ArticleBrain and behavior2026
COVID-19 Infection Is Associated With Higher Stress in Urban American Indian and Alaska Native Peoples: Results From a Cross-Sectional Survey.
Article in Brain and behavior, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionAmerican Indian and Alaska Native (AI/AN) communities experienced a disproportionate burden of COVID-19, including among the highest rates of infection, hospitalization, and mortality in the United States. The pandemic also introduced widespread stressors, and elevated perceived stress is itself a risk factor for adverse physical and mental health outcomes. Little is known about whether COVID-19 infection is associated with perceived stress among AI/AN peoples. We examined the association between self-reported COVID-19 infection and perceived stress among urban AI/AN adults.
methodsSelf-report surveys were initiated by N = 788 patients of 5 geographically dispersed health organizations that primarily served AI/AN peoples in urban settings between January and May of 2021. COVID-19 infection was assessed by participants' self-report of either a positive test result or having been informed they were infected by a health professional. Stress was measured using the Perceived Stress Scale-4 (PSS-4). The relationships between COVID-19 infection and mean stress were assessed using linear regressions; the relationships between COVID-19 infection and specified stress levels were assessed using modified Poisson regressions with results expressed as relative risk (RR).
resultsCOVID-19 infection was associated with an adjusted β = 0.9 (95% CI: 0.1, 1.8) points higher mean PSS-4 score and RR = 3.2 (95% CI: 1.2, 8.5) of high (≥13) PSS-4 score.
conclusionsCOVID-19 infection was associated with elevated perceived stress among urban AI/AN adults; this association was robust to adjustment for comorbid health conditions, social determinants of health, healthcare access, and pandemic-related stressors. Healthcare providers should be aware that AI/AN people who have been infected with COVID-19 are at higher risk of elevated stress, and further research on the downstream health consequences of stress among those infected with COVID-19 is warranted.
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