The COVID-19 pandemic has had a profound impact on mental health, contributing to an increase in persistent and elevated depression across the United States. But individuals with high assets may be shielded from the burden of persistent depression, according to a new study by Boston University School of Public Health (BUSPH).

Published in the journal Science Advances, the study found that 1 in 5 adults experienced persistent depression, both at the start of the pandemic in March and April 2020 and one year later, but those who had access to more physical, social, or financial assets—particularly higher incomes and more savings—were less likely to experience sustained depressive symptoms.

The findings also showed that job loss, financial difficulties, or relationship problems were important predictors of depression in the first year of the pandemic.

The study is the first of its kind to examine the association of assets and persistent depression across the US during the first 12 months of the pandemic.

"We have been observing particularly high rates of depressions since the beginning of COVID that have persisted throughout the first year of COVID," says study lead author Catherine Ettman, executive director of strategy and planning at BUSPH. "This suggests a substantial burden of poor mental health in the population that is persistent, particularly among those who have fewer assets."

For the study, Ettman and colleagues analyzed longitudinal survey data on depression prevalence, assets, and stressors among a nationally representative sample of US adults ages 18 and over. Approximately 25% of women reported symptoms of persistent depression at the beginning and end of the first year of COVID-19, compared to 15% of men, and adults ages 18 to 39 experienced persistent depression more than any other adult age group during this time period.

Persistent depression was highest among people in low-income households and those with fewer savings.

When adjusting for demographics, people with a household income under $20,000 were more likely to experience persistent depression than those with household incomes of $75,000 or more. Similarly, people with fewer than $5,000 in savings were more likely to experience sustained depression than those with savings of $5,000 or more. Among social assets, people who earned only a high school degree were more likely to experience depression than those who earned a college degree or more, and those who were not married were more likely to experience depression those who were married.

Notably, the researchers found that these assets did not prevent people from experiencing persistent depression after the first year of the pandemic if they still struggled with job loss, financial difficulties, or relationship issues. But absent of these stressors, having assets substantially reduced the likelihood of an individual experiencing persistent depression in March or April 2021.

"These findings show that mental illness is one of the consequences of the pandemic, and one that will stay with us for years to come," Ettman says.

Identifying ways to bolster financial assets and reduce stressors among people experiencing mental health challenges will be critical beyond the pandemic, says Dr. Sandro Galea, BUSPH dean and Robert A. Knox professor.

"It will be important to make sure that we have the resources available to help people with depression in the long-term after COVID-19, particularly those who already have fewer economic assets to protect themselves from the mental health consequences of the pandemic," Galea says.