Anxiety during the Pandemic: Racial and ethnic differences in the trajectory of fear

BACKGROUND: In addition to the threat of serious illness, COVID-19 brought abrupt changes in lifestyle resulting in widespread fear among many Americans. This study examines the evolution of anxiety over the first months of the COVID-19 pandemic, testing for differential experiences among vulnerable populations. METHODS: Phase 1 of the Census Bureau's Household Pulse Survey details the frequency of anxiety among a nationally representative sample of adults from April 23, 2020 through July 21, 2020. Negative binomial regression assessed differences in the frequency of anxiety among demographic, income, health and employment status cohorts. Propensity score matching to the 2019 National Health Interview Survey allowed previous anxiety and health status to be included in the model. RESULTS: Anxiety frequency for 944,719 individuals was observed over three months. Whites, blacks and Hispanics showed increasing frequency of anxiety over the time period, particularly blacks. Prior to COVID-19, 13% of respondents reported regular or semiregular anxiety, compared to 25–35% during the pandemic. Regression analysis suggests that frequent anxiety was highly and positively correlated with COVID-19 case fatality rate and higher levels of frequency were observed among those with poor health, incomes below $25,000, and without paid employment. LIMITATIONS: Causal inference was not able to be investigated due to the cross-sectional study design. CONCLUSIONS: While blacks showed lower levels of anxiety initially, the proportion of the population experiencing regular anxiety increased nearly 20% over the first months of the COVID-19 pandemic. This rapid increase in anxiety could be due to inequity in health and economic outcomes among blacks.