Research shows mental health disparities in LA County have increased during the COVID pandemic

New evidence has emerged about the long-term effects of the COVID-19 pandemic in Los Angeles County, as shown by a study in the diary PLOS ONEScientists from USC and the Los Angeles County Department of Public Health (DPH) found that existing disparities in mental health between white and non-white residents were widening.

The study used two surveys conducted in 2018 and spring 2021 to measure the risk of major depression among adults, as well as mortality data. Researchers looked at monthly averages between March 2020 (when the first shelter-in-place orders were issued) and mid-April 2021 (after the height of the pandemic). The county was divided into three zones based on this data:

• An area with a high COVID-19 death rate spanning metropolitan Los Angeles, South LA County, and East LA County.
• An area with a low COVID-19 death rate consisting of West LA County and the South Bay.
• An area with an average COVID-19 death rate that includes the San Gabriel, San Fernando, and Antelope Valleys.

Perhaps predictably, residents of areas with high COVID-19 mortality were more likely to experience depression than residents of areas with medium and low COVID-19 mortality. But when the researchers grouped survey respondents by race, they found a stark divide.

They observed a general trend of increasing risk for depression in the hardest-hit areas among nonwhite LA County residents, including residents of Asian, Black, Hispanic, and Native racial and ethnic groups. However, this was not true for white residents.

In 2021, nonwhite respondents in the area hardest hit by COVID-19 deaths were more at risk for depression than their peers in the low COVID-19 mortality zone.

Even in 2018, nonwhite residents of metro LA, South LA, and East LA were at greater risk for depression than nonwhite residents of West LA and the South Bay. In 2021, that gap widened. The effects the researchers documented persisted even after controlling for other factors.

“The pandemic hit nonwhites much harder than whites, and we suspected that the impact on mental health was related to living conditions,” said corresponding author Jonathan Lam, Ph.D., MPH, assistant professor of emergency medicine at the Keck School of Medicine of USC.

“You may see people in multi-generational households, which means that if COVID-19 breaks out, they may not have enough space to quarantine with family members. The types of jobs they have may be in sectors that offer few protections and little free time to even get tested. That can really add to their stress and undermine their ability to cope with the pandemic.”

Profiling differences in pandemic threats to life and well-being

The study paints a contrasting picture of the impact of COVID-19 on communities in LA County. In each of the three zones, the death rate from the coronavirus was more than twice as high among nonwhite residents than among white residents.

Other numbers showed a striking reversal. In 2018, white LA County residents had higher death rates than nonwhite residents in each of the three zones. Since most nonwhite LA County residents are Hispanic, the cause of this disparity may lie in a phenomenon known as the Latino paradox.

Trends documented since the 1980s show that Latinos had higher life expectancies and lower mortality rates compared to whites, despite facing, on average, socioeconomic factors and health risks that offset this advantage.

The study confirms mounting evidence that the coronavirus has, at least temporarily, removed the Latino paradox.

“After COVID, mortality is higher among nonwhites,” said lead author Neeraj Sood, Ph.D., a professor at the USC Price School of Public Policy and director of the COVID Initiative at the USC Schaeffer Center for Health Policy & Economics.

“There is a big divide in terms of the impact of COVID. Depending on who you are and where you live, your experience during the pandemic could be much worse.”

The 2021 study was part of the Los Angeles Pandemic Surveillance Cohort Initiative, a collaboration between the USC Schaeffer Center, the Keck School of Medicine’s Department of Population and Public Health Sciences, and the Los Angeles County Department of Public Health.

The researchers asked 1,222 participants from across the country how often they had experienced depressed mood and lack of pleasure in daily activities in the past two weeks. The existing 2018 survey captured the same measures.

The researchers’ findings expanded understanding of the understudied topic of the pandemic’s long-term effects on mental health in LA County. What they learned could help inform efforts to mitigate these hardships through programs like the Los Angeles County DPH’s Wellness Centers and Community Public Health Teams initiatives.

“These results raise awareness of the significant impact of living and working conditions on emotional well-being, particularly in lower-income communities and among Black and Latino people,” said co-author William Nicholas, Ph.D., MPH, director of the Center for Health Impact Evaluation at the Los Angeles County DPH.

“It is critical that we recognize that improving mental health requires investing in efforts that address the social and economic conditions that influence all health outcomes.”

The research could also help to target aid more effectively in the event of future virus outbreaks.

Lam said: “A similar pandemic could happen in the future. Our research provides an interesting test case for how we adapt. When we design how we allocate our mental health resources, we should invest more in the communities with the greatest need.”