Evaluating the Association Between COVID-19 and the Risk of Anxiety and Depression Among Bedford, MA Residents - Laura Nash Bedford Board of Health
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Evaluating the Association Between COVID-19 and the Risk of Anxiety and Depression Among Bedford, MA Residents Laura Nash Bedford Board of Health
Bedford, MA ● Middlesex County: 1.612 million ● Bedford: 14,123
Bedford Census Demographics
● Race & Ethnicity
○ 77.4% White
○ 15% Asian
○ 4.1% Black/African American
○ 3.2% Hispanic/Latinex
● Education:
○ High school graduate or higher: 96.8%
○ Bachelor degree or higher: 71.8%
● Median income: $128,354
● Percentage in poverty: 2.9%
Mental Health Impact Survey
● Mental health already proved to be a growing issue in Bedford, MA
● A recent report published from the Centers for Disease Control and Prevention found that adults who
were experiencing symptoms with similar characteristics to anxiety and depression from August
2020 to February 2021 increased from 36.4% to 41.5% (Vahratian et al., 2021)
● What was COVID-19’s effect like on Bedford residents?
○ Are they at an increased risk of anxiety and depression?
Anxiety & Self-Rated Mental Health
Self-Rated Mental Health
New/Worsening Symptoms
with Similar Characteristics
to AnxietyFindings
● Prevalence: 30.3%
○ Of respondents experiencing symptoms similar to Anxiety
● Statistically significant?
> table(SympAnx, MHCov)
MHCov
SympAnx 1 2 3 4 5
1 23 31 32 8 2
2 3 9 13 8 9
3 1 0 2 0 0
> prop.table(table(SympAnx,MHCov),1)
MHCov
SympAnx 1 2 3 4 5
1 0.23958333 0.32291667 0.33333333 0.08333333 0.02083333
2 0.07142857 0.21428571 0.30952381 0.19047619 0.21428571
3 0.33333333 0.00000000 0.66666667 0.00000000 0.00000000
> chisq.test(table(SympAnx,MHCov),correct = FALSE)
Pearson's Chi-squared test
data: table(SympAnx, MHCov)
X-squared = 25.351, df = 8, p-value = 0.001355Depression & Self-Rated Mental Health
Self-Rated Mental Health
New/Worsening Symptoms
with Similar Characteristics
to DepressionFindings
● Prevalence: 26.2%
○ Of respondents experiencing symptoms similar to Depression
● Statistically significant?
> table(SympDep,MHCov)
MHCov
SympDep 1 2 3 4 5
1 24 31 35 7 2
2 3 8 9 9 8
3 0 1 3 0 1
> prop.table(table(SympDep,MHCov),1)
MHCov
SympDep 1 2 3 4 5
1 0.24242424 0.31313131 0.35353535 0.07070707 0.02020202
2 0.08108108 0.21621622 0.24324324 0.24324324 0.21621622
3 0.00000000 0.20000000 0.60000000 0.00000000 0.20000000
> chisq.test(table(SympDep,MHCov),correct = FALSE)
Pearson's Chi-squared test
data: table(SympDep, MHCov)
X-squared = 29.67, df = 8, p-value = 0.0002417Additional Analysis: Income
Income
> income = 99
● Codes:
> income[IncomeTakeaways
● Data collected parallels assumptions that increased outreach and education is needed within the
community in order to meet increased needs for treating mental health conditions
● While the pandemic is ongoing, data suggests that COVID-19’s effect on an individual’s well-being has
been significant and will continue to pose an issue to public health officials for the foreseeable future
● Limitations
○ Sample size
○ Tick survey
○ Confidentiality concerns
○ Incomplete answersWas your mental health negatively impacted during the
pandemic? If so, explain your thoughts below.
● “Yes, I was so isolated and anxious”
● “Yes… [But] not in a lasting kind of way… I hope”
● “Stress of juggling needs for [children]”
● “Short fuse; Sadness”
● “Unable to adjust from working from home”
● “Hard to pay bills”
● “I got fired from my job and drank and smoked in my bed for eight months”
● “I found myself annoyed and sometimes angered at people who complained about restrictions”
● “I feel like my support structures are weaker”
● “I lacked the confidence in how I was communicating with others and became angry with myself for
not doing better to communicate”What would you like the Town of Bedford to do moving forward
to promote mental health?
● “Educate community about resources”
● “Provide information publicly (through local new - both paper and web based) as to signs of
depression and how to seek help for those in need”
● “Promote outdoor abilities-sidewalks, bike lanes, park space”
● “Offer fun activities like town gathering meditations, yoga, mindfulness etc. A way for everyone to
come back together again”
● “Continued support of social/emotional learning at schools/ resources for parents- (webinars this
past year were helpful)”
● “More anonymity when getting town services”
● “Promotion of fun and easy activities to safely bring more happiness and connection and
community back into our lives”Thank you! Questions?
1
Evaluating the Association Between COVID-19 and the Risk of Anxiety and Depression Among
Bedford, MA Residents
Laura Nash, Boston University
Bedford Board of Health2 Abstract Introduction: The COVID-19 pandemic caused staggering rates of unemployment, unstable housing, and financial hardships for many Americans. As a result, the pandemic has had profound effects on mental health (a person’s psychological, emotional, and social well-being). However, the extent to which the pandemic has affected the residents of Bedford, MA is unknown. With an abundance of mental health services and programs in place, the Board of Health (BOH) sought to understand if there was an association between risk factors for anxiety and depression and mental health changes during the pandemic. Methods: After meeting with key stakeholders, the BOH deemed that a town-wide mental health assessment was necessary to assess how to improve the systems in place. Using a mixed methods approach for the survey, it was distributed via social media platforms, news outlets, and newspaper advertisements. The survey was open for two weeks, gathering information through Google Forms. Information was then re-coded through Microsoft Excel, and uploaded into R Studio for Chi-square tests of independence. Results: On July 26th, 2021, 141 participants had completed the survey. However, 8 were excluded from the analysis for not being Bedford residents. Of the 133 Bedford residents surveyed over the course of two weeks, 26.2% of respondents reported new or worsening symptoms with similar characteristics to depression and 30.3% of respondents reported new or worsening symptoms with similar characteristics to anxiety. Chi-square tests of independence revealed that self-rated mental health during the pandemic varied significantly among those with new or worsening symptoms of depression and anxiety (p=0.0002 and p=0.001, respectively). Discussion: Data regarding the risk of developing anxiety and depression during the COVID-19 pandemic had not been analyzed in Bedford prior to this survey. Although the sample size was a limitation to the study, data collected parallels the BOH’s assumptions that increased outreach and education is needed within the community in order to meet increased needs for treating mental health conditions. While the pandemic is on-going, data suggests that COVID-19’s effect on an individual’s well-being has been significant and will continue to pose an issue to public health officials for the foreseeable future.
3
Background
Before the height of the COVID-19 pandemic, mental health within the town of Bedford,
MA was already posing to be an issue to health officials. A 2019 mental health needs assessment
revealed that 80% of survey respondents indicated one or more symptoms corresponding to a mental
health condition. In addition, the most common concerns that residents voiced was that more
education on the services offered in town needed to be offered, despite the fact that the town of
Bedford houses exemplary channels for mental health services. Many residents also cited that there
was a disconnect between the knowledge of these services and actual community outreach.
In the coming time, the onset of the COVID-19 pandemic set back any progress that had
been made in regards to improving community outreach efforts. The pandemic brought profound
changes in the way people lived their day-to-day lives. More people found themselves jobless, food
insecure, and unsure about what the future would hold. A recent report published from the Centers
for Disease Control and Prevention found that adults who were experiencing symptoms with similar
characteristics to anxiety and depression from August 2020 to February 2021 increased from 36.4%
to 41.5% (Vahratian et al., 2021). Researchers went on to insinuate that social distancing, quarantine,
and lockdown protocols had significant contributions to the rise in these numbers. On a national
level these numbers had been increasing, but would they parallel local numbers too? To date, this
question remains ambiguous. However, in an attempt to answer this question, the Bedford Board of
Health sought to understand if there was an association between risk factors for anxiety and
depression and mental health changes during the pandemic.4
Methods
The Bedford Mental Health Impact survey was developed as a continuation of 2019 Mental
Health Needs Assessment, taking into account recommendations and new questions needing to be
answered. The survey was reviewed by the Community Health Nurse, Director of Health and Human
Services, and Community Social Worker. After five rounds of revisions, 29 questions were
developed asking participants questions about demographics, self-rated health conditions, and daily
habits. Once the survey had been finalized, it had been transferred to Google Forms and opened to
the public on July 19th. For a total of 14 days the survey had been opened, and on August 2nd the
survey was closed. It is important to note that the survey could not be submitted until all of the
required fields were completed.
Since the survey had been designed for Bedford residents, respondents who had answered
“no” to question two—which had asked whether or not the participant lived or attended school in the
town of Bedford—they would be disqualified from the final data analysis. Questions three through
eight asked participants to disclose anonymous information about demographics such as gender, age,
ethnicity, education, employment, and income. Question nine asked respondents whether or not they
had been experiencing symptoms with similar characteristics to depression. If answered yes, the
respondent would move on to question ten. If no, the respondent moved to question eleven, asking5
whether or not they had been experiencing symptoms with similar characteristics to anxiety. If yes,
the respondent moved to question twelve. If no, the participant moved on to question thirteen.
Questions thirteen through eighteen asked respondents questions regarding self-rated mental health
changes and knowledge of town services. Question nineteen asked whether or not the person knew
of any mental health services in Bedford. If yes, move to question twenty. If not, skip to question
twenty-one. Questions twenty-one through twenty-five prompted participants to indicate the extent
to which they agreed or disagreed with each statement. Questions twenty-six and twenty-seven
sought to understand what changes Bedford residents had seen in their daily lives as a result of the
pandemic. Lastly, questions twenty-eight and twenty-nine were left as open-ended questions to see
what the town of Bedford could do to make residents feel more confident and comfortable in their
ability to use town services as well as to suggest improvements to the town on how to proceed in
such events in the future.
When the survey was ready to be distributed among the town, an email was sent to the
town’s mailing list, distributed in the Bedford MinuteMan, and on the town’s social media page.
Results
As of August 2nd, 2021 a total of 141 participants had completed the survey. Eight
respondents had indicated that they had not lived or attended school in the town of Bedford and were
excluded from the final data analysis. On the first day of being opened, 77 people had completed the
survey. By the end of the first week, 115 respondents had completed the survey and in the following
week the survey had been completed by an additional 26 people.
Table 1.
Demographic Value Frequency (n = Percentage
141)
Gender Male 35 24.8%6
Female 99 70.2%
Gender queer 1 0.7%
Prefer not to say/self-describe 6 4.3%
Age Under 18 1 0.7%
18 - 29 2 1.4%
30 - 39 18 12.8%
40 - 49 23 16.3%
50 - 59 27 19.1%
60+ 66 46.8%
Prefer not to answer 4 2.8%
Race/Ethnicity White 118 83.7%
Hispanic/Latinex 5 3.5%
Black/African American 1 0.7%
Asian/Pacific Islander 6 4.6%
Indian-American 1 0.7%
Prefer not to say 10 7.1%
Education Less than a high school diploma 1 0.7%
High school degree or equivalent 15 10.6%
Associate’s degree 2 1.4%
Bachelor’s degree 43 30.5%
Master’s degree 58 41.1%
Doctorate 16 11.3%
Prefer not to say 7 4.3%
Employment Full-time (40+ hours/week) 55 39.0%
Part-time (7
$100,000 - $114,999 11 7.8%
$115,000+ 55 39.0%
Prefer not to say 49 34.8%
As seen above, Table 1 described the demographics of the 141 respondents who completed
the survey. Female respondents (70.2%), those over the age of 60 (46.8%), white residents (83.7%),
those with a Master’s degree (41.1%), full-time employees (39.0%), and those making over
$115,000 (39.0%) were the most common answers to the demographic questions listed in the survey.
Figure 1.
Figure 1 represents whether or not survey respondents had reported new or worsening
symptoms with similar characteristics to depression. Those symptoms were including, but not
limited to: little interest in doing activities, feeling down or hopeless, trouble sleeping or eating,
fatigue, trouble concentrating, and/or feeling bad about oneself. A majority of respondents had
indicated that they had not experienced these feelings, however, over a quarter of participants had
indicated that they had been in fact experiencing these symptoms.
Figure 2.8
Figure 2 represents whether or not survey respondents had reported new or worsening
symptoms with similar characteristics to anxiety. Those symptoms were including, but not limited
to: feeling nervous or on edge, not being able to control worrying, trouble relaxing, restlessness,
irritability, and/or being afraid something awful might happen. A majority of respondents had
indicated that they had not experienced these feelings, however, over 31.4% of participants had
indicated that they had been in fact experiencing these symptoms.
Data Analysis
On August 2nd, 2021 the Bedford Mental Health Impact survey was closed to the public. The
information was collected via Google Forms and downloaded and uploaded into Google Excel. Once
in Excel, in order to give the text values numeric values, the Count If function was used for
seventeen of the twenty-nine questions. Once saved, the new document was then uploaded into R
Studio to generate descriptive statistics (see Table 1) and conduct Chi-square tests of independence
when appropriate.
The aim of the assessment was to examine the potential association between risk factors for
anxiety and depression and mental health changes during the pandemic. To examine this question,
two questions were developed in conjunction with the town’s Community Social Worker which
were common screening questions that are used to determine whether or not one might be at risk of
developing anxiety or depression (see Figures 1 & 2). These screening questions were analyzed with9
a self-rating system to determine mental health changes during the height of the pandemic. In R
studio, prevalence ratios were computed to determine what percentage of respondents had indicated
new or worsening symptoms of depression and anxiety. 30.3% of participants had indicated that they
had presented symptoms of anxiety and 26.2% of participants had indicated that they had presented
symptoms of depression. Given this insight, upon further data analysis, a Chi-square test of
independence revealed that mental health changes during the pandemic were statistically significant
with regards to anxiety (p-value = 0.001, X-squared = 25.35, df = 8) and depression (p-value =
0.0002, X-squared = 26.97, df = 8).
Discussion
Overall, risk factors for anxiety and depression were associated with mental health changes
during the COVID-19 pandemic. However, the results from this data analysis cannot be
generalizable to the entire population of Bedford, MA. The number of respondents who completed
the survey were overwhelmingly female, over the age of sixty-five, and retired, which is not very
similar to the demographics within the town itself: around 17% of Bedford, MA residents are over
the age of 65 and around 52% of the population is female (U.S. Census Bureau. n.d.).
Furthermore, there are several possible explanations that may have impacted this result. First,
the temporal relationship between risk factors for anxiety and depression and the pandemic are
unclear. It is unknown whether or not these symptoms had already manifested within individuals
before COVID-19 became a global phenomenon. Plus, it is possible that factors such as stress,
financial constraints, daily habits, and other extraneous factors may have led to an overestimate of
the true association between risk factors for anxiety and depression and the pandemic. Moreover,
misclassification of responses may have been present within the study. Certain words including, but
not limited to anxiety and depression, had non-specific and broad definitions that to many may have10
been misleading. Perhaps it would have been beneficial to include technical definitions for these
words, as they are a health state, not a feeling. Lastly, recall bias may have been present within the
study, as participants were asked to recall feelings, emotions, and daily habits from well over a year
ago and sometimes this information can be hard to remember.
Despite the limitations of this study, the results revealed that there was an association
between the risk factors for anxiety and depression and mental health changes during the pandemic.
They also indicate that on a local level, public health officials may begin to see an increase in the
amount of people needing mental health services. In turn, it is unknown whether or not many
municipalities have such services in place to meet this demand. For the time being, it is important
that health departments and boards of health alike generate an effective outreach campaign to enable
residents within each town to learn more about services offered at a free or low cost. With the two
open-ended questions at the end of the survey, a common theme among the responses was that
residents wished to see more community outreach and perhaps more community building
opportunities. In other words, this might look like mindfulness classes, group exercises, and other
recreational activities, which might be a salient way to foster trust between the community and
health officials. Yet, although the pandemic is on-going, it is evident that confronting these health
disparities and creating strong support systems is urgently needed as the consequences of
deteriorating mental health in various populations will create greater issues for the overall well-being
of the community in the coming time.11
References
U.S. Census Bureau QuickFacts: Bedford town, Middlesex County, Massachusetts. (n.d.).
Retrieved August 10, 2021, from
https://www.census.gov/quickfacts/fact/table/bedfordtownmiddlesexcountymassachusetts/R
HI225219
Vahratian, A. et al. (2021). Symptoms of Anxiety or Depressive Disorder and Use of Mental
Health Care Among Adults During the COVID-19 Pandemic—United States, August
2020–February 2021. MMWR. Morbidity and Mortality Weekly Report, 70.
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