The COVID-19 pandemic and the mitigation policies it prompted may have had profound consequences for the
psychological health of U.S. adults, including their risk of dying from drug overdose and suicide. To mitigate the
spread of COVID-19, some U.S. states enacted policies like stay-at-home orders and business closures. To
mitigate adverse economic and health effects, some states enacted policies like eviction moratoria and extended
unemployment benefits. These policies may have affected adults’ psychological health and related mortality
through social isolation, work-family conflict, interpersonal strain, economic wellbeing, employment disruptions,
and more. The overarching objective of this proposal is to rigorously assess how state-level COVID-19
mitigation policies have affected psychological health and related mortality from drug overdose and suicide
among working age and older adults. The project is significant and will have a sustained impact because it: 1)
identifies how states’ mitigation policies affect psychological health and mortality in both the short and longer-
terms, 2) leverages adults’ self-reports of how COVID-19 and mitigation policies affected their lives and
psychological health with county-level administrative data on drug overdose and suicide mortality, and 3)
empirically develops meaningful composite measures of state mitigation policies to assess their impact on
psychological health and mortality. The project is innovative in that it: 1) uses and extends novel survey data
from working-age adults on how the pandemic and its mitigation policies affected their lives, 2) uses recently-
developed methods for analyzing large contextual datasets containing high-dimensional and correlated data and
3) focuses on the impacts of policies on psychological health and related causes of death, specifically drug-
overdoses and suicides, in the short and longer terms. The project will accomplish its objective through three
Specific Aims. Aim 1 identifies how U.S. states’ COVID-19 policies are associated with adult psychological
health. It uses a new, national survey of U.S. adults aged 18-64 (National Wellbeing Survey) conducted in
Feb/Mar 2021 by PI Monnat. Using its self-reported data on how COVID-19 has affected people’s lives, we will
assess: a) how states’ COVID-19 policies predict individuals’ psychological health approximately one year after
COVID-19 began in the U.S., b) how economic, social, and health care conditions help explain the associations;
and c) how the associations vary by age, sex, race/ethnicity, and education. Aim 2 identifies how U.S. states’
COVID-19 policies affected fatal drug overdose and suicide rates at the county level. Using mortality data from
the National Vital Statistics System, we will assess: a) the immediate and lagged effects of states’ COVID-19
policies on county-level fatal drug overdose and suicide rates among adults aged 18 and older, b) how economic,
social, and health care conditions explain these effects, and c) variation by age, sex, and race/ethnicity. Aim 3
collects four new annual waves of the NWS, in close collaboration with the Consortium, to identify longer-term
consequences of states’ COVID-19 policies and individuals’ adaptations on adult psychological health.
