Has population mental health returned to pre-pandemic levels, among and between racialized groups and by immigration status?

Abstract

The COVID-19 pandemic profoundly impacted population health, including mental health, in ways that were patterned unevenly by pre-existing systemic inequalities such as structural gendered racism and xenophobia. However, it remains unclear whether pandemic-related mental health deterioration has persisted over time. Drawing on theories of disruptive events and structural racism, we conceptualize the pandemic as a prolonged macro-level disruptive event with unequal ramifications for different racialized groups and by immigration status. We use six waves (2017–2022) of repeated cross-sectional data from the California Health Interview Survey (CHIS; N = 121,063) from men and women from nine racialized and immigration status groups (US-born citizens, naturalized citizens, and noncitizens of White, Latina/o, and Asian racialized groups, respectively). We use multivariable regression to examine changes in psychological distress within each group, and then assess patterns of racialized health disparities between Latina/o and Asian groups, respectively, compared to White US-born citizens, who occupy the most structurally privileged social status. Our analyses reveal several key findings. First, we observed persistent increases in psychological distress from 2020 through 2022, relative to the pre-pandemic period (2017–2019), for all racialized and immigration status groups, among men and women. Second, few groups had returned to pre-pandemic distress levels as of 2022. Third, there was a consistent health advantage for White US-born citizens across the pre-pandemic and pandemic years, whose highest post-pandemic distress measure was lower or equivalent to the pre-pandemic distress of US-born Latina/o and Asian groups. Fourth, the psychological distress gap between the White US-born population and US-born Latina/o and Asian groups, respectively, grew or held steady through 2022. Finally, the 2020–2022 period was associated with a reduction in pre-pandemic health advantages among Asian immigrant groups, relative to US-born White citizens, especially among men. Our findings provide strong evidence that population mental health has not recovered from the pandemic period.