Gender and trust in government modify the association between mental health and stringency of social distancing related public health measures to reduce COVID-19: a global online survey

Objectives To investigate the associations between stringency of COVID-19 social distancing policies and mental health outcomes, and the moderating effect of trust in government and gender. Design and setting Cross sectional study involving secondary analysis of publicly available data from a global online COVID-19 survey and the Oxford COVID-19 Government Response Tracker. Participants 106,497 participants from 58 countries. Main outcome measures Outcomes were a worries index and a depression index. Predictors were stringency of policies, trust in government, and gender. Multivariable regression was conducted to determine the three-way interaction between the predictor variables for mental health outcomes, adjusting for age, income and education. Results The median age of participants (56.4% women) was 37 years (interquartile range 29 to 48 years). Women had higher worries and depression scores than men. 45.4% distrusted the government and 43.8% trusted the government to take care of its citizens. Among those who strongly trusted the government, an increase in the stringency of policies was associated with a significant increase in the worries index. Among men who distrusted the government, an increase in policy stringency was associated with an increase in the depression index but not the worries index. In women that strongly distrusted the government, there was an inversed U-shaped association between policy stringency and both the worries and depression indices. Conclusion As the stringency of public health measures increases, so too do depression and worries. The association is moderated by gender and trust in government. For safe and effective public health measures, governments should develop strategies to increase trust in their actions.