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There is a paucity of longitudinal data on the role of fear of COVID-19 in mental health and the role mental health supports may have played in this. Such evidence would be vital to understanding what was effective in protecting populations from the predicted deterioration of mental health during prolonged pandemics. Our specific objective was to examine how trajectory of symptoms of anxiety and depression related to fear of COVID-19, and what role substance use and utilization of mental health supports played in these associations. We collected baseline data in the summer of 2020 and one-time follow-up one year later in Philadelphia, Pennsylvania, US. We collected the Hospital Anxiety and Depression scale, queried worries about the infection, and only at follow-up asked the validated fear of COVID-19 scale (FCV-19S) and inquired about use of mental health supports, anxiety and sleep medication, alcohol consumption and smoking. Fear was measured on a continuous scale with no established cutoffs to define "fearful". The core of the inferences relied on path analysis that was informed by our hypotheses. Anxiety symptoms increased in severity in fewer participants (18%) than depression symptoms (58%). About a third of the participants sought one-on-one mental support from a health professional by 2021. Those who grew more anxious a year into the pandemic appeared to be more fearful, whereas those who grew more depressed were less fearful, after allowing for role of gender. Greater fear of COVID-19 at follow-up was associated with increased use of sleep and anxiety medications between baseline and follow-up, and those who sought mental health support between baseline and follow-up appeared to have improved depressive symptoms and reduced fear at follow-up. We strengthen the evidence that professional mental health supports facilitated access to anxiety medications, and reduced risk of worsening depression, which was on the rise overall at that time.