Published on: December 24, 2020
by Frontiers in Global Women’s Health:
Sex and gender differences seem to play a role in the individuals’ psychological and behavioral reactions to the COVID-19 pandemic. These differences need to be considered in planning targeted psychological interventions.
Although effective in containing the spread of COVID-19, isolation and social distancing caused an interruption in the normal routine of many people in the world, with school being closed and parents trying to balance remote working, childcare and house management. This has led to changes and disruption of individuals’ mental well-being and sleep schedule, similar to those observed following previous natural disasters.
To date, only a few studies have examined the changes in sleep quality and mood during the COVID-19 pandemic in both the general population and health care professionals. Casagrande et al. found that 57.1% of responders to an online survey reported poor quality of sleep, 32.1% reported increased symptoms of anxiety, 41.8% increased distress, and 7.6% reported symptoms of post-traumatic stress disorder (PTSD). Sleep disorders and anxiety disorders were more prevalent in women, those unemployed, and those who were worried about being infected with COVID-19 (or knew people who died due to COVID-19).
These findings are consistent with other studies conducted in the Italian, and Chinese populations , some of the most affected, confirming the significant negative impact of the pandemic on mental health. Although these studies provide a significant contribution to understanding the impact of COVID-19 on the human well-being, the effects of sex and gender in response to the pandemic, as well as the deterioration and progression of the individuals’ mental health over the course of the isolation period, remain unknown.
Sex and gender differences, seem to play a role in the individuals’ psychological and behavioral reactions to the pandemic. While often used interchangeably the two terms indicate very different things. Sex refers to a biological construct primarily associated with physical and physiological features including genes, hormones and anatomical and physiological characteristics. Gender refers instead to socially constructed roles, behavior, expressions, and identities.
To date, there is no standard method to assess gender. However, recent studies have pointed out to the need to assess sexual identity (i.e., straight, gay etc.) and gender identity (man or woman), both part of the ampler definition of gender, separately from biological sex (male and female). Both biological sex and gender have been shown to be associated with pattern of exposure, treatment, and behavioral changes associated with COVID-19.
Biological sex seems to be associated with the infection and mortality rates, with higher numbers of men suffering greater health consequences from the virus. These sex differences have been thought to be associated with the different immune response in the two sexes, with a different distribution of the ACE 2 receptors where the coronavirus binds, and with potential protective effects of estrogen. Gender, on the other hand, has been shown to play a bigger role in pattern of exposures to the virus (gender influences where people are spending time), and in the behavioral reactions to the pandemic.
It is known that sleep, empathy and mental health status may differ between the two sexes. Previous studies have in fact highlighted sex and gender differences in empathy, with females usually reporting higher scores as compared to males. Similarly, sleep architecture and quality differs in the two sexes with females having an overall better quality of sleep but higher symptoms of insomnia. Males, on the other hand, tend to have more sleep disordered breathing pathologies such as obstructive sleep apnea. The negative effects of sleep loss on cognition also seem to be differential in the two sexes due to hormonal effects. Finally, mood disorders are more prevalent in females as compared to males and recent studies have tried to explain these differences highlighting how immune mechanisms may differently contribute to stress susceptibility and associated mood disorders. However, how these sex differences manifest during the isolation in response to the pandemic is still unclear.
This new study found that compared to males, females reported lower quality of sleep, sleep efficiency, and greater symptoms of insomnia. They also reported significantly higher symptoms of anxiety, depression, and greater distress in relation to a traumatic event. In addition, females reported higher scores on the IRI empathy scale and all its subcomponents. Similar results were found when analyzing gender identity differences due to the great overlap between biological sex and gender identity in our sample. Over the course of the isolation period, sleep, and mood worsened, especially in females. Finally, we found that the most significant predictors of poor quality of sleep during the isolation were depression, anxiety and trauma scores. There were no statistically significant associations between IRI empathy scores and sleep variables, nor associations with symptoms of insomnia. A separate correlation analysis showed that higher IRI empathy scores were associated with higher depression anxiety and trauma scores.
The data provides evidence that the greatest predictors of changes in sleep quality during the isolation period are heightened anxiety, depression, and trauma symptoms, especially in females. Higher anxiety, depression, and trauma were however positively associated with empathy, perhaps indicating a positive role of fear, and anxiety responses to a crisis.
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