Evidence map›Paper›PMID 40017931›Full record

ArticleBMJ public health2025

Associations between local COVID-19 policies and anxiety in the USA: a longitudinal digital cohort study.

Aaron E Cozen, Rita Hamad, Soo Park, Gregory M Marcus, Jeffrey E Olgin, Madelaine Faulkner Modrow, Amy Chiang, Matthew Brandner, Jaime H Orozco, Kristen Azar and 10 more

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05548803 (Comparing Patient-reported Impact of COVID-19 Shelter-in-place Policies and Access to Containment and Mitigation Strategies, Overall and in Vulnerable Populations), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05548803 completednot on this map

Comparing Patient-reported Impact of COVID-19 Shelter-in-place Policies and Access to Containment and Mitigation Strategies, Overall and in Vulnerable Populations

TypeobservationalSponsorUniversity of California, San FranciscoRan2020 to 2024Enrolled52,351ConditionsCovid19
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors.

Aaron E CozenDept of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.ORCID 0000-0003-2409-0023
Rita HamadDepartment of Social & Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA.ORCID 0000-0003-0730-4077
Soo ParkDept of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.
Gregory M MarcusDivision of Cardiology, University of California San Francisco, San Francisco, California, USA.
Jeffrey E OlginDivision of Cardiology, University of California San Francisco, San Francisco, California, USA.
Madelaine Faulkner ModrowDept of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.
Amy ChiangDivision of General Internal Medicine, University of California San Francisco, San Francisco, California, USA.ORCID 0000-0003-3282-4963
Matthew BrandnerDept of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.
Jaime H OrozcoDept of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.ORCID 0009-0008-0813-1175
Kristen AzarDept of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.
Sylvia E K SudatCenter for Health Systems Research, Sutter Health, Walnut Creek, California, USA.
Carmen R IsasiDept of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
Natasha WilliamsDept of Population Health, New York University Grossman School of Medicine, New York, New York, USA.
Pelin OzlukElevance Health Inc, Indianapolis, Indiana, USA.
Heather KitzmanUniversity of Texas Southwestern Medical Center, Dallas, Texas, USA.ORCID 0000-0003-1219-6189
Sara J KnightDivision of Epidemiology, University of Utah, VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA.
Ana Sanchez-BirkheadCollege of Nursing, University of Utah, Salt Lake City, Utah, USA.
John KornakDept of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.
Thomas CartonLouisiana Public Health Institute, New Orleans, Louisiana, USA.
Mark PletcherDept of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.ORCID 0000-0002-6966-1312

Funding

CTSA UM1 Program at University of UtahUM1TR004409 · NCATS · UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH · PI RACHEL HESS, Jennifer Juhl Majersik · 2023 to 2026
$21.9M
The Health ePeople Resource for Mobilized ResearchU2CEB021881 · NIBIB · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI MARCUS, GREGORY M, OLGIN, JEFFREY E · 2015 to 2020
$10.3M
The Impacts of County-Level COVID- 19 -Related Public Health and Social Policies on Racial/Ethnic and Socioeconomic Disparities in Mental Health and Healthcare UtilizationU01MH129968 · NIMH · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI HAMAD, RITA · 2021 to 2025
$3.4M
Gates Foundation INV-017206NCATS NIH HHS UM1 TR004409NIBIB NIH HHS U2C EB021881NIMH NIH HHS U01 MH129968
6 · The paper itself

Abstract

abstractIntroduction: A lack of coordinated federal guidance led to substantial heterogeneity in local COVID-19 policies across US states and counties. Local government policies may have contributed to increases in anxiety and mental health disparities during the COVID-19 pandemic. Methods: We analysed associations between composite policy scores for containment and closure, public health or economic support from the US COVID-19 County Policy Database and self-reported anxiety scores (Generalised Anxiety Disorder-7) from COVID-19 Citizen Science participants between 22 April 2020 and 31 December 2021. Results: In 188 976 surveys from 36 711 participants in 100 counties across 28 states, associations between anxiety and containment and closure policy differed by employment (p<0.0001), with elevated anxiety under maximal policy for people working in hospitality and food services (+1.05 vs no policy; 95% CI: 0.45, 1.64) or arts and entertainment (+0.56; 95% CI 0.15, 0.97) and lower anxiety for people working in healthcare (-0.43; 95% CI -0.66 to -0.20) after adjusting for calendar time, county-specific effects and COVID-19 case rates and death rates. For public health policy, associations differed by race and ethnicity (p=0.0016), with elevated anxiety under maximal policy among participants identifying as non-Hispanic Black (+1.71; 95% CI 0.26, 3.16) or non-Hispanic Asian (+0.74; 95% CI 0.05, 1.43) and lower anxiety among Hispanic participants (-0.63, 95% CI -1.26 to -0.006). Associations with public health policy also differed by gender (p<0.0001), with higher anxiety scores under maximal policy for male participants (+0.42, 95% CI 0.09, 0.75) and lower anxiety for female participants (-0.40, 95% CI -0.67 to -0.13). There were no significant differential associations between economic support policy and sociodemographic subgroups. Conclusions: Associations between local COVID-19 policies and anxiety varied substantially by sociodemographic characteristics. More comprehensive containment policies were associated with elevated anxiety among people working in strongly affected sectors, and more comprehensive public health policies were associated with elevated anxiety among people vulnerable to racial discrimination.

Indexed as

AnxietyCOVID-19Mental HealthPublic HealthSociodemographic Factors

Identifiers

PMID40017931
PMCPMC11812870

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.