Changes in reported levels of depression and anxiety among rural and urban populations during the COVID-19 pandemic

The COVID-19 pandemic has affected nearly everyone, however experiences and perceptions of COVID have been different across rural and urban areas in the United States, including effects on mental health. The purpose of the current study is to examine changes in levels of reported anxiety and depression within rural and urban populations before and during the COVID-19 pandemic in the United States. Using the National Health Interview Survey (NHIS), we used a repeated cross-sectional study design including adults (age 18 or older) who were sampled in 2019 and 2020. We examined the relationship between worsening mental health outcomes (depression and anxiety) and rurality, controlling for individual's demographic and health-related measures. Individuals living in an urban area were more likely to report worsening anxiety (28.8% vs. 23.0% p < 0.001) and use of mental health services (10.4% vs. 8.1% p = 0.054) in the previous 12 months than their rural counterparts. No significant differences were detected in the likelihood of reporting worsening depression, when comparing those living in rural versus urban areas. We found that individuals living in urban areas were more likely to report worsening anxiety than those living in rural areas during the COVID-19 pandemic. Urban areas were affected earlier and more severely as early epicenters of the COVID-19 pandemic in the United States, which may have contributed to worsening anxiety among these populations as compared to rural populations. Additionally, our findings may reflect urban and rural population differences in the perception and/or enforcement of COVID-19 policies such as lockdown and social distancing policies.