Risk perception and coping mechanisms by gender identity and education level during the COVID-19 syndemic in Spain.

Background: It is important to have a detailed understanding of the association between risk perception, coping mechanisms, and mental health outcomes during the COVID-19 syndemic across axes of inequity such as gender identity and education level.

Methods: We conducted a cross-sectional study among 2,066 adults (≥ 18 years) living in Spain via an online survey from April 8 to May 28, 2021. Anxiety and depression were the main outcomes considered to assess mental health, measured with the Generalized Anxiety Disorder 7 item (GAD-7) and Patient Health Questionnaire 9 item (PHQ-9), respectively. We analyzed the distribution of anxiety and depression levels across risk perception and coping mechanism variables, stratifying by gender identity and education level.

Results: Anxiety and depression levels were associated with age in a gradient fashion, with the 18-30 age group reporting the highest anxiety levels in both women (aOR: 3.11, 95% CI: 1.57-6.17) and men (aOR: 4.92, 1.90-12.74). This gradient was maintained especially in individuals with university level studies. For women, higher anxiety levels were associated with perceived risk in meeting up with friends and family (aOR: 1.73, 1.12-2.67) and being out in public (aOR 2.98, 2.15-4.14), whereas men perceived more risk in occupying closed public spaces and using public transportation (e.g., aOR: 2.14, 95% CI: 1.09-4.22). Connecting with friends and family was the most effective coping mechanism. In general, women reported more effective coping mechanisms than men and findings were strongest in the population with university level studies. Likewise, men with university level studies reported more effective coping mechanisms than men without university level studies.

Conclusions: Women and men with university level studies reported higher risk perception and more effective coping mechanisms during the COVID-19 syndemic than individuals without a university level education. These findings reveal possible strategies for primary care and public health agencies to follow to improve mental health outcomes along different axes of inequity, especially in the case of future syndemics and public health crises.