Impact of the COVID-19 pandemic on mental health, relationship satisfaction, and socioeconomic status: United States

Abstract Background The coronavirus disease 2019 pandemic disproportionately impacted mental health and relationship satisfaction, particularly among individuals from lower socioeconomic status (SES) backgrounds. Aim The aim of this study is to examine the relationship between the pandemic and mental health outcomes (depression, anxiety, substance use, and psychological distress) using a mediated moderation analysis. Method Secondary data analysis was conducted using data from a state-wide screening, brief intervention, and referral to treatment project, with 1,718 participants throughout Rhode Island, United States. The Client Outcome Measures for Discretionary Programs tool was administered during interviews. A mediated moderation model assessed the pandemic’s impact (independent variable), relationship satisfaction (mediator), and SES (moderator) on five outcomes: alcohol use, cannabis use, anxiety, depression, and psychological distress. Generalized Linear Mixed Effects Models estimated associations, adjusting for participant and regional variations. Results While no significant total mediated effects were found ( p > 0.05), higher relationship satisfaction was associated with lower anxiety ( β = −0.13, p < 0.0001), depression ( β = −0.18, p < 0.0001), and psychological distress ( β = −0.16, p < 0.0001). A small positive association with alcohol use was found ( β = 0.04, p = 0.0938) with relationship satisfaction. SES moderated mental health outcomes, with low-income participants experiencing greater depression ( β = −0.09, p = 0.0015) and psychological distress ( β = −0.12, p = 0.0015). Conclusion Findings underscore the role of SES and relationship satisfaction in mental health during crises. Targeted interventions and policies addressing SES disparities, and relationship-based services are recommended.