Gender sensitivity of the COVID-19 mental health research in Europe: a scoping review

Abstract

Background The integration of sex and gender aspects into the research process has been recognized as crucial to the generation of valid data. During the coronavirus pandemic, a great deal of research addressed the mental state of hospital staff, as they constituted a population at risk for infection and distress. However, it is still unknown how the gender dimension was included. We aimed to appraise and measure qualitatively the extent of gender sensitivity. Methods In this scoping review, we searched MEDLINE, EMBASE, CINAHL PsycINFO and Social Sciences Citation Index (SSCI) from database inception to November 11, 2021. All quantitative studies with primary data published in English, German, or Spanish and based in the European Union were selected. Included studies had to have assessed the mental health of hospital staff using validated psychometric scales for depression, anxiety, PTSD symptoms, distress, suicidal behavior, insomnia, substance abuse or aggressive behavior. Two independent reviewers applied eligibility criteria to each title/abstract reviewed, to the full text of the article, and performed the data extraction. A gender sensitivity assessment tool was developed and validated, consisting of 18 items followed by a final qualitative assessment. Two independent reviewers assessed the gender dimension of each included article. Results Three thousand one hundred twelve studies were identified, of which 72 were included in the analysis. The most common design was cross-sectional (75.0%) and most of them were conducted in Italy (31.9%). Among the results, only one study assessed suicidal behaviors and none substance abuse disorders or aggressive behaviors. Sex and gender were used erroneously in 83.3% of the studies, and only one study described how the gender of the participants was determined. Most articles (71.8%) did not include sex/gender in the literature review and did not discuss sex/gender-related findings with a gender theoretical background (86.1%). In the analysis, 37.5% provided sex/gender disaggregated data, but only 3 studies performed advanced modeling statistics, such as interaction analysis. In the overall assessment, 3 papers were rated as good in terms of gender sensitivity, and the rest as fair (16.7%) and poor (79.2%). Three papers were identified in which gender stereotypes were present in explaining the results. None of the papers analyzed the results of non-binary individuals. Conclusions Studies on the mental health of hospital staff during the pandemic did not adequately integrate the gender dimension, despite the institutional commitment of the European Union and the gendered effect of the pandemic. In the development of future mental health interventions for this population, the use and generalizability of current evidence should be done cautiously.