key: cord-1048338-cpybe21v authors: Rabbani, D. F.; Khan, D. H. A.; Piryani, D. S.; Khan, A. R.; Abid, D. F. title: Psychological and social impact of COVID-19 in Pakistan: Need for Gender Responsive Policies date: 2020-11-01 journal: nan DOI: 10.1101/2020.10.28.20221069 sha: 54ecd011daf1123b0ce6594dfcedd4f65840cb5c doc_id: 1048338 cord_uid: cpybe21v COVID-19 has rapidly crossed borders, infecting people throughout the world. Women may be especially vulnerable to depression and anxiety due to the pandemic, This study attempted to assess how gender impacts risk perceptions, anxiety levels behavioral responses to the COVID 19 pandemic in Pakistan in order to recommend gender responsive health policies A cross-sectional online survey was conducted.. Participants were asked to complete a sociodemographic data form, the Hospital Anxiety and Depression Scale (HADS), and questions on their risk perceptions, preventive behavior and information exposure. Regression analysis was used to assess effects of factors such as age, gender and household income on anxiety levels. Of the 1390 respondents, 478 were women, and 913 were men. Women considered their chances of survival to be relatively lower than men ( 59 % women vs 73% men). They were also more anxious (62% women vs 50% men), and more likely to adopt precautionary behavior, such as avoiding going to the hospital (78% women vs. 71% men), not going to work (72% women and 57% men), and using disinfectants (93% women and 86% men). Men were more likely to trust friends, family and social media as reliable sources of COVID-19 information, while women were more likely to trust doctors. Women experience a disproportion burden of the psychological and social impact of the pandemic compared to men. Involving doctors in healthcare communication targeting women, might prove effective. Social media and radio programs may be effective in disseminating information related to COVID among men. and 91% men), avoiding going out (87% women vs. 71% men, p-value: <0.001), avoiding 1 8 0 crowded areas (96% women and 92% men, p-value: 0.003), refraining from going to hospital or 1 8 1 clinic (78% women and 71% men, p-value: <0.001), avoiding to go to work (72% women and 1 8 2 57% men, p-value: <0.001), avoiding social events (97% women and 93% men, p-value: 0.046), 1 8 3 and avoiding domestic travel (93% women and 86% men, p-value: <0.001). (Table 4 .) Information about COVID-19 provided by the doctor was considered reliable by significantly 1 8 6 more women compared to men (very reliable/reliable: 91% women and 88% men, p-value: CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) 1 3 0.041). Most of the respondents (very reliable/reliable: 81% women and 82% men) thought that 1 8 8 the information provided through official websites such as those run by the government is 1 8 9 reliable. Significantly more men than the women believed that the radio (very reliable/reliable: 1 9 0 46% women vs. 55% men, p-value: 0.014), and family or friends (very reliable/reliable: 46% 1 9 1 women vs. 55% men, p-value: 0.003) are reliable sources for gaining information about COVID-1 9 2 19. Furthermore, television (very reliable/reliable: 57% women vs. 61% men), newspaper (very 1 9 3 reliable/reliable: 56% women vs. 58% men), magazine (very reliable/reliable: 39% women and 1 9 4 44% men), social media such as Facebook, WhatsApp, Instagram (very reliable/ reliable: 28% 1 9 5 women vs. 32% men) and unofficial websites (very reliable/reliable: 22% women and 31% men) were considered as reliable information sources by more men than women. (Table. 5) 1 9 7 1 9 8 Table 6 demonstrates the predictors of anxiety. Gender, age, and household income had a 1 9 9 significant positive association with anxiety. Women were nearly two times more likely to be 2 0 0 anxious than men (aOR: 1.70, 95% CI: 1.26-2.28). Moreover, respondents of a younger age (25-2 0 1 34 years) (aOR 2.30, 95% CI: 1.26-4.18) were nearly two times more likely to have anxiety than 2 0 2 respondents above 55 years of age. Respondents with a household income between PKR 60,000 2 0 3 and PKR 120,000 were more likely to have anxiety than respondents with a household income of 2 0 4 >PKR 120,000 (aOR: 1.84; 95% CI: 1.27-2.67). Table 7 shows the predictors of depression. Only household income was found have a household income of PKR 60,000 -PKR 120,000 were more likely to have anxiety in 2 0 9 . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) 1 4 comparison with respondents who had a household income of >PKR 120,000 (aOR: 1.99; 95% 2 1 0 CI: 1.38-2.87). CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) 1 5 This study assessed how gender roles in Pakistan can impact anxiety levels and behavioural 2 1 4 responses among men and women during the COVID-19 pandemic. Both men and women were 2 1 5 found to be mildly anxious due to the COVID-19 pandemic. However, compared to men, more 2 1 6 women perceived the disease to be fatal, and were more likely to engage in preventive behavior. These results highlight a greater need to develop gender-responsive policies in the fight to Overall, fewer women than men responded to the questionnaire. This may be due to a prominent 1 8 exiting from the labor market. These developments are concerning, and emphasize the urgent 2 7 8 need to develop labour policies which protect women in the workforce. Women were more likely to report that they avoid going to hospitals. Furthermore, they were 2 8 0 also more likely to perceive that doctors were a reliable source of information. It may be too 2 8 1 soon to estimate the impact of COVID-19 on maternal and child health services, but one study 2 8 2 estimates that a modest decline of 10% in coverage of pregnancy-related and newborn health pandemic. Clinics operated by Marie Stopes International, which is the largest private provider 1 9 radio could be explained by the significantly larger proportion of men who came from smaller 3 0 0 cities and towns. Furthermore, men in this study were more likely to trust friends and family than 3 0 1 women. Pakistanis are considered to be a collectivistic society, with an emphasis on men 3 0 2 engaging in commitments to the members of their 'group', friends and family (56). Similarly, 3 0 3 men were more likely to trust social media sources than women. The lockdown enforced due to 3 0 4 COVID pandemic has resulted in online activity substituting social activity between families, by the state and its opponents, meant that Syrians were very distrustful of official news sources 3 1 0 (38). Facebook users were much more likely to share official news sources. Therefore, radio 3 1 1 content, as well as shareable social media content might be an appropriate avenue to provide In this study, women depicted higher levels of anxiety and depression in comparison with men, 3 1 6 which suggests that they hold a greater psychiatric burden of the COVID-19 pandemic. One 3 1 7 study conducted in India found that 33% of the respondents had experienced either depression or respondents suffered some psychological impact from the outbreak (58). In both studies, women 3 2 0 were found to have suffered a greater psychological impact due to the pandemic as compared to 3 2 1 men. Similarly, our findings corroborate with data from Turkey, where women had significantly CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted November 1, 2020. . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted November 1, 2020. Psychiatry. 2020;0020764020927051. Abbottabad, Pakistan. Gen Psychiatry. 2020;33(5). . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted November 1, 2020. Available from: https://www.mariestopes.org/covid-19/stories-from-the-frontline/ Oct 22]. Available from: https://www.thenews.com.pk/tns/detail/652596-lost-protection Pandemic. World Bank; 2020. . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted November 1, 2020. ; https://doi.org/10.1101/2020.10.28.20221069 doi: medRxiv preprint . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted November 1, 2020. is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted November 1, 2020. ; https://doi. org/10.1101 org/10. /2020 . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted November 1, 2020. ; https://doi.org/10. 1101 /2020 Don't know 28 (5.9) 59 (6.5) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted November 1, 2020. ; https://doi.org/10.1101/2020.10.28.20221069 doi: medRxiv preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted November 1, 2020. ; is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted November 1, 2020. ; https://doi.org/10.1101 https://doi.org/10. /2020 is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted November 1, 2020. ; https://doi.org/10.1101/2020.10.28.20221069 doi: medRxiv preprint . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted November 1, 2020. ; https://doi.org/10.1101/2020.10.28.20221069 doi: medRxiv preprint . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted November 1, 2020. ; https://doi.org/10. 1101 /2020 Chance of survival if infected with COVID-19 Social media platforms