This report describes mental health challenges faced by communities during the COVID-19 pandemic.

This report describes a disruption of routine and nonemergency care during June, with 41% of adults delaying medical care because of concerns about COVID-19.

This report describes a survey taken during May among adults in the United States that found widespread support for stay-at-home orders and nonessential business closures and a high degree of adherence to COVID-19 mitigation guidelines.

Adverse mental health symptoms among US adults were more prevalent during the early phase (April-June 2020) of the coronavirus disease 2019 (COVID-19) pandemic compared with prepandemic estimates (eg, 3-fold increased prevalences of anxiety and depression symptoms, 2-fold increased prevalence of suicidal ideation).^1,2 In June 2020, 2238 (40.9%) of 5470 US adults reported adverse mental or behavioral health symptoms. During this time, the prevalence of symptoms was lower in adults aged 65 years or older (141 of 933 [15.1%]) than in young adults aged 18 to 24 years (547 of 731 [74.9%]; P < .001).¹ Given suggestions that acute increases in the prevalence of adverse mental health symptoms may represent a transient response to mass trauma,³ we sought to determine whether these patterns persisted in September 2020 and to examine disproportionately affected demographic groups.

Aims: Markedly elevated adverse mental health symptoms were widely observed early in the coronavirus disease-2019 (COVID-19) pandemic. Unlike the U.S., where cross-sectional data indicate anxiety and depression symptoms have remained elevated, such symptoms reportedly declined in the U.K., according to analysis of repeated measures from a large-scale longitudinal study. However, nearly 40% of U.K. respondents (those who did not complete multiple follow-up surveys) were excluded from analysis, suggesting that survivorship bias might partially explain this discrepancy. We therefore sought to assess survivorship bias among participants in our longitudinal survey study as part of The COVID-19 Outbreak Public Evaluation (COPE) Initiative. Methods: Survivorship bias was assessed in 4039 U.S. respondents who completed surveys including the assessment of mental health as part of The COPE Initiative in April 2020 and were invited to complete follow-up surveys. Participants completed validated screening instruments for symptoms of anxiety, depression and insomnia. Survivorship bias was assessed for (1) demographic differences in follow-up survey participation, (2) differences in initial adverse mental health symptom prevalence adjusted for demographic factors and (3) differences in follow-up survey participation based on mental health experiences adjusted for demographic factors. Results: Adjusting for demographics, individuals who completed only one or two out of four surveys had significantly higher prevalence of anxiety and depression symptoms in April 2020 (e.g. one-survey v. four-survey, anxiety symptoms, adjusted prevalence ratio [aPR]: 1.30, 95% confidence interval [CI]: 1.08–1.55, p = 0.0045; depression symptoms, aPR: 1.43, 95% CI: 1.17–1.75, p = 0.00052). Moreover, individuals who experienced incident anxiety or depression symptoms had significantly higher adjusted odds of not completing follow-up surveys (adjusted odds ratio [aOR]: 1.68, 95% CI: 1.22–2.31, p = 0.0015, aOR: 1.56, 95% CI: 1.15–2.12, p = 0.0046, respectively). Conclusions: Our findings reveal significant survivorship bias among longitudinal survey respondents, indicating that restricting analytic samples to only respondents who provide repeated assessments in longitudinal survey studies could lead to overly optimistic interpretations of mental health trends over time. Cross-sectional or planned missing data designs may provide more accurate estimates of population-level adverse mental health symptom prevalence than longitudinal surveys.