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Mask Mandate's Effect on Job Loss Expectation and Mental Health in the United States during the COVID-19 Pandemic.

BACKGROUND
Uncertainty around economic recovery from a pandemic, in addition to restrictions on mobility and socializing, can be isolating and stressful. While preventive measures, such as mask mandates, are expected to mitigate spread of the disease and lower concerns of future job loss, state- and local-level mandates could signal that infection rates are worse in the mandated areas and decrease consumer confidence and mobility. Thus, the association between mask mandates and psychological well-being is unclear.


AIMS OF THE STUDY
Twenty-five states in the United States implemented statewide mask mandates early in the pandemic. This study seeks to examine the effect of mask mandates on self-reported job loss expectation and mental health.


METHODS
This study analyzes U.S. Census Bureau's Household Pulse Survey data, collected between April 23rd and July 21st, 2020. Using a panel subset of the data, fixed effects models are estimated to understand statewide mask mandate's effect on psychological well-being over a twelve-week period while controlling for individual-level unobserved heterogeneity. All data are then state-aggregated, and fixed effects models are estimated to examine average differences in job loss expectation and mental health between mandate and non-mandate states.


RESULTS
In the individual-level panel data, job loss expectation was lower by 1.1 percentage point by the second week of a statewide mask mandate and by 1.6 percentage point by the third week, compared to average job loss expectation in states without a mask mandate and to the mandate states before the policy implementation. Average job loss expectation was 6.5 percentage point lower by the twelfth week in the five states that were the first to implement statewide mask mandates. Mental health status improved steadily from the fourth week on in states with a mask mandate. Analysis of state-aggregated data indicates considerable variability and lack of uniformity in mask mandates' impact on job loss expectation and mental health status.


DISCUSSION
Local-level mandates, such as those at the county-level, could not be identified in these data. The impact of a mask mandate could be underestimated when only state-level mandates are considered, and local regulations are excluded. This is a limitation of this study.


IMPLICATIONS FOR HEALTH CARE PROVISION
The staggered state-by-state approach to implementing mask mandates and the considerable variability in enforcement of mask rules has possibly contributed to lack of uniformity and consistency in how mask mandates impact subjective psychological well-being.


IMPLICATIONS FOR HEALTH POLICIES
The lack of statistically significant impact of statewide mask mandates on the two outcome variables in the state-aggregated data, and on long-run job loss expectation in the individual-level panel data, could be indicative of the complexities of effective science communication regarding behavioral recommendations to promote overall well-being.


IMPLICATIONS FOR FURTHER RESEARCH
Multiple variants of SARS-CoV-2, the virus that causes COVID-19, has emerged around the world. Further research could more clearly assess the degree to which communicating public health implications of these variants has evolved, and whether it has elicited behavior change and affected psychological well-being.