COVID-19 Infection Is Associated With Higher Stress in Urban American Indian and Alaska Native Peoples: Results From a Cross-Sectional Survey.

INTRODUCTION: American 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. METHODS: Self-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). RESULTS: COVID-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. CONCLUSIONS: COVID-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.