Mental health and pain trends among U.S. adults with arthritis: A comparative analysis of 2019 and 2023 national data

Introduction: The COVID-19 pandemic led to broad increases in depression, anxiety, and psychological distress. Adults with arthritis may be especially vulnerable due to high baseline pain, functional limitations, and longstanding psychosocial burden. This study evaluated changes in depression, anxiety, counseling use, and pain burden from 2019 to 2023 and compared outcomes between adults with and without arthritis using nationally representative U.S. data. Methods: Adults ≥18 years from the 2019 and 2023 National Health Interview Survey (NHIS) Adult Files were analyzed. Outcomes included lifetime depression, lifetime anxiety disorder, current counseling use, and three-month pain frequency and interference. Demographic and clinical characteristics were compared by year and arthritis status. Changes were assessed using proportion comparisons. Multivariable logistic regression examined associations between race/ethnicity and arthritis, mental-health, and pain outcomes, adjusting for age, sex, and survey year. Results: The sample included 61,519 adults (31,997 in 2019; 29,522 in 2023). Depression, anxiety, counseling use, and pain burden all increased significantly from 2019 to 2023 (p < .001). Arthritis prevalence remained stable (25.7 %–26.2 %). Across both years, adults with arthritis had roughly twice the prevalence of depression (28.5 % vs 16.4 % in 2023) and anxiety (24.9 % vs 16.1 %) compared with those without arthritis, and substantially higher frequent pain (53.6 % vs 16.5 %). Within the arthritis cohort, depression and anxiety remained stable, while counseling use increased modestly (7.7 %–9.0 %, p = .004). Racial and ethnic disparities persisted across arthritis, pain, and mental-health outcomes. Conclusion: Adults with arthritis consistently showed higher depression, anxiety, and pain than those without arthritis, with no evidence of post-pandemic worsening. These findings suggest longstanding vulnerability rather than new pandemic-related change and support integrating brief mental-health screening into routine musculoskeletal care to improve timely recognition and referral.