positive screen for GAD for each additional stressor. The 2020 stressors most strongly associated with positive screen for GAD in 2022 were job loss and difficulty paying rent. Efforts to address the stressors affecting groups with the highest burden of anxiety after the pandemic may help mitigate poor mental health exacerbated during the COVID-19 pandemic.