Summary In this study, we examined emotional distress using annual representative survey data from 1.53 million people surveyed in 113 countries between 2009 and 2021. Participants reported whether they had experienced worry, sadness, stress, or anger for much of the previous day. Estimates within the country showed that the prevalence of feelings of emotional distress increased from 25 to 31% between 2009 and 2021, with those with low levels of education and income experiencing the largest increases in distress. Globally, the pandemic period was characterized by an initial surge in distress in 2020 followed by a recovery in 2021. |
Emerging evidence suggests that psychological distress has increased substantially in recent years in the United States and the United Kingdom. Spurred by evidence documenting the rise in “deaths of despair” and distress in the United States, a recent study showed that extreme distress among American adults increased from 3.6% in 1993 to 6.4% in 2019 This increase was related to low education and the precariousness of the labor market. A second US study found an increase in distress among working-age adults from 16.1% in 1999-2000 to 22.6% in 2017-2018. In the UK, increases in distress have been identified since 2010 in young adults and since 2015 in working-age adults. Additionally, there is evidence that these increases may have been exacerbated by the COVID-19 pandemic.
On a global scale, the demographic impacts of the 2008 to 2010 financial crisis and the COVID-19 pandemic in 2020 have been linked to increased mental health difficulties and emotional distress in affected nations. However, a comprehensive picture of contemporary trends in distress situations has not yet emerged. To address this issue, we examined the most up-to-date data from the Gallup World Poll ’s representative survey of 113 countries to estimate global changes in feelings of emotional distress from 2009 to 2021, including during the COVID-19 pandemic.
Results
Regression analyzes showed that the prevalence of feelings of distress increased from 25.16% in 2009 to 31.19% in 2021, an overall increase of 6.03 percentage points [95% CI (4.32, 7.75 )]. Statistically significant increases in levels of emotional distress were observed between 2009 and 2021 across all demographic groups examined (Fig. 1) and were greatest among those with primary education [9.53%, 95% CI (7.06, 11 .99)] and those in the lowest income quintile [7.27%, 95% CI (5.44, 9.10)].
From 2009 to 2021, there was a substantial increase in feelings of stress [9.97%, 95% CI (7.38, 12.56)], sadness [6.31%, 95% CI (4.41, 8 .22)] and worry [6.22%, 95% CI (4.00, 8.47)]. Anger did not increase significantly over the study period [1.61%, 95% CI (−0.1, 3.32)].
The 2020 pandemic dummy variable was statistically significant [B = 2.49, 95% CI (0.71, 4.27)] in a model accounting for the curvilinear time trend in distress, indicating that in 2020, distress increased 2.5 percentage points above the existing level. Pre-pandemic trend in distress. Significant increases in distress were found in 2020 among most demographic groups, except those aged ≥55 years and the lowest education and income groups.
The largest increase in distress observed in 2020 was among those under 35 years of age [B = 3.98, 95% CI (2.02, 5.93)]. Distress levels decreased from 2020 to 2021 [B = -1.47, 95% CI (-2.55, -0.39)]. The dummy variable for the 2021 wave was not statistically significant [B = 1.04, 95% CI (−0.74, 2.82)]. This indicated that for 2021, distress levels did not significantly deviate from the existing temporal trend in distress, as estimated using pre-pandemic distress data.
Figure : Estimated time trends in emotional distress among 1.53 million participants aged 15 years and older in 113 countries between 2009 and 2021. Figure panels are based on regression analysis and show distress trends by (A) group age, (B) sex of participant, (C) education levels, and (D) income quintiles.
Discussion
Using a 113-country sample of more than 1.5 million adults , this study provides insight into recent global changes in emotional distress. From 2009 to 2021, the prevalence of feelings of distress increased markedly from 25 to 31 percent, an increase of 6 percentage points or 24 percent. Increases in distress were found across all demographic groups and were greatest among the most disadvantaged groups.
These findings are consistent with evidence of increasing distress and growing socioeconomic disparities in distress in the United States. Understanding the factors (e.g. economic insecurity, political instability, reduced social cohesion) that explain potential growing disparities in distress on a global scale will now be crucial. It will also be important to determine the health implications of increased levels of distress, including distress-related outcomes such as increased opioid use.
We found that distress levels increased by 2.5 percentage points during the pandemic in 2020 above the general trend of increasing distress time. This finding is consistent with evidence from longitudinal studies indicating that the pandemic had a small adverse psychological effect . Furthermore, the increase in pandemic-related distress found in this study was short-lived . Distress levels decreased from 2020 to 2021 and at this point were no higher than expected based on pre-pandemic trends. This result is consistent with findings suggesting that populations adapted flexibly to the stressful circumstances of the pandemic and recovered relatively quickly from the distressing impact of the initial lockdown period.
This study draws on global survey data to quantify recent population-level changes in emotional distress, including during the COVID-19 pandemic. However, the study is limited in its reliance on a brief measure of self-reported distress, relatively small national annual samples, which may increase sampling error, and reliance on a subset of 113 countries to estimate global changes in emotional distress.
