The study from H. Wang et al.

(2020) did not explicitly state the prevalence rates, but the

associated risk factors for higher psychological distress symptoms were reported (i.e., younger

age groups and female gender are more likely to develop psychological distress). Other

predictive factors included being migrant workers, profound regional severity of the outbreak,

unmarried status, the history of visiting Wuhan in the past month, higher self-perceived impacts

of the epidemic (Qiu et al., 2020).

Interestingly, researchers have identified personality traits to be predictive of

psychological distresses. For example, persons with negative coping styles, cyclothymic,

depressive, and anxious temperaments exhibit a greater susceptibility to psychological outcomes

(Moccia et al., 2020). Additionally, they also found that participants with more social support

and time to rest during the pandemic exhibited lower stress levels.

The intensity of overall stress was evaluated and reported in four studies. The prevalence of overall
stress was variably reported between 8.1% to over 81.9% (C. Wang et al., 2020a; Samadarshi et al.,
2020; Mazza et al., 2020). Females and the younger age group are often associated with higher stress
levels as compared to males and the elderly. Other predictive factors of higher stress levels include
student status, higher number of lockdown days, unemployment, having to go out to work, having an
acquaintance infected with the virus, presence of chronic illnesses, poor self-rated health, and presence
of specific physical symptoms (C. Wang et al., 2020a; Samadarshi et al., 2020; Mazza et al., 2020).

In addition to associated risk factors, a few studies also identified factors that protect

individuals against symptoms of psychological illnesses during the pandemic. Timely

dissemination of updated and accurate COVID-19 related health information from authorities

was found to be associated with lower levels of anxiety, stress, and depressive symptoms in the

general public (C. Wang et al., 2020). Additionally, actively carrying out precautionary measures

that lower the risk of infection, such as frequent handwashing, mask-wearing, and less contact

with people also predicted lower psychological distress levels during the pandemic (C. Wang et

al., 2020a). Some personality traits were shown to correlate with positive psychological
 outcomes. Individuals with positive coping styles, secure and avoidant attachment styles usually

presented fewer symptoms of anxiety and stress (H. Wang et al., 2020).

Moccia et al., 2020). Y. Zhang et al (2020) also found that participants with more social support and time
to rest during the pandemic exhibited lower stress levels.

This whole situation has drastically changed the life of people living in Spain
in a matter of days. The population is experiencing a new, unpredictable and
rapidly evolving situation. They have to stay confined at home, family
dynamics have remarkably changed, travel is restricted, and there has been a
reduction in leisure activities and social life. The work situation has also
changed thoroughly; many people have temporary or permanently lost their
jobs, many are working from home, sometimes with insufficient preparation
for doing so, and those who work in sectors considered essential appear to
experience heavy workloads, increased levels of stress and a greater exposure
to the virus. In fact, in Wuhan, residents compared this health crisis with “the
end of the world” (Lima et al., 2020). Lima, C. K. T., de Carvalho, P. M. M., de Lima, I. A.
S., de Nunes, J. V. A. O., Saraiva, J. S., de Souza, R. I., et al. (2020). The emotional impact of
coronavirus 2019-Ncov (New Coronavirus Disease). Psychiatry Res. 287:112915. doi:
10.1016/j.psychres.2020.112915

Among women who have young children, previous research in Ethiopia, India, and Vietnam found that
women who experience family-related stressful life events, such as illness or death within the household
and financial uncertainty, are more likely to experience episodes of severe mental distress. .

Gausman J, Austin SB, Subramanian S, Langer A. Adversity, social capital, and mental distress among
mothers of small children: A cross-sectional study in three low and middle-income countries. PLoS One
2020;15:e0228435.

Interventions should be based on a comprehensive assessment of risk factors leading

to psychological issues, including poor mental health before a crisis, bereavement,
injury to self or family members, life-threatening circumstances, panic, separation
from family and low household income

 Kun P
 Han S
 Chen X
 Yao L

Prevalence and risk factors for posttraumatic stress disorder: a cross-sectional study
among survivors of the Wenchuan 2008 earthquake in China.
Depress Anxiety. 2009; 26: 1134-1140
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Gender and women's mental health

Gender disparities and mental health: The Facts
Mental illness is associated with a significant burden of morbidity and disability.
Lifetime prevalence rates for any kind of psychological disorder are higher than previously thought, are
increasing in recent cohorts and affect nearly half the population.
Despite being common, mental illness is underdiagnosed by doctors. Less than half of those who meet
diagnostic criteria for psychological disorders are identified by doctors.
Patients, too, appear reluctant to seek professional help. Only 2 in every 5 people experiencing a mood, anxiety
or substance use disorder seeking assistance in the year of the onset of the disorder.
Overall rates of psychiatric disorder are almost identical for men and women but striking gender differences are
found in the patterns of mental illness.
Why gender?
Gender is a critical determinant of mental health and mental illness. The morbidity associated with mental illness
has received substantially more attention than the gender specific determinants and mechanisms that promote
and protect mental health and foster resilience to stress and adversity.
Gender determines the differential power and control men and women have over the socioeconomic
determinants of their mental health and lives, their social position, status and treatment in society and their
susceptibility and exposure to specific mental health risks.
Gender differences occur particularly in the rates of common mental disorders - depression, anxiety and somatic
complaints. These disorders, in which women predominate, affect approximately 1 in 3 people in the community
and constitute a serious public health problem.
Unipolar depression, predicted to be the second leading cause of global disability burden by 2020, is twice as
common in women.
Depression is not only the most common women's mental health problem but may be more persistent in women
than men. More research is needed.
Reducing the overrepresentation of women who are depressed would contribute significantly to lessening the
global burden of disability caused by psychological disorders.
The lifetime prevalence rate for alcohol dependence, another common disorder, is more than twice as high in
men than women. In developed countries, approximately 1 in 5 men and 1 in 12 women develop alcohol
dependence during their lives.
Men are also more than three times more likely to be diagnosed with antisocial personality disorder than women.
There are no marked gender differences in the rates of severe mental disorders like schizophrenia and bipolar
disorder that affect less than 2% of the population.
Gender differences have been reported in age of onset of symptoms, frequency of psychotic symptoms, course of
these disorders, social adjustment and long term outcome.
The disability associated with mental illness falls most heavily on those who experience three or more comorbid
disorders. Again, women predominate.
Gender specific risk factors
Depression, anxiety, somatic symptoms and high rates of comorbidity are significantly related to interconnected
and co-occurrent risk factors such as gender based roles, stressors and negative life experiences and events.
Gender specific risk factors for common mental disorders that disproportionately affect women include gender
based violence, socioeconomic disadvantage, low income and income inequality, low or subordinate social
status and rank and unremitting responsibility for the care of others.
The high prevalence of sexual violence to which women are exposed and the correspondingly high rate of Post
Traumatic Stress Disorder (PTSD) following such violence, renders women the largest single group of people
affected by this disorder.
The mental health impact of long term, cumulative psychosocial adversity has not been adequately investigated.
Restructuring has a gender specific effect on mental health
 Economic and social policies that cause sudden, disruptive and severe changes to income, employment and
social capital that cannot be controlled or avoided, significantly increase gender inequality and the rate of
common mental disorders.
Gender bias
Gender bias occurs in the treatment of psychological disorders. Doctors are more likely to diagnose depression
in women compared with men, even when they have similar scores on standardized measures of depression or
present with identical symptoms.
Female gender is a significant predictor of being prescribed mood altering psychotropic drugs.
Gender differences exist in patterns of help seeking for psychological disorder. Women are more likely to seek
help from and disclose mental health problems to their primary health care physician while men are more likely
to seek specialist mental health care and are the principal users of inpatient care.
Men are more likely than women to disclose problems with alcohol use to their health care provider.
Gender stereotypes regarding proneness to emotional problems in women and alcohol problems in men, appear
to reinforce social stigma and constrain help seeking along stereotypical lines. They are a barrier to the accurate
identification and treatment of psychological disorder.
Despite these differences, most women and men experiencing emotional distress and /or psychological disorder
are neither identified or treated by their doctor.
Violence related mental health problems are also poorly identified. Women are reluctant to disclose a history of
violent victimization unless physicians ask about it directly.
The complexity of violence related health outcomes increases when victimization is undetected and results in
high and costly rates of utilization of the health and mental health care system.
For a complete referenced discussion of these issue please see the following document:
 Gender disparities in mental health
pdf, 112kb
Women's mental health: The Facts
 Depressive disorders account for close to 41.9% of the disability from neuropsychiatric disorders
among women compared to 29.3% among men.
 Leading mental health problems of the older adults are depression, organic brain syndromes and
dementias. A majority are women.
 An estimated 80% of 50 million people affected by violent conflicts, civil wars, disasters, and
displacement are women and children.
 Lifetime prevalence rate of violence against women ranges from 16% to 50%.
 At least one in five women suffer rape or attempted rape in their lifetime.
Depression, anxiety, psychological distress, sexual violence, domestic violence and escalating rates of substance
use affect women to a greater extent than men across different countries and different settings. Pressures created
by their multiple roles, gender discrimination and associated factors of poverty, hunger, malnutrition, overwork,
domestic violence and sexual abuse, combine to account for women's poor mental health. There is a positive
relationship between the frequency and severity of such social factors and the frequency and severity of mental
health problems in women. Severe life events that cause a sense of loss, inferiority, humiliation or entrapment
can predict depression.
Up to 20% of those attending primary health care in developing countries suffer from anxiety and/or depressive
disorders. In most centres, these patients are not recognized and therefore not treated. Communication between
health workers and women patients is extremely authoritarian in many countries, making a woman's disclosure
of psychological and emotional distress difficult, and often stigmatized. When women dare to disclose their
problems, many health workers tend to have gender biases which lead them to either over-treat or under-treat
women.
Research shows that there are 3 main factors which are highly protective against the development of mental
problems especially depression. These are:
 having sufficient autonomy to exercise some control in response to severe events.
 access to some material resources that allow the possibility of making choices in the face of severe
events.
 psychological support from family, friends, or health providers is powerfully protective.
WHO's Focus in Women's Mental Health
 Build evidence on the prevalence and causes of mental health problems in women as well as on the
mediating and protective factors.
 Promote the formulation and implementation of health policies that address women's needs and
concerns from childhood to old age.
 Enhance the competence of primary health care providers to recognize and treat mental health
consequences of domestic violence, sexual abuse, and acute and chronic stress in women.
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