Abstract
Context
It is widely recognised that the COVID-19 pandemic has negatively impacted individuals’ mental health. However, little emphasis has been put on the possible influence of socio-economic factors in the relationship. In the context of the COVID-19 pandemic, our objectives were (i) to assess the relationship between education level and mental health in French adults, and (ii) to study the influence of the economic, social, health and the COVID-19-related factors in men and women respectively.
Method
Data are from 32,581 individuals representative of the French population who responded to the weekly survey “Baromètre COVID-19” between April 7th and May 31st 2020. Education level was self-reported (university degree, high school qualification, vocational certificate/qualification, no diploma). Anxiety-depressive state was derived from four items related to the frequency of occurrence of depressive and anxiety symptoms, and summarized in an overall validated anxiety-depressive score. Multivariate linear regression analyses were carried out with nested adjustments of variables related to economic, social, health and COVID-19 contexts to assess the relationship between education and anxiety-depressive state.
Results
In total, 45% of individuals reported symptoms of anxiety-depressive state (53% in women versus 36% in men). Among men, those with a vocational certificate/qualification and those with no diploma had a greater risk of having a higher anxiety-depressive state compared to those with a university degree (βVocational certificate/qualification = 0.16 [0.04; 0.27]; βNo diploma = 0.75 [0.43; 1.07]) while among women, the risk of anxiety-depressive state increased as education level decreased (βBaccalaureate = 0.37 [0.25; 0.49]; βVocational certificate/qualification = 0.41 [0.28; 0.54]; βNo diploma = 0.8 [0.49; 1.12]). For both men and women, economic, health, and COVID-19 factors partly attenuate these associations while social factors marginally modified the relationship. After accounting for confounders and intermediate variables, the absence of a diploma remained associated with anxiety-depressive state among men, while the whole educational gradient of anxiety-depressive state persisted among women.
Conclusion
In France, at the end of the first wave of COVID-19, individuals with a lower level of education had a higher risk of anxiety-depressive state. This association was more pronounced for women, highlighting a process of social inequality in health possibly related to gender. This should be considered in future prevention and public health interventions.
| Original language | English |
|---|---|
| Article number | 1405 |
| Journal | BMC Public Health |
| Volume | 23 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 21 Jul 2023 |
Bibliographical note
Funding Information:This research received funding by the Agence Nationale de la Recherche (ANR): ANR-20-COVI-0088–01 and the Région Occitanie Pyrénées-Méditerranée: n°2000–7460. MKI receives support from the Gendhi project (Horizon 2020 European research Council, Gendhi-Synergy Grant Agreement SGY2019-856478).
Funding Information:
The research leading to these results has been co-financed by the French National Research Agency (Agence Nationale de la Recherche, n° ANR-20-COVI-0088-01) and the Région Occitanie (arrêté n°2000-7460). These results are part of the EPIDEMIC interdisciplinary program (2020-2021) of the Institut Fédératif d'Études et de Recherches Interdisciplinaires Santé Société—IFERISS FED 4142. We would also like to thank all the participants in the surveys and studies that contributed to the analyses presented here. Consortium name The EPIDEMIC consortium: Basson Jean-Charles2 4, Beltran Grégory2, Boulaghaf Laurence2, Cave Alizé2, Cipriani Enzo3, Coeurdevey Eleonore2, Croiset Aurélie3, Delpierre Cyrille1, Faya-Robles Alfonsina1, Guillemot Cassandra3, Joannès Camille1, Kelly-Irving Michelle1, Klinkenberg Joséphine3, Maurel Marine1, Neufcourt Lola1, Nicaise Sarah2, Sordes Florence3, Soulier Alexandra1, Srocynski Meryl2.1CERPOP-UMR1295, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France2Interdisciplinary Federal Research Institute on Health and Society (IFERISS-Fed 4241), Université Toulouse III Paul Sabatier, Toulouse, France3CERPPS—EA7411, Université Toulouse II, Toulouse, France4CRESCO, Université Toulouse III, France
Publisher Copyright:
© 2023, The Author(s).
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