Longitudinal associations of COVID-19-related stressors and psychological distress among healthcare workers based on sex and gender

Abstract

Background

Healthcare workers faced immense challenges during the early COVID-19 pandemic, contributing to their psychological distress. Female workers have been shown to be at higher risk, but most studies only measured birth-assigned sex, thereby overlooking sociocultural (gender) differences.

Objective

To examine the respective roles of sex and gender in the association between COVID-19–related occupational stressors and psychological distress among healthcare workers over time during the early phase of the pandemic.

Methods

This longitudinal study examined 382 Canadian healthcare workers (12.8% male, 87.2% female; 92.9% white) monitored weekly over 8 weeks during the first two waves of the pandemic. Using sociodemographic and work data, we developed a composite gender index and investigated how sex, gender, and COVID-19-related stressors related to psychological distress (anxiety, depression, posttraumatic stress) using linear mixed models.

Results

COVID-19-related stressors were associated with higher distress. A more feminine gender score, but not female sex, predicted higher distress. A modest interaction was observed based on a small subgroup, suggesting lower anxiety and posttraumatic stress among medically vulnerable workers with higher feminine gender scores. Overall distress decreased modestly over time, although models explained a limited proportion of variance.

Conclusion

These findings underscore the need to go beyond birth-assigned sex in mental health assessments of healthcare workers during public health crises.