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Stress in America 2021

One year later, a new wave of pandemic health concerns

Cite this
American Psychological Association. (2021, March 11). One year later, a new wave of pandemic health concerns. https://www.apa.org/news/press/releases/stress/2021/one-year-pandemic-stress

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On March 11, 2020, the World Health Organization declared COVID-19 a global pandemic. Within a week, millions went home to shelter in place for what they thought would be a few weeks, hoping that their sacrifice would stop the spread of the coronavirus.

One year later, more than 500,000 U.S. residents have died from the coronavirus, while the nation also has grappled with racial injustice, a brutal election cycle and civil unrest.

In our October 2020 report, Stress in AmericaTM 2020: A National Mental Health Crisis, the American Psychological Association issued a warning about the impact of these stressful events on long-term physical and mental health. We warned that Americans faced a second pandemic — one that would persist even after the physical threat of the virus has been addressed. Our most recent survey of U.S. adults, conducted in late February 2021 by The Harris Poll, indicates that this is coming to fruition.

Survey responses reveal that physical health may be declining due to an inability to cope in healthy ways with the stresses of the pandemic. Many reported they have gained or lost an undesired amount of weight, are drinking more alcohol to cope with stress and are not getting their desired amount of sleep. This is particularly true of parents, essential workers, young people and people of color. These reported health impacts signal many adults may be having difficulties managing stressors, including grief and trauma, and are likely to lead to significant, long-term individual and societal consequences, including chronic illness and additional strain on the nation’s health care system.

Key survey findings include

  • A majority of adults (61%) reported experiencing undesired weight changes since the start of the pandemic, with more than 2 in 5 (42%) saying they gained more weight than they intended. Of this group, adults reported gaining an average of 29 pounds (with a typical gain of 15 pounds, which is the median).
  • Two in 3 Americans (67%) said they are sleeping more or less than they wanted to since the pandemic started. Similar proportions reported less (35%) and more (31%) sleep than desired. Nearly 1 in 4 adults (23%) reported drinking more alcohol to cope with their stress during the coronavirus pandemic.
  • Nearly half of Americans (47%) said they delayed or canceled health care services since the pandemic started.
  • Nearly half of parents (48%) said the level of stress in their life has increased compared with before the pandemic. More than 3 in 5 parents with children who are still home for remote learning (62%) said the same.
  • Essential workers were more than twice as likely as those who are not to have received treatment from a mental health professional (34% vs. 12%) and to have been diagnosed with a mental health disorder since the coronavirus pandemic started (25% vs. 9%).
  • Black Americans were most likely to report feelings of concern about the future. More than half said they feel uneasy about adjusting to in-person interaction once the pandemic ends (57% vs. 51% Asian, 50% Hispanic and 47% white).
  • Gen Z adults (46%) were the most likely generation to say that their mental health has worsened compared with before the pandemic, followed by Xers (33%), Millennials (31%), Boomers (28%) and older adults (9%).

This report elaborates on these findings and proposes strategies to help us navigate this secondary crisis. APA is committed to helping people emerge from this challenging time poised to embrace and shape a brighter future together.

Pandemic-related stress comes with serious health consequences

The prolonged stress experienced by adults, especially the high levels of stress reported by Americans directly linked to the pandemic, is seriously affecting mental and physical health, including changes to weight, sleep and alcohol use.

Weight change is a common symptom when people are having difficulty coping with mental health challenges. A majority of adults (61%) reported experiencing undesired weight changes, since the start of the pandemic, with more than 2 in 5 (42%) saying they gained more weight than they intended. Of this group, adults reported gaining an average of 29 pounds (with a median gain of 15 pounds), and 1 in 10 (10%) said they gained more than 50 pounds. For the 18% of Americans who said they lost more weight than they wanted to, the average amount of weight lost was 26 pounds (median of 12 pounds).

Significant weight gain poses long-term health risks. According to the National Institutes of Health, people who gain more than 11 pounds are at higher risk of developing Type II diabetes mellitus and coronary heart disease, and people who gain more than 24 pounds are at higher risk of developing ischemic stroke. And according to the Centers for Disease Control and Prevention, people who are overweight are more likely to develop serious illness from the coronavirus.

Adults also reported changes in sleep and increased alcohol consumption. Two in 3 Americans (67%) said they are sleeping more or less than they wanted to since the pandemic started. Similar proportions reported less (35%) and more (31%) sleep than desired. Nearly 1 in 4 adults1 (23%) reported drinking more alcohol to cope with their stress during the coronavirus pandemic. This proportion jumps to more than half of adults (52%) who are parents with early elementary school-age children (5-7 years old).

Overall, physical health has taken a back seat. Nearly half of Americans (47%) said they delayed or canceled health care services since the pandemic started. Additionally, more than half of U.S. adults (53%) said they have been less physically active than they wanted to be since the pandemic started.

Three in 4 adults who reported a high stress level (rating of 8 – 10 on a scale where 1 means “little or no stress” and 10 means “a great deal of stress”) during the past year related to the pandemic (75%) reported undesired weight changes since the start of the pandemic, compared with 43% of those who reported a low stress level (rating of a 1–3). They also were more likely to report sleeping more or less than they wanted to since the start of the pandemic (84% vs. 42% for low stress) and drinking more alcohol to cope with stress (38% vs. 10% for low stress). Further, more than 3 in 5 of those who reported high stress (63%) said they have been less physically active than they wanted to be since the start of the pandemic, compared with 42% of those who reported a low stress level.

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1Data among adults ages 21+


How to identify unhealthy habits, change behavior and manage weight

Identify unhealthy habits 

  • Take note of when you are overeating, making poor food choices or drinking alcohol: What time of the day is it? Did something stressful happen? Are you bored? Answering these kinds of questions can help you determine if your habits aren’t healthy. 
  • Pay attention to how you feel after a certain activity.
  • For instance, drinking might make you feel better in the moment but worse the day after. If you notice this is happening, try substituting this behavior with another activity that doesn’t make you feel worse later.

Change behavior

  • Make the goals you set for yourself specific and attainable. For instance, if you’re trying to drink less during the pandemic, determine a specific number of days and drinks by which you want to limit your alcohol consumption.
  • Find an accountability buddy. Telling a close friend or family member about your goals can help you stay on track and they can check on your progress.

Manage weight

  • If you are feeling stressed and are gaining weight, instead of trying to lose weight, start by trying to maintain your weight by not overeating and staying active. This can help you develop healthy eating habits.
  • To maintain weight or stop yourself from losing weight, establish a routine for eating three meals a day — either by setting an alarm to signal mealtimes or blocking off time in your calendar. If trying to decide what to eat feels overwhelming, repeating the same breakfast and lunch every day can help build routine.
  • If you can’t get outside, go for a walk inside. Plan a route through your home that lets you take about 25 steps and take this route while you’re in a meeting, catching up with a friend on the phone or taking a 5-minute break during your workday.

Methodology

The Pandemic Anniversary Survey was conducted online within the United States by The Harris Poll on behalf of the American Psychological Association between Feb. 19 and 24, 2021, among 3,013 adults age 18+ who reside in the U.S. Interviews were conducted in English and Spanish. Data were weighted to reflect their proportions in the population based on the 2020 Current Population Survey (CPS) by the U.S. Census Bureau. Weighting variables included age by gender, race/ethnicity, education, region, household income and time spent online. Hispanic adults also were weighted for acculturation, taking into account respondents’ household language as well as their ability to read and speak in English and Spanish. Country of origin (U.S./non-U.S.) also was included for Hispanic and Asian subgroups. Weighting variables for Gen Z adults (ages 18–24) included education, age by gender, race/ethnicity, region, household income and size of household, based on the 2019 CPS. Propensity score weighting was used to adjust for respondents’ propensity to be online. A propensity score allows researchers to adjust for attitudinal and behavioral differences between those who are online versus those who are not, those who join online panels versus those who do not, and those who responded to this survey versus those who did not. Because the sample is based on those who were invited and agreed to participate in research panels, no estimates of theoretical sampling error can be calculated.

Subgroup analysis

Throughout the written summary, statistically significant differ- ences by subgroups are noted. Statistical significance testing was conducted at the 95% level of confidence. All comparative claims made in this report are statistically significant. Demographic sub-groups of adults are defined below:

  • Essential Worker: Yes (n=784); No (n=2,229)
  • Generation: Gen Z adults (18–24 years old) n=522; Millennials (25–42 years old) n=1,022; Xers (43–56 years old) n=563; Boomers (57–75 years old) n=806; Older adults (age 76 or older) n=100
  • Parental Status: Any children under the age of 18 (n=1,003); No children (n=2,010)

    » Parental Gender: Male (n=395); Female (n=607)
    » Age of Children: Young children ages 0–4 (n=273); School age 5–7 (n=163); Tweens ages 8–12 (n=279); Teens ages 13–17 (n=288)
    » Still Have Children Home for Remote Learning: Yes (n=506); Yes, Fathers (n=178); Yes, Mothers (n=325) 

  • Race/Ethnicity: White (n=1,098); Hispanic (n=706); Black (n=703); Asian (n=403)
  • Received COVID-19 Vaccine: Yes (n=654); No (n=2,359)

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