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Primary Submission Category: Mental health/function

State Policy Contexts, COVID-19 Response Policies, and Mental Health among U.S. Working-Age Adults

Authors:  Iliya Gutin, Shannon Monnat, Jennifer Karas Montez, Emily Wiemers, Douglas Wolf,

Presenting Author: Iliya Gutin*

Multiple indicators of poor mental health, morbidity, and mortality reflect a deterioration in adult mental health over recent decades in the United States, a troubling trend which was exacerbated during the COVID-19 pandemic. Yet, like many health outcomes, national estimates can obscure important geographic heterogeneity. This study examines how adult mental health over a 30-year period was associated with major changes in states’ policy contexts during that period, combined with states’ policy responses to the COVID-19 pandemic starting in 2020. We use nationally representative data on adults ages 25-64 in the 1993-2022 annual waves of the Behavioral Risk Factors Surveillance System (N= 5,878,722), merged with time-varying measures of state policy context indices, measured on a liberal-to-conservative continuum, and COVID-19 policy indices, while accounting for key individual-level and state-level confounders. During the 1993-2022 period, each unit increase in state policy conservatism was associated with 0.3 more days of reported poor mental health in the past month and 8-10% higher probability of “extreme distress,” defined as experiencing 30 days of poor mental health in the last month. States’ COVID-19-related policies were associated with adults’ mental health outcomes, net of the states’ overall policy context index. Specifically, stronger restrictions on in-person interactions and (unexpectedly) more robust economic supports were associated with worse mental health. Overall, our results show that state policy contexts were a strong predictor of adult mental health and that those contexts continued to predict mental health during the pandemic, over and above states’ pandemic policies. Our findings corroborate studies finding negative mental health externalities from limiting in-person interactions during the pandemic.