Gender and Race Differences in Mental Health and Well-Being Among Older Americans During the COVID-19 Pandemic

Abstract

The objectives of this study were to investigate (1) gender and race differences in mental health and psychological well-being among older adults during the COVID-19 pandemic and (2) whether there were significant interaction effects between gender and race. This study used the National Health and Aging Trends Study (NHATS) and COVID-19 public use data files. It focused on mental health and psychological well-being, including loneliness, no time to yourself, poor sleep quality, anxiety, depression, and post-traumatic stress disorder (PTSD). The sample consisted of 2465 older adults, and multivariate logistic and linear regression models were adopted for the analysis. The results show that approximately two out of five older people (43%) experienced poor sleep, followed by loneliness (35%), anxiety (30%), depression (23%), and no time to themselves (11%). The average PTSD score was 11. Mental health and psychological well-being varied by gender and race. There were significant interaction effects on anxiety and depression between females and Black older adults. Black females reported lower levels of anxiety and depressive symptoms than Black males, although the differences were not statistically significant. Black older adults were more likely to experience PTSD but less likely to feel lonely and have poorer sleep than their White counterparts. Female older adults reported poorer mental health and psychological well-being than males, except for Black females. Black females had the lowest levels of anxiety, depression, loneliness, and highest quality of sleep among all females of different ethnic and racial origins.

Keywords

COVID-19 / Gender / Mental health / Older adults / Psychological well-being / Race and ethnicity / United States

References

Alobuia WM, Dalva-Baird NP, Forrester JD, Bendavid E, Bhattacharya J, Kebebew E. Racial disparities in knowledge, attitudes and practices related to COVID-19 in the USA. Journal of Public Health, 2020, 42(3): 470-478

Azar KMJ, Shen ZJ, Romanelli RJ, Lockhart SH, Smits K, Robinson S, Brown S, Pressman AR. Disparities in outcomes among COVID-19 patients in a large health care system in California. Health Affairs, 2020, 39(7): 1253-1262

Baker TA, Buchanan NT, Mingo CA, Roker R, Brown CS. Reconceptualizing successful aging among black women and the relevance of the strong black woman archetype. Gerontologist, 2015, 55(1): 51-57

Boserup B, McKenney M, Elkbuli A. Disproportionate impact of COVID-19 pandemic on racial and ethnic minorities. The American Surgeon, 2020, 86(12): 1615-1622

Bruine de Bruin W, Bennett D. Relationships between initial COVID-19 risk perceptions and protective health behaviors: A national survey. American Journal of Preventive Medicine, 2020, 59(2): 157-167

Carr D. COVID-19: Trends, disparities, and consequences for older adults. The Journals of Gerontology: Series B, 2021, 76(3): e65-e67

CDC (Center for Disease Control and Prevention). 2019. Caregiving for family and friends—A public health issue. https://www.cdc.gov/aging/caregiving/caregiver-brief.html. Accessed 26 May2023.

CDC (Center for Disease Control and Prevention). 2022. Long COVID or post-COVID conditions. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html. Accessed 26 May 2023.

Collins PH. Intersectionality’s definitional dilemmas. Annual Review of Sociology, 2015, 41: 1-20

Dale SK, Safren SA. Resilience takes a village: Black women utilize support from their community to foster resilience against multiple adversities. AIDS Care, 2018, 30(Supplement 5): S18-S26

DeMatteis, J.M., V.A. Freedman, R. Jiao, and J.D. Kasper. 2021. National health and aging trends study development of round 10 survey weights. NHATS technical paper #28. Baltimore, MD: Johns Hopkins University School of Public Health.

DeSouza F, Parker CB, Spearman-McCarthy EV, Duncan GN, Black RMM. Coping with racism: A perspective of COVID-19 church closures on the mental health of African Americans. Journal of Racial and Ethnic Health Disparities, 2021, 8(1): 7-11

Eagly AH. Sex differences in social behavior: A social-role interpretation, 1987, New York: Psychology Press

Ferrín M. Reassessing gender differences in COVID-19 risk perception and behavior. Social Science Quarterly, 2022, 103(1): 31-41

Freedman, V.A., and M. Hu. 2020. COVID-19 supplement to the national health and aging trends study user guide. Beta release. v. 3. Baltimore, MD: Johns Hopkins Bloomberg School of Public Health.

Freedman VA, Schrack JA, Skehan ME. National health and aging trends study user guide: Rounds 1–12 beta release, 2023, Baltimore: Johns Hopkins Bloomberg School of Public Health

Galasso V, Pons V, Profeta P, Becher M, Brouard S, Foucault M. Gender differences in COVID-19 attitudes and behavior: Panel evidence from eight countries. Proceedings of the National Academy of Sciences of the United States of America, 2020, 117(44): 27285-27291

Gamsızkan, Z., M. Ali Sungur, and G. Erdemir. 2021. How do older age, gender and risk groups affect protective behaviours and mental health in the COVID-19 pandemic? International Journal of Clinical Practice 75(6): Article e14150.

Garcia MA, Homan PA, García C, Brown TH. The color of COVID-19: Structural racism and the disproportionate impact of the pandemic on older black and Latinx adults. The Journals of Gerontology: Series B, 2021, 76(3): e75-e80

García-Fernández, L., V. Romero-Ferreiro, S. Padilla, P.D. López-Roldán, M. Monzó-García, and R. Rodriguez-Jimenez. 2021. Gender differences in emotional response to the COVID-19 outbreak in Spain. Brain and Behavior 11(1): Article e01934.

Goldmann E, Hagen D, Khoury EE, Owens M, Misra S, Thrul J. An examination of racial and ethnic disparities in mental health during the COVID-19 pandemic in the U.S. South. Journal of Affective Disorders, 2021, 295: 471-478

González-Sanguino C, Ausín B, Castellanos MÁ, Saiz J, López-Gómez A, Ugidos C, Muñoz M. Mental health consequences during the initial stage of the 2020 Coronavirus pandemic (COVID-19) in Spain. Brain, Behavior, and Immunity, 2020, 87: 172-176

Goveas JS, Ray RM, Woods NF, Manson JE, Kroenke CH, Michael YL, Shadyab AH, Meliker JR Associations between changes in loneliness and social connections, and mental health during the COVID-19 pandemic: The women’s health initiative. The Journals of Gerontology: Series A, 2022, 77(Supplement_1): S31-S41.

Gruenewald TL, Seeman TE. Stress and aging: A biological double jeopardy?. Annual Review of Gerontology and Geriatrics, 2010, 30: 155-177

Hansen M, Andersen TE, Armour C, Elklit A, Palic S, Mackrill T. PTSD-8: A short PTSD inventory. Clinical Practice and Epidemiology in Mental Health, 2010, 6: 101-108

Heath CD. A womanist approach to understanding and assessing the relationship between spirituality and mental health. Mental Health, Religion & Culture, 2006, 9(2): 155-170

Jackson JS, Knight KM, Rafferty JA. Race and unhealthy behaviors: Chronic stress, the HPA axis, and physical and mental health disparities over the life course. American Journal of Public Health, 2010, 100(5): 933-939

Jin, J.M., P. Bai, W. He, F. Wu, X.F. Liu, D.M. Han, S. Liu, and J.K. Yang. 2020. Gender differences in patients with COVID-19: Focus on severity and mortality. Front Public Health 8: Article 152.

Keyes CLM. The Black-White paradox in health: Flourishing in the face of social inequality and discrimination. Journal of Personality, 2009, 77(6): 1677-1706

Lalani, N., D.J. Xu, C. Yun, and G.W. Arling. 2023. Structural equation model of coping and life satisfaction of community-dwelling older people during the COVID-19 pandemic. Journal of Patient-Reported Outcomes 7(1): Article 46.

Laufer A, Shechory Bitton M. Gender differences in the reaction to COVID-19. Women Health, 2021, 61(8): 800-810

Macias Gil RM, Marcelin JR, Zuniga-Blanco B, Marquez C, Mathew T, Piggott DA. COVID-19 pandemic: Disparate health impact on the Hispanic/Latinx population in the United States. The Journal of Infectious Diseases, 2020, 222(10): 1592-1595

Muñoz-Price, L.S., A.B. Nattinger, F. Rivera, R. Hanson, C.G. Gmehlin, A. Perez, S. Singh, B.W. Buchan, et al. 2020. Racial disparities in incidence and outcomes among patients with COVID-19. JAMA Network Open 3(9): Article e2021892.

Pallant J. SPSS survival manual: A step by step guide to data analysis using IBM SPSS, 2020, New York: Routledge

Price-Haywood EG, Burton J, Fort D, Seoane L. Hospitalization and mortality among black patients and white patients with COVID-19. New England Journal of Medicine, 2020, 382(26): 2534-2543

Resnick B, Galik E, McPherson R, Boltz M, Van Haitsma K, Kolanowski A. Gender differences in disease, function, and behavioral symptoms in residents with dementia. Western Journal of Nursing Research, 2022, 44(9): 812-821

Riehm KE, Brenneke SG, Adams LB, Gilan D, Lieb K, Kunzler AM, Smail EJ, Holingue C Association between psychological resilience and changes in mental distress during the COVID-19 pandemic. Journal of Affective Disorders, 2021, 282: 381-385

Sarrasanti N, Donkor FK, Santos C, Tsagkari M, Wannous C. Its about time we care about an equitable world: Women’s unpaid care work and COVID-19. IEEE Engineering Management Review, 2020, 48(4): 37-45

Selden TM, Berdahl TA. COVID-19 and racial/ethnic disparities in health risk, employment, and household composition. Health Affairs, 2020, 39(9): 1624-1632

Thomeer MB, Moody MD, Yahirun J. Racial and ethnic disparities in mental health and mental health care during the COVID-19 pandemic. Journal of Racial and Ethnic Health Disparities, 2023, 10(2): 961-976

Webb LM, Chen CY. The COVID-19 pandemic’s impact on older adults’ mental health: Contributing factors, coping strategies, and opportunities for improvement. International Journal of Geriatric Psychiatry, 2022

Willey, B., K. Mimmack, G. Gagliardi, M.L. Dossett, S. Wang, O.J. Udeogu, N.J. Donovan, J.R. Gatchel, et al. 2022. Racial and socioeconomic status differences in stress, posttraumatic growth, and mental health in an older adult cohort during the COVID-19 pandemic. eClinicalMedicine 45: Article 101343.

Williams II, R.D., A. Shah, M.M. Dot, K. Fields, and M. FitzGerald. 2021. The impact of COVID-19 on older adults: Findings from the 2021 international health policy survey of older adults. https://www.commonwealthfund.org/publications/surveys/2021/sep/impact-covid-19-older-adults. Accessed 26 May 2023.

Woods-Giscombe C, Robinson MN, Carthon D, Devane-Johnson S, Corbie-Smith G. Superwoman schema, stigma, spirituality, and culturally sensitive providers: Factors influencing African American women’s use of mental health services. Journal of Best Practices in Health Professions Diversity, 2016, 9(1): 1124-1144.

Xu, D.J., and G. Arling. 2023. Are frail older people from racial/ethnic minorities at double jeopardy of putting off healthcare during the pandemic? International Journal of Environmental Research and Public Health 20(2): Article 1034.

Ya’qoub, L., I.Y. Elgendy, and C.J. Pepine. 2021. Sex and gender differences in COVID-19: More to be learned! American Heart Journal Plus: Cardiology Research and Practice 3: Article 100011.

Zaninotto P, Iob E, Demakakos P, Steptoe A. Immediate and longer-term changes in the mental health and well-being of older adults in England during the COVID-19 pandemic. JAMA Psychiatry, 2022, 79(2): 151-159

Zhao, S.Z., J.Y.H. Wong, Y. Wu, E.P.H. Choi, M.P. Wang, and T.H. Lam. 2020. Social distancing compliance under COVID-19 pandemic and mental health impacts: A population-based study. International Journal of Environmental Research and Public Health 17(18): Article 6692.