Risk Factors Linked to Anxiety Disorders Differ Between Men and Women During the Pandemic

Summary: Pandemic-associated risk factors for anxiety differ between men and women, researchers say. Higher anxiety in males was associated with COVID misinformation, while women’s anxiety was more commonly associated with concerns about employment. Overall, the prevalence of general anxiety disorder was significantly higher in women than in men.

Source: University of Toronto

The COVID-19 pandemic is an anxiety-inducing stressor that affects every aspect of our daily lives. A new Canadian study has found that the pandemic-related risk-factors associated with anxiety differ between men and women.

The new nation-wide research, published online in the Journal of Affective Disorders, estimates that 13.6%, or one out of seven Canadians, experienced clinically significant levels of Generalized Anxiety Disorder (GAD) in the early months of the COVID-19 pandemic. (Before the pandemic, past research set the 12-month prevalence of GAD in Canada at 2.6%.)

In addition, the study found that high anxiety in men is related to exposure to COVID-19 misinformation, while women’s anxiety was tied to precarious employment. The prevalence of Generalized Anxiety Disorder among women was significantly higher than among men (17.2% vs. 9.9%, respectively.)

“It is fundamental that we strive to understand the social factors that contributed to these striking differences,” says the lead author Shen (Lamson) Lin, a doctoral candidate at the University of Toronto’s Factor-Inwentash Faculty of Social Work. “The COVID-19 pandemic is the first to occur in conjunction with widespread use of social media, which facilitates the distribution of misinformation, such as vaccine rumors and unproven treatments, also known as the COVID-19 infodemic. My study discovered that frequent exposure to fake COVID-19 news is associated with mental health consequences, particularly for men.”

As exposure to suspected COVID-19 misinformation increased among men, the odds of anxiety disorders escalated. Men in the lowest exposure bracket (i.e., those who reported that they were exposed to misinformation at least once a week) were three times more likely to report high anxiety, while men in the highest exposure bracket (i.e., those who reported that they were exposed to misinformation multiple times a day) were six and a half times more likely to report clinically significant anxiety compared to those who reported that they rarely or never saw misinformation about COVID-19.

Women’s anxiety levels were more likely to be impacted by increased job precarity due to business closures, layoffs, mandatory quarantines and COVID-19 infections. Women who experienced job precarity during the pandemic had triple the odds of experiencing Generalized Anxiety Disorder compared to women who were securely employed, after controlling for confounding variables, including sociodemographic factors. Precious employment among men did not correlate with anxiety disorders, possibly because job precarity was not evenly distributed among genders.

“Gender-based occupational segregation results in women being overrepresented in the health and social care workforce, where they are often underpaid and have a higher risk of exposure to COVID-19 pathogens,” says Lin. “Women are also overrepresented in foodservice and accommodation sectors, which were hard hit by the COVID-19 crisis”.

The study analyzed the publicly available data from the Canadian Perspective Survey Series which included 1,753 men and 2,016 women aged 15 years and older. Anxiety symptoms were assessed by the standardized Generalized Anxiety Disorder-7 (GAD-7) scale that evaluates symptoms such as feeling nervous, unable to control worrying, have trouble relaxing, and becoming easily annoyed in the past two weeks. In addition, this research also identifies common risk factors of anxiety disorders for both genders, including increased intake of alcohol, cannabis and junk/sweet food during the COVID-19 outbreak.

“Mental health interventions need to be gender responsive,” says Lin. “They should also tackle upstream social determinants of health in this public health emergency.”

Abstract

Generalized anxiety disorder during COVID-19 in Canada: Gender-specific association of COVID-19 misinformation exposure, precarious employment, and health behavior change

Background

Growing evidence has demonstrated the mental health sequelae of the COVID-19 pandemic. Few studies have examined how pandemic-related stressors and resilience factors of anxiety affect women and men differently in Canada.

Methods

Population-based data from the Canadian Perspective Survey Series (CPSS-4: July 20 to 26, 2020) were analyzed to examine the relationship between Generalized Anxiety Disorder-7 scale (GAD-7) with COVID-19 misinformation exposure, precarious employment, and health behavior changes, after adjusting for socio-demographic variables. Stratified by gender, two multinomial logistic regression were conducted to calculate the likelihood of having minimal–mild anxiety (1≤ GAD score <10) and moderate–severe anxiety (GAD score ≥10), compared to no anxiety symptoms (GAD=0).

Results

Overall, respondents (n = 3,779) were mainly Canadian-born (76.3%), aged >25 years (85.4%) and high school graduate (87.9%). The population prevalence of moderate–severe GAD was 13.6%, with women significantly higher than men (17.2% vs. 9.9%, p<0.001). For women (n = 2,016), GAD was associated with being absent from work due to COVID-19 reasons (OR=3.52, 99% CI:1.12–11.04), younger age (ORs range from 2.19 to 11.01, p’s<0.01), being single/widowed (OR=2.26, 99% CI 1.18–4.33), no past-week contacts outside household (OR=2.81, 99% CI:1.24–6.37), no outdoor exercise (OR=1.86, 99% CI:1.13–3.07). For men (n = 1,753), GAD was associated with frequent fake news exposure (dose-response relations: ORs range from 3.14 to 6.55, p’s<0.01), increased time of watching TV (OR=2.62, 99% CI: 1.31 – 5.27), no indoor exercise (OR=1.91, 99% CI:1.07–3.42). For both genders, GAD was associated with increased intake of alcohol, cannabis, and junk/sweet food (p’s<0.01).

Limitations

Cross-sectional data prohibits causal inferences; self-reporting biases of GAD symptoms requires confirmation with diagnostic records.

Conclusion

The gendered impact of the COVID-19 pandemic was observed in the associations between clinically significant anxiety with COVID-19 misinformation exposure, job precarity, and addictive behaviors in Canada. Mental health interventions need to be gender responsive and should tackle upstream social determinants of health in this public health emergency.