Introduction

The COVID-19 pandemic brought about unprecedented disruptions, impacting upon, but extending far beyond, public health. Numerous studies [1–3] suggest that mental health deteriorated during the pandemic, although the extent to which adverse impact was encountered varied markedly across socioeconomic and demographic groups. Specifically, research highlighted that young people and women faced more severe mental health challenges during the pandemic [2, 4, 5]. The gender gap in mental health outcomes pre-dated the pandemic, with women being nearly twice as likely to experience a mental health problem, such as anxiety or depression, compared to men [6, 7]. This gap was exacerbated at the onset of the COVID-19 pandemic, with women experiencing a decline in mental wellbeing twice that of men in April 2020, and young women suffering worse outcomes [4].

Despite young people and women suffering worse mental health during the pandemic, it’s unclear if a gender gap persists in young adults. Etheridge and Spantig [4] suggested that social isolation and caring responsibilities were responsible for most of the gender gap in mental health outcomes at the onset of the COVID-19 pandemic. However, it remains unclear whether these factors also contribute to the decline in mental health in young women, and if a gender gap in mental health remains prevalent within a young adult population.

During COVID-19, societal shifts included widespread adoption of remote work, increased reliance on digital technologies for communication and services, disruptions in education and employment, and altered social norms due to restrictions on social gatherings. Closures of workplaces and enforced social isolation disrupted social networks and increased loneliness, which further exacerbated mental health problems [8, 9]. Moreover, the closure of schools and childcare centres shifted responsibilities onto parents and caregivers, especially impacting women due to existing gender inequalities in caregiving and work [10, 11].

This paper aims to investigate the gender gap in mental health among young adults during the COVID-19 pandemic, exploring the influence of social, domestic, and caregiving roles. The research builds upon existing studies to better understand the complexities of mental health inequalities exacerbated by the pandemic’s societal shifts and stresses.

Methods

Results

Descriptive analysis of GHQ in September 2021 highlights that the mental health gender gap persists, with women experiencing a higher level of psychological distress compared to men, indicated by a higher GHQ score. Young people and women experienced consistently higher psychological distress throughout the pandemic, with the greatest increases being registered during periods of lockdown in April 2020 (wave 2) and November 2020 (wave 7). The gender gap in mean GHQ scores was most pronounced at the outset of the pandemic in April 2020, gradually narrowing to a difference of 1.35 between men and women by September 2021. However, as of September 2021, a significant mental health age gap persisted between young adults (ages 16–24) and older adults (ages 65+), with a mean difference of 2.56 for young men and 2.63 for young women compared to their older counterparts, respectively. However, mental health recovered to near pre-pandemic levels for all ages and genders by September 2021 (see Figs 1 and 2), despite a persistent age and gender gap.

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Fig 1. Mean male and female GHQ scores across time.

Data from UKHLS: waves 10 and 11 of the mainstage UKHLS study, and waves 1–9 of the COVID-19 survey.

https://doi.org/10.1371/journal.pone.0305680.g001

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Fig 2. Mean young male and female GHQ scores across time.

Data from UKHLS: waves 10 and 11 of the mainstage UKHLS study, and waves 1–9 of the COVID-19 survey.

https://doi.org/10.1371/journal.pone.0305680.g002

Table 1 reports mean psychological distress (GHQ) by various socioeconomic and demographic characteristics, loneliness and domestic time use at baseline (2019), at the beginning of the pandemic (April 2020), the end of the pandemic (September 2021) and a difference between GHQ scores from these start and end dates. Overall, women, younger people, people who were unemployed, single parents, people living in an urban area, and people with a long-term limiting illness had higher GHQ scores than their comparator groups throughout the pandemic. Loneliness resulted in extreme increases in GHQ score, with those who reported often feeling lonely having an average GHQ scores 12.5 points higher compared to those who hardly or never felt lonely. GHQ scores for those who felt lonely also increased across the pandemic, unlike other demographics who experienced a recovery in mental health from April 2020 to September 2021. The prevalence of young women who were often feeling lonely was highest during periods of lockdown, with the peak occurring during the first lockdown (April 2020). Conversely, a higher proportion of young men experienced frequent loneliness during the third lockdown period in the UK (January 2021), nearly matching the levels reported by young women during the same period (see S6 Appendix).

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Table 1. Mean GHQ scores (2019- September 2021).

https://doi.org/10.1371/journal.pone.0305680.t001

Model I (Table 2) show that young adults are likely to experience an increase of 0.66 to their GHQ score when compared to older adults, without controlling for any factors other than age. Women’s GHQ score was more likely to be 1.57 points higher compared to men. Young women similarly demonstrated an increased probability of having a higher GHQ score by 0.9 points compared to men and women over the age of 25. Model II shows that loneliness had a strong relationship with GHQ, with those who felt sometimes or often lonely having a higher probability to experience increased psychological distress, indicated by a higher GHQ score. This model also lowered the effect of gender and particularly age, lowering the probability for young adults and women to experience an increased GHQ score. Loneliness also accounts for a large amount of the variation in GHQ scores (34%). Time spent on childcare does have a clear relationship with GHQ, however cleaning for between 6–10 hours per week appears to have a small positive effect on GHQ when compared to cleaning for only 0–6 hours per week. However, neither domestic time use variables shows an effect on the age and gender coefficients.

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Table 2. Random-effects regression analysis (Models I-IV) showing the change in GHQ score associated with age and gender.

https://doi.org/10.1371/journal.pone.0305680.t002

When controlling for sociodemographic factors in model VI (education, ethnicity, health, employment status, marital status, housing composition, geographical indicators and time), we see that the effect of being a young adult has decreased further to -0.65, with loneliness still having a significant impact on GHQ scores. The coefficient for being female also decreases to 0.97. Living in a household with children or having a disability was also associated with a higher probability of having a higher GHQ score compared to those living with adults only and to individuals who are living without a disability respectively.

Discussion

This research finds that mental health steeply declined during the early months of the pandemic, before recovering when lockdown restrictions were eased (waves 4–6 = June-September 2020), which is similar to previous research [2, 23]. During the beginning of June and throughout the summer period, strict lockdowns were lifted across the UK, and schools and non-essential shops introduced a phased re-opening. National restrictions were relaxed, and local authorities were given additional powers to enforce social distancing or regional lockdowns in their local constituency. By August, the “Eat out to help out” scheme was introduced to support and stimulate the service industry, and lockdown restrictions were further loosened, with bowling alleys and indoor theatres and reopening. However, by mid-September, many of these restrictions returned, and a second lockdown was announced in England on the 31^st of October, with devolved nations shortly adopting localized lockdowns in areas with a high coronavirus infection rate. Given the context of the changing social and economic landscape during the pandemic, it is unsurprising that as lockdown restrictions eased, people’s mental health generally increased. At this time, many would have been able to visit their families and friends for the first time in months or be able to return to work after months of uncertainty. This clearly highlights the impact of these restrictive measures on mental health.

Consistent with broader patterns observed in other wellbeing and mental health metrics, GHQ scores typically have lower levels during the summer months (April to October) and higher during the winter period, as documented by Banks & Xu [2]. However, previous studies using the same panel sample conclude that the rise in GHQ scores was unlikely to be due to seasonal differences or year to year variation [24]. Additionally, by treating time as a nested level within individuals, this method allows for the examination of within-person changes while also capturing any potential effects of seasonal trends. Because of this approach we can be confident that any changes in GHQ are not seasonal and must be the result of other factors.

Long term trends show a second steep increase in mental health issues during the second and third periods of lockdown in the UK (waves 7–9 = November 2020 to March 2021), before recovering again in September 2021, demonstrating a similar pattern to the mental health decline at the onset of the first lockdown. Overall, mental health has returned to near pre-pandemic levels by 2021, though young people and women continue to report higher levels of psychological distress compared to men and older adults, suggesting that the pandemic did not alter relative risk across age and gender. These results are in line with previous research [3] which also found that young women were more vulnerable to mental health decline during periods of lockdown. The mental health gender gap persists until September 2021 but has reduced from a 1.1-point average difference between young men and young women’s GHQ score, to a 0.6-point difference, suggesting that the gender gap was much larger at the beginning of the pandemic and has narrowed over time. This gap is smaller than it was in 2019, however this may be due to young men’s mental health being slower to recover and seeing a greater decline than women compared to their pre-pandemic values. This may indicate a broader issue wherein men may encounter difficulties in recovering their mental well-being following the COVID-19 pandemic, especially considering the existing stigma and gender norms surrounding their access to mental health assistance [25]. Despite this, the mental health gender gap continued to be a present issue during the pandemic, highlighting ongoing inequalities in young people’s mental health outcomes.

We find that during the pandemic, young women are more likely to experience a reduction in mental health when lonely. As noted by previous research [4], this effect may be due to women’s larger support networks (for example having a greater number of close friends), which may greatly impact their mental health when these support networks are disrupted by restrictions on social gatherings [26, 27]. Similar results were found by previous research that women were more vulnerable to mental health decline during periods of lockdown [3, 28]. Though this research did not investigate social support through the role of friendships, it did identify that young people’s and young women’s mental health was more impacted during periods of lockdown, with a greater reduction of mental health at the beginning of periods of lockdown, and a greater increase after lockdown restrictions were lifted. Additionally, loneliness had a more severe effect on young people’s psychological distress, as evidenced by an increased probability of a higher GHQ score for individuals who reported that they “often” felt lonely.

While extensive research has explored the gendered effects of domestic labor and gender inequality on women’s mental health amidst the pandemic [4, 29], our study indicates that domestic inequality is unlikely to be the primary cause of the mental health gender gap among young adults. An increased amount of time spent on cleaning or childcare did not affect young people’s GHQ scores in comparison to older age groups, which can be explained by the small proportion of young adults with childcare responsibilities- only 7.7% of those ages 16–24 reported caring for children for more than 15 hours per week. In comparison, the proportion of the next age bracket, 25–34 years old’s, was 48.6% (See S7 Appendix). Overall, it is unlikely that childcare responsibilities and domestic duties are responsible for the mental health gender gap within a young adult population.

Conclusions

Social factors, specifically loneliness, contribute to the mental health gender gap within the young adult population. Young people, especially young women, experienced the greatest reductions in their mental health during strict lockdown periods, likely due to loneliness and social isolation. It is imperative when addressing future pandemic responses to strike a balance between protecting public health and maintaining the mental health of vulnerable groups. Promotion of policies to address loneliness within a younger population, and especially in young women, may help young people’s mental health to recover in the aftermath of the pandemic. Additionally, long-term trends in mental health should be monitored. Although this research suggests that mental health within the UK population has recovered to pre-pandemic levels, it is unknown what the longer-term effects of the pandemic will be on mental health and other health behaviours. Additionally, a gender gap persists in mental health outcomes beyond the beginning of the pandemic. This gap must be addressed through promotion of gender equality and equal access to mental health services. Young men’s mental health also seems to have been slower to rebound, with a more pronounced decline and slower recovery compared to young women, relative to their pre-pandemic levels. This suggests that while progress has been made in narrowing the gender gap, challenges persist, and further efforts may be needed to fully address and understand the complexities of mental health disparities during and after the pandemic.

Supporting information

Acknowledgments

The UKHLS, supported by the Economic and Social Research Council and multiple Government Departments, is scientifically led by the Institute for Social and Economic Research at the University of Essex. The research data are distributed by the UK Data Service. It should be emphasized that these organizations are not responsible for the analysis or interpretation of the data.