Differential Effects of Pandemic-Related Stressors on Mental Health by Age and Sex

Overview

Journal Healthcare (Basel)

Specialty Health Services

Date 2025 Feb 13

PMID 39942413

Authors

Joshua B Borja

Scott B Patten

Affiliations

Soon will be listed here.

Abstract

Objective: There have been consistent concerns about a greater impact of COVID-19 on the mental health of younger people and females. We aimed to explore the potential synergistic effect of various pandemic-related stressors with age and sex on the mental health of the general Canadian household population during the COVID-19 pandemic.

Methods: Using cross-sectional data from the Statistics Canada 2022 Mental Health and Access to Care Survey (MHACS), frequencies for major depressive episode (MDE), generalized anxiety disorder (GAD), general psychological distress, and various pandemic-related and demographic factors were estimated. Odds ratios were estimated using binary logistic regression models. These estimates used a replicate bootstrapping procedure recommended by Statistics Canada. Finally, Relative Excess Risk due to Interaction (RERI) models were used for each outcome to evaluate the interactions of each pandemic-related stressor with age and sex on an additive scale.

Results: Past-12-month MDE and GAD, psychological distress, and the various COVID-19 stressors were more prevalent in young people and females. Overall, the stressors were confirmed to be associated with these outcomes. There were greater-than-additive interactions between age and difficulty accessing healthcare, loneliness, physical health problems, household relationship challenges, and work stress; and between sex and severe illness of a loved one, loneliness, work stress, LGBTQ2+ status, marital status, difficulty accessing healthcare, physical health problems, job/income loss, and financial difficulties. Generally, evidence of synergy was found between age and pandemic-related stressors and sex and pandemic-related stressors.

Conclusions: Greater-than-additive interactions of pandemic-related stressors with age and sex may indicate synergistic vulnerabilities within females and young people. Future pandemics, via corresponding stressors, may be associated with increased mental health vulnerability in females, youth, and especially young females.

References

Kessler R, Angermeyer M, Anthony J, de Graaf R, Demyttenaere K, Gasquet I . Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry. 2008; 6(3):168-76. PMC: 2174588. View

Yan S, Xu R, Stratton T, Kavcic V, Luo D, Hou F . Sex differences and psychological stress: responses to the COVID-19 pandemic in China. BMC Public Health. 2021; 21(1):79. PMC: 7789895. DOI: 10.1186/s12889-020-10085-w. View

Vallieres F, Murphy J, McBride O, Shevlin M, Gilmore B, Travers A . The role of psychosocial factors in explaining sex differences in major depression and generalized anxiety during the COVID-19 pandemic. BMC Public Health. 2022; 22(1):1563. PMC: 9382004. DOI: 10.1186/s12889-022-13954-8. View

Jones E, Mitra A, Bhuiyan A . Impact of COVID-19 on Mental Health in Adolescents: A Systematic Review. Int J Environ Res Public Health. 2021; 18(5). PMC: 7967607. DOI: 10.3390/ijerph18052470. View

Schmidt S, Barblan L, Lory I, Landolt M . Age-related effects of the COVID-19 pandemic on mental health of children and adolescents. Eur J Psychotraumatol. 2021; 12(1):1901407. PMC: 8075089. DOI: 10.1080/20008198.2021.1901407. View

Rao S, Dimitropoulos G, Williams J, Sharifi V, Fahim M, Munir A . Associations between negative COVID-19 experiences and symptoms of anxiety and depression: a study based on a representative Canadian national sample. Health Promot Chronic Dis Prev Can. 2024; 44(2):56-65. PMC: 11013027. DOI: 10.24095/hpcdp.44.2.03. View

VanderWeele T, Robins J . The identification of synergism in the sufficient-component-cause framework. Epidemiology. 2007; 18(3):329-39. DOI: 10.1097/01.ede.0000260218.66432.88. View

Wang J . Work stress as a risk factor for major depressive episode(s). Psychol Med. 2005; 35(6):865-71. DOI: 10.1017/s0033291704003241. View

Holmes A, Christelis N, Arnold C . Depression and chronic pain. Med J Aust. 2014; 199(S6):S17-20. DOI: 10.5694/mja12.10589. View

10.

Brooks S, Webster R, Smith L, Woodland L, Wessely S, Greenberg N . The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020; 395(10227):912-920. PMC: 7158942. DOI: 10.1016/S0140-6736(20)30460-8. View

11.

Khattar J, Griffith L, Jones A, De Rubeis V, de Groh M, Jiang Y . Symptoms of depression and anxiety, and unmet healthcare needs in adults during the COVID-19 pandemic: a cross-sectional study from the Canadian Longitudinal Study on Aging. BMC Public Health. 2022; 22(1):2242. PMC: 9713148. DOI: 10.1186/s12889-022-14633-4. View

12.

Keyes K, Pratt C, Galea S, McLaughlin K, Koenen K, Shear M . The burden of loss: unexpected death of a loved one and psychiatric disorders across the life course in a national study. Am J Psychiatry. 2014; 171(8):864-71. PMC: 4119479. DOI: 10.1176/appi.ajp.2014.13081132. View

13.

Heck N . The Potential to Promote Resilience: Piloting a Minority Stress-Informed, GSA-Based, Mental Health Promotion Program for LGBTQ Youth. Psychol Sex Orientat Gend Divers. 2015; 2(3):225-231. PMC: 4564052. DOI: 10.1037/sgd0000110. View

14.

Lee C, Cadigan J, Rhew I . Increases in Loneliness Among Young Adults During the COVID-19 Pandemic and Association With Increases in Mental Health Problems. J Adolesc Health. 2020; 67(5):714-717. PMC: 7576375. DOI: 10.1016/j.jadohealth.2020.08.009. View

15.

Ettman C, Abdalla S, Cohen G, Sampson L, Vivier P, Galea S . Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic. JAMA Netw Open. 2020; 3(9):e2019686. PMC: 7489837. DOI: 10.1001/jamanetworkopen.2020.19686. View

16.

McQuaid R, Cox S, Ogunlana A, Jaworska N . The burden of loneliness: Implications of the social determinants of health during COVID-19. Psychiatry Res. 2020; 296:113648. PMC: 9754822. DOI: 10.1016/j.psychres.2020.113648. View

17.

Watterson R, Williams J, Lavorato D, Patten S . Descriptive Epidemiology of Generalized Anxiety Disorder in Canada. Can J Psychiatry. 2016; 62(1):24-29. PMC: 5302105. DOI: 10.1177/0706743716645304. View

18.

Villanti A, LePine S, Peasley-Miklus C, West J, Roemhildt M, Williams R . COVID-related distress, mental health, and substance use in adolescents and young adults. Child Adolesc Ment Health. 2022; 27(2):138-145. PMC: 9018497. DOI: 10.1111/camh.12550. View

19.

Shin H, Park C . Gender differences in social networks and physical and mental health: are social relationships more health protective in women than in men?. Front Psychol. 2024; 14:1216032. PMC: 10782512. DOI: 10.3389/fpsyg.2023.1216032. View

20.

Racine N, McArthur B, Cooke J, Eirich R, Zhu J, Madigan S . Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis. JAMA Pediatr. 2021; 175(11):1142-1150. PMC: 8353576. DOI: 10.1001/jamapediatrics.2021.2482. View