# Psychological distress and compliance with sanitary measures during the Covid-19 pandemic

## TL;DR

This study finds that psychological distress affects compliance with sanitary measures during the pandemic differently in men and women.

## Contribution

The study reveals gender-specific and education-based differences in how psychological distress influences compliance with sanitary measures.

## Key findings

- Women with psychological distress showed increased compliance with sanitary measures.
- Men with psychological distress, especially those with low education, showed decreased compliance.
- Educational level modified the relationship between distress and compliance in men.

## Abstract

This study aims to understand the relationship between the experience of psychological distress and compliance with COVID-19 sanitary measures. We testeed whether this relationship was modified by individuals’ gender and socioeconomic status (i.e., educational level and employment).

Data from four European cohort studies (n = 13,635), were analysed using an Individual Participant Data (IPD) meta-analytic approach. Mixed effect models were employed to examine associations between mental health difficulties and compliance with sanitary measures, as well as effect modification by socioeconomic status. Statistical models were stratified by gender.

We found a statistically significant association between mental health difficulties and increased compliance with sanitary measures in women, while amongst men the statistically significant association observed was opposite. Moreover, there was a statistically significant interaction between participants’ educational level and mental health difficulties amongst men only, indicating especially low compliance levels with COVID-19 sanitary measures amongst individuals with only primary schooling and who reported psychological distress.

The association between psychological distress and compliance with sanitary measures is complex–positive in women, negative in men. Men experiencing mental health difficulties, especially those with lower educational attainment, exhibit low levels of compliance with sanitary measures. These results suggest that psychological distress and its possible consequences should be considered when designing measures addressing infectious disease spread.