• Yusuf Ransome, Hui Luan, Insang Song, David A Fiellin, and Sandro Galea.
• Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut. Electronic address: yusuf.ransome@yale.edu.
• Am J Prev Med. 2022 Mar 1; 62 (3): 326-332.

IntroductionLimited evidence exists about the association between prior prevalence of poor mental health at the area level and subsequent rates of COVID-19 infections. This association was tested using area-level nationwide population data in the U.S.MethodsA nationwide study including 2,839 U.S. counties was conducted. Poor mental health was the age-adjusted average number of days within the past 30 days that adults reported poor mental health, including depression, stress, and problems with emotions, from the Behavioral Risk Factor Surveillance System. COVID-19 infection rates were cumulative confirmed cases between January 22 and October 7, 2020 per 100,000 people in the general population. Bayesian spatial mixed-effects regression estimated the relationship between COVID-19 infection and poor mental-health days at the county level in 2019 and change in poor mental health between 2010 and 2019, adjusted for several covariates.ResultsPoor mental-health days in 2019 were positively associated with higher COVID-19 infection rates (RRR=1.059, 95% credible interval=1.003, 1.117). Change in mental health was not significantly associated with COVID-19.ConclusionsPrior rates of poor mental health in a county were associated with a higher burden of COVID-19 infection. Interventions that improve well-being and strengthen mental-health systems at the community and other geographic levels are needed to address post-COVID-19 mental health problems.Copyright © 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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