Psychological distress and compliance with sanitary measures during the Covid-19 pandemic: effect modification by participant gender and socioeconomic characteristics, an IPD meta-analysis.

Background: This study aims to understand how individuals’ psychological distress is related to compliance with COVID-19 sanitary measures. In addition, we explored whether gender and socioeconomic status (i.e educational level and employment status) modify the relationship between psychological distress and compliance with COVID-19 sanitary measures. Methods: 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 the interaction with socioeconomic status. Models were additionally stratified by gender to capture gender-specific patterns. Results: We found a significant positive association between mental health difficulties and compliance with sanitary measures in women, while amongst men the association was also significant but negative. Moreover, there was a statistically significant interaction between participants’ educational level and mental health difficulties amongst men only, indicating even lower compliance levels amongst those with only primary schooling. Conclusion: The association between psychological distress and compliance with sanitary measures  is unclear - positive for women, negative for male. Men experiencing mental health difficulties, especially those with lower educational attainment, exhibited lower compliance with sanitary measures.