Change in Health-Related Socioeconomic Risk Factors and Mental Health During the Early Phase of the COVID-19 Pandemic: A National Survey of U.S. Women

Abstract

Background: During a pandemic, women may be especially vulnerable to secondary health problems driven by its social and economic effects. We examined the relationship between changes in health-related socioeconomic risks (HRSRs) and mental health. Materials and Methods: A cross-sectional survey of 3,200 women aged 18-90 years was conducted in April 2020 using a quota-based sample from a national panel (88% cooperation rate). Patterns of change in HRSRs (food insecurity, housing instability, interpersonal violence, and difficulties with utilities and transportation) were described. Weighted, multivariate logistic regression was used to model the odds of depression, anxiety, and traumatic stress symptoms among those with and without incident or worsening HRSRs. Results: More than 40% of women had one or more prepandemic HRSRs. In the early pandemic phase, 49% of all women, including 29% with no prepandemic HRSRs, had experienced incident or worsening HRSRs. By April 2020, the rates of depression and anxiety were twice that of prepandemic benchmarks (29%); 17% of women had symptoms of traumatic stress. The odds of depression, anxiety, and posttraumatic stress symptoms were two to three times higher among women who reported at least one incident or worsening HRSR; this finding was similar for women with and without prepandemic HRSRs. Conclusions: Increased health-related socioeconomic vulnerability among U.S. women early in the coronavirus disease 2019 (COVID-19) pandemic was prevalent and associated with alarmingly high rates of mental health problems. Pandemic-related mental health needs are likely to be much greater than currently available resources, especially for vulnerable women.

COVID-19-Related Food Insecurity Among Households with Dietary Restrictions: A National Survey

“…We acknowledge limitations to these findings. Although our dataset closely resembles U.S. population data for women, 28 our findings are limited in generalizability by the use of a panel-based quota sample rather than a probability sample. Our use of an online survey may underestimate food insecurity by excluding a small subset of households with limited internet access—a more prevalent condition among Black and Hispanic households than in White and Asian households.…”

“… 15 , 16 , 59 Our study may be limited by sample size, in particular for analyses with smaller subgroups; the overall study was designed to ensure reasonably precise estimates in subgroups of interest for the primary objectives of the National Women's COVID Health Study (ie, racial/ethnic groups). 28 However, in a post hoc analysis calculating the minimally detectable difference between those with no food restriction and those with both FA and CeD (our smallest comparison group), given that 35% of the sample with no food restrictions were food insecure, we were powered to detect a difference in proportion of food insecurity between groups of 14% (power = 0.80, alpha = 0.05). Similarly, for the subgroup of the sample with CeD (5.4%), we calculate a minimally detectable difference between households with no food restrictions and those with CeD of 12%.…”

“…The details of the survey sample for the National Women's Health COVID-19 Study have been previously described. 28 Between April 10 and April 24, 2020, a U.S. national sample of adult women was recruited using the Opinions 4 Good (Op4G) Health Care Panel. 29 Op4G is a philanthropic market research company whose panels of participants have been used in prior peer-reviewed studies.…”

“…29 Op4G is a philanthropic market research company whose panels of participants have been used in prior peer-reviewed studies. 28 , 30 , 31 Op4G maintains sociodemographic and health characteristics for each panelist to facilitate targeted recruitment of eligible individuals for future studies. The Op4G Health Care Panel comprises 350,000+ members recruited pre-pandemic using a combination of methods including nonprofit community partners, web campaigns, and word of mouth.…”

Comparison of Mental Health Symptom Changes from pre-COVID-19 to COVID-19 by Sex or Gender: A Systematic Review and Meta-analysis

“…13,14 Some studies have reported that COVID-19 mental health effects have been greater for women than men. 5,[15][16][17][18] These, however, have been cross-sectional studies that evaluated proportions of participants above cut-offs on self-report measures without consideration of pre-COVID-19 differences, even though mental health disorders and symptoms are more common among women. [19][20][21][22][23] Evidence from longitudinal cohorts that compare mental health symptoms pre-COVID-19 to during COVID-19 is needed.…”