Lifestyle and mental health disruptions during COVID-19

Significance

COVID-19 has affected casual life in unprecedented ways. Drawing on a longitudinal dataset of college students before and during the pandemic, we document dramatic changes in physical activity, sleep, time use, and mental health. We show that biometric and time-use data are critical for understanding the mental health impacts of COVID-19, as the pandemic has tightened the link between life style behaviors and depression. Our findings besides suggest a puzzle : Disruptions to physical activity and mental health are strongly associated, but renovation of forcible activity through a short-run intervention does not help improve genial health. These results highlight the large shock of COVID-19 on both life style and wellbeing and offer directions for interventions aimed at restoring mental health .

Abstract

Using a longitudinal dataset linking biometric and sketch data from several cohorts of young adults before and during the COVID-19 pandemic ( N=682 ), we document big disruptions to physical activity, sleep, clock time function, and mental health. At the onset of the pandemic, average steps decline from 10,000 to 4,600 steps per sidereal day, sleep increases by 25 to 30 min per nox, time spent socializing declines by over half to less than 30 minute, and screen time more than doubles to over 5 h per day. Over the course of the pandemic from March to July 2020 the proportion of participants at risk for clinical depression ranges from 46 % to 61 %, up to a 90 % increase in depressive disorder rates compared to the like population merely prior to the pandemic. Our analyses suggest that dislocation to physical action is a leading gamble factor for depression during the pandemic. however, restoration of those habits through a short-run interposition does not meaningfully improve mental wellbeing. A mental health crisis has emerged during the COVID-19 pandemic. The US Centers for Disease Control and Prevention ( CDC ) estimates that as of June 2020 about one-third of US adults were suffering from anxiety or depression ( 1 ). The rates are about two times higher for young adults, a population that has already seen a meaning increase in the prevalence of mental health disorders over the past decade ( 2 ). Over 60 % of individuals age 18 to 24 y were estimated to be at gamble for natural depression or anxiety and a quarter reported considering suicide in the former calendar month. These estimates represent a large increase in depressive disorder rates compared to about 11 % of all adults in 2019 ( 3 ) and about 25 % of college students prior to the pandemic ( 4 ). The heighten in depression has occurred at the lapp time that stay-at-home orders, campus closures, and social distance measures have caused major disruptions to everyday life, altering the way people live, work, study, and interact.

In this newspaper we document disruptions in physical bodily process, sleep, and time manipulation among young adults at the onset of the pandemic and examine the relationship between these disruptions and mental health. We take advantage of a health study that has enrolled multiple cohorts of US college students from February 2019 through July 2020. Participants received clothing devices ( Fitbits ) and answered repeated surveys about their wellbeing and time use over the course of a semester. Participants in the 2020 cohort began the study in February and continued participating after the university moved all classes online in March and encouraged students not to return to campus. These data allow us to make two elementary contributions. First, we can conduct longitudinal psychoanalysis examining how physical activeness and genial health have evolved during the pandemic compared both to baseline prepandemic levels vitamin a well as to prior cohorts. The practice of prepandemic data are critical as the study behaviors exhibit significant seasonal patterns. second, we can link biometric measures of physical activity and sleep to survey measures of mental wellbeing and social distance. This approach path allows us to identify risk factors for depression during COVID-19 and compare those factors to predictors of natural depression prior to the pandemic. We beginning document large changes to forcible action and sleep. Over the path of the 3-mo semester, average steps worsen by over half from 10,000 to 4,600 steps per day, overall physical action declines by about a third from 4.4 planck’s constant to 2.9 h per sidereal day, and rest increases by about 25 to 30 min per night. We besides find dramatic shifts in self-reported time manipulation. Time spent socializing with others declines by over half to less than 30 min per day, while screen time more than doubles to over 5 h per day ( excluding screen time for classes or work ). These life style disruptions stand aboard bare increases in depression during the pandemic. We estimate that at the end of the spring 2020 semester in April an estimate 61 % of our participants were at risk for clinical depression. This represents about a 90 % increase over rates of 32 % in the like population just 2 mo earlier prior to the pandemic. Using difference-in-differences and individual fixed-effects regressions, we show that the changes in forcible action, sleep, social interactions, filmdom time, and depression are all statistically significant compared to changes in anterior cohorts ( P < 0.001 ). The coincident decline of both physical activity and mental health is peculiarly distressing, as prior work suggests that the coexistence of mental health problems alongside poor physical activeness worsens overall health outcomes ( 5 ). In credit line with this knead, we find that big declines in physical bodily process during COVID-19 are associated with 15 to 18 percentage point higher rates of depression compared to modest disruptions in baseline habits ( P=0.012 ). To link life style and genial health we exploit our rich longitudinal data and use tree-based classification methods to identify hazard factors for natural depression during COVID-19. Taken together, the predictors of depression in the 2020 cohort differ significantly from prior cohorts ( P < 0.001 ). When we examine particular risk factors we find that changes in life style behaviors are more closely linked to depressive disorder during the pandemic than in anterior cohorts. In particular, bombastic disruptions in physical activeness emerge as a leading risk factor for depression during COVID-19. In contrast to prepandemic cohorts in which there is little relationship between disruptions and mental health, those participants who sustain their baseline exercise habits during the pandemic are at importantly lower gamble of depression. Building on this analysis, after the give 2020 semester ended in April we continued to track a subsample of our participants through July 2020. During this period, we find attest of a partial “ bounce spinal column ” in physical activeness and mental health toward service line levels. average casual steps increase to about 6,400 steps per day in May and remain steadily through July, closing about a one-third of the decline from the attack of the pandemic in March and April. There is besides some decay in average measures of depression, with estimated rates of low ranging from 46 % to 50 % in May through July. This represents an improvement compared to the end of the semester in April but remains flat over this period and is however about 50 % higher than prepandemic rates. In order to examine whether a policy intervention could help counteract some of the adverse impacts of the pandemic, we implemented a randomized intervention halfway through this period. building on our findings and on prior work on the link between physical activity and mental health ( 6 ), in June 2020 we randomized one-half of our participants to receive incentives for walking at least 10,000 steps per day for 2 wk. Our intervention significantly increased average steps by about 2,300 steps per day and forcible natural process by about 40 min per day compared to the control group ( P < 0.001 ), with the treatment group close to their baseline prepandemic levels. however, the impingement on drill did not translate into an improvement in mental health measured at the end of the intervention menstruation. In a postintervention follow-up we find that average steps in the treatment group declined to the like levels as in the control condition group about a workweek after the intervention ended. In July 2020, 1 missouri after the interposition ended, we find no differences in average measures of depression between treatment participants who were randomized to the physical activity intervention and participants in the master group. Our survey contributes to the growing literature examining the impact of the coronavirus pandemic on forcible natural process and mental wellbeing. life style disruptions during COVID-19 have been documented in studies focusing on a unmarried type of behavior, such as exercise ( 7 ), rest ( 8 ), social distance ( 9, 10 ), or genial health ( 11 ⇓ ⇓ ⇓ ⇓ ⇓ ⇓ ⇓ ⇓ ⇓ – 21 ). While our sample distribution is not nationally representative, our measures of mental health are in line with those from larger and nationally representative samples using diverse measures of mental health both anterior to the pandemic ( 4 ) and during the pandemic ( 1, 22 ). * associate work using cross-section data finds an affiliation between self-reported changes in physical natural process during the pandemic and measures of mental health ( 25 ). This composition besides relates to the broader inquiry on the determinants of genial health ( 26 ⇓ ⇓ ⇓ – 30 ) angstrom well as work on health behavior change. Prior studies demonstrate how change circumstances or context can promptly disrupt healthy habits ( 31, 32 ). In accession to documenting such disruptions as a consequence of the pandemic, our work investigates the relationships between disruptions in life style habits and wellbeing. Taken together, our findings suggest a puzzle : Why are disruptions to physical activity and mental health strongly associated but restoration of physical activity through our intervention does not meaningfully improve mental health ? First, the impingement of physical action may require a longer-term intervention. Second, physical activity may have important interactions with other life style behaviors such as social interactions. It may besides reflect correlation coefficient with other unobserved determinants of mental health. finally, it could be the case that the kinship between physical activeness and depression is driven more by mental health than it is by life style habits. For exemplar, the hard association between sustenance of healthy habits and depression during COVID-19 could partially reflect individuals ’ ability to adapt to adversity and sustain their life style despite the pandemic. such resilience in the face of bombastic disruptions may be critical for wellbeing during COVID-19 .

Data and Methods

Enrollment and Data Collection.

We enrolled three cohorts of students from the University of Pittsburgh in the learn : spring 2019, fall 2019, and spring 2020. The report was approved by the University of Pittsburgh Institutional Review Board and was preregistered in the American Economic Association Randomized Controlled Trials ( AEA RCT ) Registry ( RCT ID AEARCTR-0003235 ). Data and materials can be accessed at Open Science Framework ( hypertext transfer protocol : //osf.io/f85e3/ ) ( 33 ). A detailed description of the methods and measures can be found in SI Appendix. At the get down of each semester, we invited college students at the University of Pittsburgh to participate in a semester-long experiment on health. eligible participants signed a accept form in the lab at the begin of the study. They then filled out a baseline survey, received a clothing tracker ( a Fitbit Alta HR device ), and installed a custom-made smartphone application on their earphone which allowed us to track their Fitbit datum. Throughout the semester we continuously collected daily Fitbit data, which measures steps, forcible action, and sleep based on heart rate and movement. We besides collected hebdomadally measures of prison term use through a diary sketch following the social organization of the american Time Use Survey ( 34 ). †

We measured mental health at the begin, middle ( spring 2020 only ), and conclusion of the semester. Our elementary standard of mental health is depressive disorder, which we assessed using the Center for Epidemiologic Studies Depression Scale ( CES-D ) ( 35 ). The CES-D is a validate self-report legal document designed to assess the frequency of symptoms of depression, such as helplessness or forlornness, on a scale from 0 ( rarely or none of the time ) to 3 ( most or all of the time ) and has a total score between 0 and 60. Our primary benchmark for depression is a CES-D sexual conquest of 16 or above, which is considered the cutoff for clinical concern, implying senior high school levels of depressive symptoms ( 36 ). We additionally assessed anxiety, resilience, and life satisfaction. In the spring 2020 age group we continued to track a subsample of participants who agreed to continue their participation after the semester ended in April 2020. In June 2020 we randomized half of the participants to an intervention group to increase physical activity and half to a restraint group for a 2-wk intervention period. This RCT was preregistered in the AEA RCT Registry ( RCT ID AEARCTR-0005949 ). We measured mental health in May equitable before the treatment, mid-june at the goal of the intervention, and mid-july a month after the intervention ended .

Sample and Analysis.

Our sample includes all participants for whom we have a baseline survey, including baseline mental health measures : spring 2019 ( nitrogen = 150 ), fall 2019 ( north = 315 ), and bounce 2020 ( n = 316 ). ‡ The aggregate cohorts include N=682 alone participants. In SI Appendix, Fig. S.1 we report the sample sizes at each stage of the study. We present descriptive statistics for our sample distribution in SI Appendix, Table S.1. While our sample is not nationally representative, as we noted above, our measures of baseline mental health are in line with estimates from representative surveys. We award estimates reweighted to match a nationally representative sample on sex, age, and race/ethnicity and the results do not change ( SI Appendix, Table S.11 ). The chief analyses include all participants who have at least one observation for the relevant consequence. We examine attrition directly and besides conduct several sensitivity checks to address abrasion concerns ( SI Appendix, section 4B ). Unless celebrated differently below, our results are robust to these sensitivity analyses .

Discussion

The COVID-19 pandemic has upended much of club in unprecedented ways. The measures adopted to mitigate the public health emergency, such as margin closures, travel restrictions, and lockdowns, have affected labor movement markets, pulmonary tuberculosis patterns, and economic activities all over the populace ( 11, 15, 45 ⇓ ⇓ – 48 ). The shock of such disruptions on mental health is of critical policy concern. Over the last two decades mental health disorders have imposed a growing load on company, with estimated costs of over $ 200 billion per year in the United States alone ( 49 ). These costs may well increase as a resultant role of the pandemic. The consequences of COVID-19 for genial health have been awful, as highlighted in a May 2020 United Nations policy brief urging the external community to protect vulnerable populations ( 50 ). Among those identified as a specific population of concern were adolescents and young adults, who have faced big disruptions to their education and support situations and may suffer lifelong economic impacts from the pandemic. Our findings provide evidence of these disruptions and highlight the heavy bell of the pandemic on the wellbeing of college students. We document several findings linking life style disruptions to mental health. First, we show large disruptions to physical activity, sleep, and time manipulation, particularly at the onset of the pandemic in March and April. Second, we document hearty declines in mental health with dramatic increases in depression. Third, we find that risk factors for depressive disorder diverge substantially during the pandemic compared to prior cohorts, with evidence that the pandemic tightened the relationship between the alimony of life style habits and mental health. last, while disturbance of physical habits is a leading predictor of depression during COVID-19, the restoration of habits through our short-run treatment does not help restore wellbeing during the pandemic. Why is this ? First, the impingement of physical activity may require a more intensive treatment. Prior function on physical natural process and mental health has focused on interventions that encourage exercising two or three times per workweek over an extend period, broadly 8 to 12 wk ( 6 ). In contrast, our interposition offered incentives based on steps and occurred every day, and for a shorter period. future interventions could test incentives for more intensive physical activeness or could extend our incentives for steps over a longer period. In our context, the coincident decline in physical activity and mental health occurred over a short-circuit meter period ( largely in mid-march ). We therefore were interested in testing whether restoring physical natural process in a similarly short clock time span could have an impingement on wellbeing. We besides note that, even among the subgroup of participants who experienced free burning increases in physical bodily process over the 6 wk spanning the intervention and postintervention periods, there is short shock on mental health. second, physical bodily process may have important interactions with other life style behaviors such as sociable interactions, for example because it is frequently undertaken in a social context ( 50 ). future influence could attempt to restore physical activity in conjunction with other significant life style habits. Third, there may be important drivers of mental health during the pandemic that we do not measure, for exercise related to the motion to remote education. While we explore some of these, such as the role of where students are located when classes move on-line, there may be omitted variables driving the effects of on wellbeing that we document in this paper. Another possibility is that the kinship between physical action and wellbeing is driven chiefly by genial health quite than lifestyle. That is, changes in life style habits may be ( early on ) symptoms of natural depression. Relatedly, physical bodily process and mental health disruptions could both be driven by participants ’ underlie response to the pandemic. For example, our results may reflect that the kinds of people who are able to maintain their life style during the pandemic are the kinds of people who are besides better able to maintain their mental health in the confront of major disruptions. We find evidence that these people may be those who, prior to the pandemic, were most resilient to stress and least prone to anxiety. Prior function has shown that it is possible to foster resilience ( 51 ). future work could explore whether doing so can help mitigate the big impact of the COVID-19 pandemic on forcible bodily process and mental wellbeing .

Data Availability.

Anonymized data have been deposited in Open Science Framework ( hypertext transfer protocol : //osf.io/f85e3/ ) ( 33 ).

Acknowledgments

The project was funded by J-PAL North America. We thank Ben Schenck, Cole Tucci, Mallory Avery, and William Wang for excellent research aid. Published under the PNAS license .

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