Despite the May 11, 2023 official end date of the COVID-19 Public Health Emergency in the United States (US),1 health and societal issues surrounding the COVID-19 pandemic and its endemic phase will likely be long-lasting. Individuals with disabilities comprise one group disproportionately affected by the pandemic.2 More serious impacts of COVID-19 borne by people with disabilities stretch across disability type, from physical to psychological functioning.3 While the Centers for Disease Control and Prevention (CDC) estimate approximately 27.2% or 66 million United States adults have a disability,4 this number has likely grown in the wake of the pandemic as a proportion of individuals recovering from the virus acquire long-term limitations. According to a Center for American Progress analysis of US Bureau of Labor Statistics data, some 1.2 million more people were identified as having a disability in 2021 than in 2020.5 Though such physical issues have great impact, psychological issues spurred by fear, isolation, and often divisive rhetoric surrounding COVID-19 continue to have long-lasting implications as well.6

Synthesis research indicates depression prevalence remained elevated in US adults from March 2020 through much of 2021.7 Federal estimates show elevated symptoms of depression continue nationwide.8 Depression symptoms have not been experienced uniformly, however. Factors including age, disability status, education level, race and Hispanic ethnicity, sex, and sexuality may correlate with symptom differences.8, 9, 10, 11 Outweighing multiple demographic factors, disability shows a strong association with pandemic mental health issues.10 National Center for Health Statistics (NCHS) data indicate above 40% of people with disabilities consistently experienced symptom presence from April 14, 2021 through October 30, 2023. This amount greatly exceeds that of people without disabilities. During that period, less than 20% of people without disabilities reported symptom presence.8

Myriad causes may contribute to elevated symptom presence in people with disabilities. Federal data indicate that US adults with disabilities already experienced depression symptom presence at a significantly higher level than counterparts without disabilities prior to the pandemic.12 In addition to greater risk of serious outcomes from COVID-19 infection,2 people with disabilities disproportionately experienced employment and other economic effects, possibly increasing distress.10 Care rationing also affected people with disabilities at greater proportions.13,14 Rationing included allotment of lower importance in ventilator supply algorithms, intensive care placement, and vaccine access, as well as increased barriers to routine care.13,14 People with disabilities encountered outsized restrictions due to hospitals' reliance on life expectancy—a metric often biased against individuals with disabilities and other groups experiencing oppression.15 Earlier pandemic stages featured preemptive placements of individuals with disabilities in skilled nursing facilities to free hospital space, moves often detrimental as such facilities experienced high virus transmission rates and were already stretched past their limits.16 Though the pandemic's crisis nature and other critical events may demand resource rationing, overly exclusionary metrics introduce biases more related to perception than evidence.17

Small-scale surveys suggest ties between pandemic-related perceived prejudice and elevated mental health concerns for people with disabilities.11,18 While pandemic era disability-related prejudice may be tied to desires of non-disabled individuals not to be reminded of their own vulnerability,18 face masking presented another tangible reminder of vulnerability.19 Relaxation and removal of masking mandates provide real and metaphorical symbols of perceived public disregard for people with disabilities, a phenomena Grunawalt terms “necropolitical” in an exploration of the COVID-19 anti-mask movement's effect on people with disabilities.19 While discussing signs and slogans prevalent at national anti-mask protests, the author notes, “The overarching dismissal of vulnerable lives by anti-maskers in these signs reveals an underlying eugenic-adjacent ideology beneath this movement. In the same breath they claim virtually nobody is affected, they make distinctions between ‘weak’ and ‘strong’ bodies, content with removing these vulnerable groups from the population if it means they can return to normal.”19(p4)

Grunawalt's work argues that, within the anti-mask movement, mask wearing equates to weakness.19 In light of Cox and colleagues' Integrated Perspective on Prejudice and Depression,20 stereotyping people with disabilities as weak may contribute to their adverse psychological outcomes. The framework maintains one group, the Source, holds stereotypes about another group, the Target. Stereotypes lead Sources to discriminate against Targets. Targets then experiences depression.20

Possible psychological effects of such “eugenic-adjacent”19(p4) dogma on people with disabilities, those frequently at risk from anti-masking behaviors, are not as directly traceable as physical effects of COVID-19. However, exploration of depression symptom presence preceding and following incidents of masking restriction reductions may offer perspective on psychological ramifications. The present research examines whether relaxations in national masking mandates may have coincided with alterations in depression-related symptoms for adults with disabilities.