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May 20, 2024
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Inequality on the frontline: A multi-country study on gender differences in mental health among healthcare workers during the COVID-19 pandemic.

Publicated to:Glob Ment Health (Camb). 11 e34- - 2024-01-01 11(), DOI: 10.1017/gmh.2024.18

Authors: Czepiel D; McCormack C; da Silva ATC; Seblova D; Moro MF; Restrepo-Henao A; Martínez AM; Afolabi O; Alnasser L; Alvarado R; Asaoka H; Ayinde O; Balalian A; Ballester D; Barathie JAL; Basagoitia A; Basic D; Burrone MS; Carta MG; Durand-Arias S; Eskin M; Fernández-Jiménez E; Frey MIF; Gureje O; Isahakyan A; Jaldo R; Karam EG; Khattech D; Lindert J; Martínez-Alés G; Mascayano F; Mediavilla R; Narvaez Gonzalez JA; Nasser-Karam A; Nishi D; Olaopa O; Ouali U; Puac-Polanco V; Ramírez DE; Ramírez J; Rivera-Segarra E; Rutten BPF; Santaella-Tenorio J; Sapag JC; Šeblová J; Soto MTS; Tavares-Cavalcanti M; Valeri L; Sijbrandij M; Susser ES; Hoek HW; van der Ven E

Affiliations

Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. - Author
Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, New York, NY, USA. - Author
Department of Clinical Epidemiology and Biostatistics, Pontifical Xavierian University, Bogotá, Colombia. - Author
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA. - Author
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. - Author
Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy. - Author
Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. - Author
Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Nigeria. - Author
Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. - Author
Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands. - Author
Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain. - Author
Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain. - Author
Department of Psychiatry, University College Hospital, Ibadan, Nigeria. - Author
Department of Psychiatry, University of Ibadan, Ibadan, Nigeria. - Author
Department of Psychology, Koc University, Istanbul, Turkey. - Author
Department of Public Health and Family Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. - Author
Department of Public Health, School of Medicine, University of Valparaíso, Valparaiso, Chile. - Author
Department Psychiatry A, Razi Hospital La Manouba, Manouba, Tunisia. - Author
Departments of Health Policy & Management and Epidemiology & Biostatistics, Downstate Health Sciences University, Brooklyn, NY, USA. - Author
Dirección de Investigación Ciencia y Tecnología, Universidad San Francisco Xavier de Chuquisaca, Sucre, Bolivia. - Author
Emergency Department, Motol University Hospital, Prague, Czech Republic. - Author
Faculty of Health and Social Work, University of Applied Sciences Emden/Leer, Emden, Germany. - Author
Faculty of Medical Sciences, University of San Carlos of Guatemala, Guatemala City, Guatemala. - Author
Faculty of Medicine, University of São Paulo, São Paulo, Brazil. - Author
Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon. - Author
Institute of Health Sciences, Universidad de O'Higgins, Rancagua, Chile. - Author
National Institute of Health Named After Academician S. Avdalbekyan, Yerevan, Armenia. - Author
National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico. - Author
Parnassia Psychiatric Institute, Parnassia Groep, The Hague, The Netherlands. - Author
Population Health Research Section, King Abdullah International Medical Research Center (KAIMRC), King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia. - Author
Question Driven Design and Analysis Group, New York, NY, USA. - Author
School of Behavioral and Brain Sciences, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico. - Author
School of Medicine and Psychiatric Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. - Author
School of Public Health, University of Chile, Santiago, Chile. - Author
Second Faculty of Medicine, Charles University, Prague, Czech Republic. - Author
Social and Community Academic Unit, University of Chubut, Chubut, Argentina. - Author
Unidad de Investigación, Consultora Salud Global Bolivia, Sucre, Bolivia. - Author
University Hospital, Federal University of Rio Grande, Rio Grande, Brazil. - Author
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Abstract

Healthcare workers (HCWs) were at increased risk for mental health problems during the COVID-19 pandemic, with prior data suggesting women may be particularly vulnerable. Our global mental health study aimed to examine factors associated with gender differences in psychological distress and depressive symptoms among HCWs during COVID-19. Across 22 countries in South America, Europe, Asia and Africa, 32,410 HCWs participated in the COVID-19 HEalth caRe wOrkErS (HEROES) study between March 2020 and February 2021. They completed the General Health Questionnaire-12, the Patient Health Questionnaire-9 and questions about pandemic-relevant exposures. Consistently across countries, women reported elevated mental health problems compared to men. Women also reported increased COVID-19-relevant stressors, including insufficient personal protective equipment and less support from colleagues, while men reported increased contact with COVID-19 patients. At the country level, HCWs in countries with higher gender inequality reported less mental health problems. Higher COVID-19 mortality rates were associated with increased psychological distress merely among women. Our findings suggest that among HCWs, women may have been disproportionately exposed to COVID-19-relevant stressors at the individual and country level. This highlights the importance of considering gender in emergency response efforts to safeguard women's well-being and ensure healthcare system preparedness during future public health crises.

Keywords

Covid-19Cross-countryGender differencesHealthcare disparitiesHealthcare workersMental health

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Glob Ment Health (Camb) due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2024 there are still no calculated indicators, but in 2023, it was in position 85/276, thus managing to position itself as a Q2 (Segundo Cuartil), in the category Psychiatry.

Independientemente del impacto esperado determinado por el canal de difusión, es importante destacar el impacto real observado de la propia aportación.

Según las diferentes agencias de indexación, el número de citas acumuladas por esta publicación hasta la fecha 2025-07-23:

  • Scopus: 5

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-07-23:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 69.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 69 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 8.65.
  • The number of mentions on the social network X (formerly Twitter): 12 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.
  • Assignment of a Handle/URN as an identifier within the deposit in the Institutional Repository: https://repositorio.uam.es/handle/10486/720495

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Argentina; Armenia; Bolivia; Brazil; Chile; Colombia; Czech Republic; Germany; Guatemala; Italy; Japan; Lebanon; Mexico; Netherlands; Niger; Puerto Rico; Saudi Arabia; Tunisia; Turkey; United States of America.