Fluctuating recovery: Trajectories of young adult mental health through the COVID-19 pandemic 2020-2022

Chang Zhao; Ritika Rastogi; G Alice Woolverton; Tiffany Yip; Hyeouk Chris Hahm; Cindy H Liu

doi:10.1016/j.jad.2025.119694

Fluctuating recovery: Trajectories of young adult mental health through the COVID-19 pandemic 2020-2022

J Affect Disord. 2025 Jun 16:389:119694. doi: 10.1016/j.jad.2025.119694. Online ahead of print.

Authors

Chang Zhao¹, Ritika Rastogi², G Alice Woolverton¹, Tiffany Yip³, Hyeouk Chris Hahm⁴, Cindy H Liu⁵

Affiliations

¹ Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
² Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA.
³ Department of Psychology, Fordham University, Bronx, NY, USA.
⁴ School of Social Work, Boston University, Boston, MA, USA.
⁵ Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: chliu@bwh.harvard.edu.

PMID: 40532882
DOI: 10.1016/j.jad.2025.119694

Abstract

Background: Young adults experienced significant mental health challenges during the onset of the COVID-19 pandemic, yet the long-term trajectories of their mental health remain unclear. This longitudinal study examined anxiety and depression symptom trajectories among U.S. young adults from April-June 2020 to April-June 2022, identifying patterns of recovery, demographic disparities, and symptom fluctuation.

Methods: Data were drawn from the COVID-19 Adult Resilience Experiences Study (CARES), which followed 1221 U.S. young adults (ages 18-30; 83 % women) across four waves via online surveys. Mixed-effects growth models estimated trajectories of anxiety (GAD-7) and depression (PHQ-8) symptoms. Paired-samples t-tests tested mean differences between consecutive timepoints.

Results: At baseline, anxiety (B = 9.59 (0.16), p < .001) and depression (B = 9.07 (0.16), p < .001) symptom levels approached the clinical cutoff (≥10). Significant decreases over time were observed for anxiety (B = -0.29 (0.03), p < .001) and depression symptoms (B = -0.20 (0.03), p < .001). However, symptom improvements were not uniform; for example, gender minorities showed persistently elevated depression symptoms. Anxiety and depression symptoms also fluctuated significantly across timepoints.

Conclusions: These findings challenged narratives of sustained mental health deterioration among young adults during the pandemic by demonstrating recovery. However, recovery varied by demographic groups. Symptom fluctuations underscored the need for flexible, responsive mental health care, particularly during periods of heightened societal stress.

Keywords: Anxiety; COVID-19; Depression; Health disparities; Longitudinal; Young adults.