Abstract
OBJECTIVE: There have been consistent concerns about a greater impact of COVID-19 on the mental health of younger people and females. We aimed to explore the potential synergistic effect of various pandemic-related stressors with age and sex on the mental health of the general Canadian household population during the COVID-19 pandemic. METHODS: Using cross-sectional data from the Statistics Canada 2022 Mental Health and Access to Care Survey (MHACS), frequencies for major depressive episode (MDE), generalized anxiety disorder (GAD), general psychological distress, and various pandemic-related and demographic factors were estimated. Odds ratios were estimated using binary logistic regression models. These estimates used a replicate bootstrapping procedure recommended by Statistics Canada. Finally, Relative Excess Risk due to Interaction (RERI) models were used for each outcome to evaluate the interactions of each pandemic-related stressor with age and sex on an additive scale. RESULTS: Past-12-month MDE and GAD, psychological distress, and the various COVID-19 stressors were more prevalent in young people and females. Overall, the stressors were confirmed to be associated with these outcomes. There were greater-than-additive interactions between age and difficulty accessing healthcare, loneliness, physical health problems, household relationship challenges, and work stress; and between sex and severe illness of a loved one, loneliness, work stress, LGBTQ2+ status, marital status, difficulty accessing healthcare, physical health problems, job/income loss, and financial difficulties. Generally, evidence of synergy was found between age and pandemic-related stressors and sex and pandemic-related stressors. CONCLUSIONS: Greater-than-additive interactions of pandemic-related stressors with age and sex may indicate synergistic vulnerabilities within females and young people. Future pandemics, via corresponding stressors, may be associated with increased mental health vulnerability in females, youth, and especially young females.