Women living in the United States who experienced health-related socioeconomic vulnerability at the beginning of the COVID-19 pandemic were associated with highly increased rates of mental health problems. These findings from a cross-sectional national survey of women were published in the Journal of Women’s Health.

A diverse group of women (N=350,000) living in the US were recruited by Opinions 4 Good (Op4G), a survey research firm. Participants were recruited with a nested quota sampling strategy on the basis of ethnicity, age, and educational attainment. A total of 3200 women completed the survey between April 10 and 24 in 2020. The survey comprised 152 questions on the topics of sociodemographic characteristics, pre-pandemic socioeconomic vulnerabilities, pandemic-related changes, and mental health conditions.

Participants were aged 18 to 44 (44.6%), 45 to 64 (33.0%), or 65 years and older (22.4%), 73.4% were White, 13.9% were Hispanic, 12.8% were Black, and 5.8% were Asian, 62.0% were married or had a partner, 30.0% earned $50,000 to $99,999 annually, 62.8% had more than a high school education, and 61.1% had no children living at home.

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The most frequently reported health-related socioeconomic risk (HRSR) pre-pandemic was food insecurity (37%); 22% of women reported 2 or more HRSRs. The women reporting pre-pandemic vulnerabilities were more likely to be younger, non-White, and Hispanic; to have lower annual income but more household members; to live in the western US; and to be in poorer health (P <.05) than women without vulnerabilities.

After April of 2020, 49% of women indicated their HRSRs worsened, including 29% of women who did not report pre-pandemic HRSRs. The worsening factors were food insecurity (40%), transportation problems (17%), interpersonal violence (13%), housing insecurity (6%), and utility difficulties (2%).

Conversely, nearly a third of women (32%) reported an improvement in their HRSRs early in the pandemic. The most frequently improved factors were decreases in interpersonal violence (13%) and restoration of utility services (13%). However, most of the women reporting some HRSR improvements also reported worsening in other domains (76%).

Reports of depression (29%) and anxiety (29%) doubled or tripled after the onset of the COVID-19 pandemic according to pre-pandemic estimates. Many women (21%) had comorbid anxiety and depression or traumatic stress (17%).

Stratified by pre-pandemic vulnerabilities, for each additional HRSR, risk for depression or anxiety increased by a factor of 1.9 (95% CI, 1.8-2.1) and traumatic stress symptoms by a factor of 1.5 (95% CI, 1.4-1.6).

Women who reported only HRSR improvement were at decreased risk for depression (adjusted odds ratio [aOR], 0.5; 95% CI, 0.3-0.8) and stress (aOR, 0.5; 95% CI, 0.3-0.9) but not anxiety (aOR, 0.6; 95% CI, 0.4-1.1).

This study may have been limited by relying on a 2-item food insecurity screener, which could have led to overestimations and participant answers may have included some recall bias.

These data indicated that women with pre-pandemic health-related socioeconomic vulnerabilities were at increased risk for worsening mental health during the beginning of the pandemic. The study authors speculated that pandemic-related mental health needs have not been fully realized among women living in the US.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please refer to the original article for a full list of authors’ disclosures.


Lindau ST, Makelarski JA, Boyd K, et al. Change in health-related socioeconomic risk factors and mental health during the early phase of the COVID-19 pandemic: A national survey of U.S. women. J Womens Health. 2021;30(4):502-513. doi:10.1089/jwh.2020.8879