Joel C. Cantor, Carl Van Horn, James Walkup, Dawne Mouzon, and Michael Yedidia

Concern about mental health in the COVID-19 pandemic has been appropriately high. A recent review of a vast and diverse literature on the topic last year concluded that mental health did in fact worsen in the pandemic, but that – on average – people remained remarkably resilient in the face of pandemic stressors. But averages can hide important variations. The authors of the review concluded that some subgroups, such as health care workers and adolescents, have fared less well over time.

A new analysis of mental health symptoms from late April through July 2021 using a national survey from the US Census Bureau documented wide racial/ethnic disparities. The study found much greater reports of depressive and anxiety symptoms among Hispanic and Black respondents compared to non-Hispanic whites. These racial/ethnic differences were explained largely by structural factors such as job and income loss, which are disproportionately experienced by people of color. Interestingly, the study also concluded that more generous state policies, such as higher unemployment benefits and expanding Medicaid eligibility, slightly mitigated negative impacts on mental health across the board, regardless of race/ethnicity.

The same structural forces that drive broad social inequities have been major factors in mental health resilience during the pandemic. Economic factors, such as the likelihood of job loss and discrimination in hiring, disproportionally affect minority populations, and these factors are also key mediators of mental health outcomes. Policy factors may also reinforce these disparities. For example, states with the highest shares of African Americans also disproportionately offer comparatively low unemployment insurance benefits and have been least likely to expand Medicaid under the Affordable Care Act.

While the impact of the pandemic has been profound and may continue for the foreseeable future, society also regularly experiences other kinds of shocks with grave potential consequences for health and wellbeing and similar inequities in impact. Business cycles regularly mete out such stressors. At the bottom of these cycles, periodic recessions disproportionately affect low-wage workers, those without a college education, and people of color, all of whom are more likely to lose jobs and remain unemployed over the long term. This leads to a particularly vicious cycle – job loss negatively impacts mental health, and diminished mental health, in turn, reduces the likelihood of successful job search.

Public policies that address structural impediments to achieving positive mental health in the face of crises such as the pandemic and major recessions are sorely needed. In our New Jersey Policy Lab project, we are looking at one such opportunity at the intersection of unemployment and mental health by considering ways to link delivery of mental health supports to high-risk individuals receiving unemployment insurance (UI). While state departments of labor which administer UI do not have the capacity or expertise to deliver mental health services, we believe that there are opportunities to develop public-private partnerships where local healthcare organizations or state health agencies work with UI program administrators to identify and assist individuals at greatest risk of diminished mental health and long-term unemployment during economic downturns.