Depression and loneliness during April 2020 COVID-19 restrictions in the United States, and their associations with frequency of social and sexual connections

Purpose: To estimate the prevalence of depression and loneliness during the US COVID-19 response, and examine their associations with frequency of social and sexual connections.

Methods: We conducted an online cross-sectional survey of a nationally representative sample of American adults (n = 1010), aged 18-94, running from April 10-20, 2020. We assessed depressive symptoms (CES-D-10 scale), loneliness (UCLA 3-Item Loneliness scale), and frequency of in-person and remote social connections (4 items, e.g., hugging family member, video chats) and sexual connections (4 items, e.g., partnered sexual activity, dating app use).

Results: One-third of participants (32%) reported depressive symptoms, and loneliness was high [mean (SD): 4.4 (1.7)]. Those with depressive symptoms were more likely to be women, aged 20-29, unmarried, and low-income. Very frequent in-person connections were generally associated with lower depression and loneliness; frequent remote connections were not.

Conclusions: Depression and loneliness were elevated during the early US COVID-19 response. Those who maintained very frequent in-person, but not remote, social and sexual connections had better mental health outcomes. While COVID-19 social restrictions remain necessary, it will be critical to expand mental health services to serve those most at-risk and identify effective ways of maintaining social and sexual connections from a distance.