ABSTRACT
Objective The COVID-19 pandemic dramatically altered social determinants of health including work, education, social connections, movement, and perceived control;and loneliness was commonly experienced. This longitudinal study examined how social determinants at the personal (micro), community (meso), and societal (macro) levels predicted loneliness during the pandemic. Methods Participants were 2056 Australian adults surveyed up to three times over 18 months in 2020 and 2021. Multi-level mixed-effect regressions were conducted predicting loneliness from social determinants at baseline and two follow-ups. Results Loneliness was associated with numerous micro determinants: male gender, lifetime diagnosis of a mental health disorder, experience of recent stressful event(s), low income, living alone or couples with children, living in housing with low natural light, noise, and major building defects. Lower resilience and perceived control over health and life were also associated with greater loneliness. At the meso level, reduced engagement with social groups, living in inner regional areas, and living in neighbourhoods with low levels of belongingness and collective resilience was associated with increased loneliness. At the macro level, increased loneliness was associated with State/Territory of residence. Conclusions Therapeutic initiatives must go beyond psychological intervention, and must recognise the social determinants of loneliness at the meso and macro levels. Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of the Australian Association for Cognitive and Behaviour Therapy.
ABSTRACT
Public Significance Statement The current study explored the ways that housing and employment instability brought on by the COVID-19 pandemic contributed to heightened psychological distress among a sample of transgender and gender diverse (TGD) individuals collected using an online survey platform. Our findings indicate that TGD individuals experienced heightened levels of psychological distress directly related to employment and housing instability which is a crucial and timely concern given that TGD individuals experienced greater psychological distress, unemployment, and housing instability relative to the general population prior to the pandemic. Receiving a COVID-19 diagnosis or experiencing symptoms associated with COVID-19 also predicted heightened levels of psychological distress. It is recommended that additional TGD-specific protections be implemented and expanded upon in order to meet the current and impending needs of TGD individuals. Transgender and gender diverse (TGD) individuals are faced with various societal factors that contribute to health disparities. As COVID-19 spreads, health disparities that existed prior to the pandemic have become exacerbated. The current study aims to address factors that may be negatively impacting TGD individuals during the COVID-19 pandemic by exploring their experiences related to symptoms of depression, symptoms of anxiety, employment, and housing. TGD participants (N = 342) were recruited from an online participant recruitment platform and answered questions related to their psychological well-being and changes in employment and housing since the start of the pandemic. Adverse changes in employment since the start of the pandemic were reported by almost 1/3 of participants and were associated with higher depression and anxiety. Changes in housing were reported by almost 1/4 of participants and were associated with higher anxiety. Experiencing COVID-19 symptoms or receiving a COVID-19 diagnosis were also associated with higher anxiety. Findings indicate TGD individuals who experienced changes in employment and housing since the start of the COVID-19 pandemic experience greater levels of psychological distress. Findings may inform mental health providers and policymakers on the repercussions the pandemic has had on TGD individuals.