Trends in psychological distress and COVID-19 incidence across 15 U.S. metropolitan statistical areas in 2020

The United States experienced three surges of COVID-19 community infection since the World Health Organization declared the pandemic on March 11, 2020. The prevalence of psychological distress among U.S. adults increased from 11 % in 2019 to 35.9 % in April 2020 when New York City become the epicenter of the COVID-19 outbreak. Analyzing 21 waves of the Household Pulse Survey data collected between April 2020 and December 2020, this study aimed to examine the distress level in the 15 most populated metropolitan areas in the U.S. Our study found that, as the pandemic swept from East to South and soared in the West, 39.9%–52.3 % U.S. adults living in these 15 metropolitan areas reported symptoms of psychological distress. The highest distress levels were found within the Western areas including Riverside-San Bernardino-Ontario (52.3 % in July 2020, 95 % CI: 44.9%–59.6 %) and Los Angeles-Long Beach-Anaheim (49.9 % in December 2020, 95 % CI: 44.5%–55.4 %). The lowest distress level was observed in Washington-Arlington-Alexandria ranging from 29.1 % in May 2020 to 39.9 % in November 2020. COVID-19 and its complex ecology of social and economic stressors have engaged high levels of sustained psychological distress. Our findings will support the efforts of local, state and national leadership to plan interventions by addressing not only the medical, but also the economic and social conditions associated with the pandemic.