Gender as a social and structural variable: research perspectives from the National Institutes of Health (NIH)

Evolving demographics of eligible patient population can impact enrollment of a biomarker clinical study

In a prospective clinical study to better understand how biological markers can improve diagnosis of and prognosis for asthmatic and atopic conditions, we contacted over 3500 eligible patients and observed noticeable differences in the range of their likelihood to enroll based on gender (3.8-13.4%), race and ethnicity (4.8-29.8%), and distance to study site (1.1-29.2%). Both the eligible patients and enrolled participants exhibited a more diverse racial and ethnic composition compared to local population demographics. Based on the eligible patients that the study team contacted ("eligible patients", n = 3648) and those who agreed to enroll ("enrolled participants", n = 454), we analyzed the gender, age, race and ethnicity composition of the groups, together with their proximity to the study site. Living close to the study site was the largest contributor to a patient's decision to enroll for both adults (odds ratio OR: 2.26, 95% confidence interval CI: 1.64-3.15, p < 0.001) and children (OR: 2.59, 95% CI: 1.67-4.41, p < 0.001). We also observed that patients from White and non-Hispanic racial and ethnic background were more likely to participate in the study among both pediatric (OR: 1.51, CI: 0.92-2.62, p = 0.122) and adult patients (OR: 1.81, CI: 1.18-2.89, p = 0.009). Eligible patients of female gender were also more likely to enroll in both adult (OR: 1.53, CI: 1.16-2.05, p = 0.003) and pediatric groups (OR: 2.14, CI: 1.42-3.22, p < 0.001). Overall, the pediatric patients (18 years old or younger) were much less willing to participate in the clinical biomarker study. Nonetheless, as they age, the enrollment likelihood increased accordingly (5 years OR: 1.71, CI, 1.32-2.21, p < 0.001). The eligible patient population of the study reflected the evolving demographics and different disease prevalence for asthma and other allergic diseases in adult and pediatric groups. These factors in turn influenced the composition of the enrolled participants.

Childcare Barriers and Appointment Nonadherence Among Women in a Safety-Net Health System

Importance

Health-related social needs (HRSNs) contribute to appointment nonadherence. Childcare needs are an underrecognized HRSN that particularly affect women.

Objective

To determine whether self-reported childcare barriers were associated with appointment nonadherence among women.

Design, Setting, and Participants

This cross-sectional study used linked survey and electronic health record (EHR) data. Survey data were collected from November 2023 to May 2024 and EHR data were extracted for the 1 year prior to the survey date for each participant. Data were analyzed between June and September 2024. This single-center study was conducted in a safety-net health system in Dallas County, Texas. EHR data included ambulatory care encounters. Eligible participants included women aged 18 years or older referred to gynecology for abnormal cervical cancer screening who reported having childcare responsibilities.

Exposure

Self-reported childcare barriers to appointments in the past year.

Main Outcomes and Measures

Regression analysis was used to evaluate the primary outcome of appointment nonadherence rate during the year prior to survey date.

Results

Of 1264 women eligible for the survey, 836 were successfully reached by telephone, of whom 671 women (53.1% of eligible sample) were included in the sample. Among the 671 initial respondents, 486 women reported having childcare responsibilities (72.4%). The mean (SD) age of the study sample was 34.8 (8.6) years, 405 (83.3%) identified as Hispanic, and 349 (71.8%) preferred Spanish. Additionally, 105 women reported childcare barriers to attending appointments in the past year (21.6%). Women with self-reported childcare barriers were mean 2.9 years younger and more likely to receive Medicaid (38 [36.2%]) than women without childcare barriers (89 [23.4%]). Women with self-reported childcare barriers were more likely to care for an increased number of children and younger children than women without. The mean (SD) appointment nonadherence rate was 25.1% (21.8%) among women with self-reported childcare barriers compared with 15.2% (22.1%) among women without. The adjusted difference in appointment nonadherence was 8.8 (95% CI, 3.6-14.0) percentage points (P = .001) higher among women with self-reported childcare barriers.

Conclusions and Relevance

In this cross-sectional study of women in a safety-net health system, self-reported childcare barriers were associated with increased appointment nonadherence. Younger women with younger children were most likely to report childcare barriers to appointments. These findings highlight the importance of childcare needs as a HRSN that warrants screening and intervention.

Gender, Adverse Changes in Social Engagement and Risk of Unhealthy Eating: A Prospective Cohort Study of the Canadian Longitudinal Study on Aging (2011-2021)

BACKGROUND

Social isolation is linked to survival and health. However, dietary effects of social activities, and gender differences, over time are unknown.

METHODS

A prospective study of adults (45+y) reporting daily fruit or vegetable (F/V) intake (at wave 1) from the Canadian Longitudinal Study on Aging (CLSA). Multivariable mixed logistic regression assessed changes in social isolation or breadth of social participation (wave 1 to 2) in relation to adverse changes in F/V (non-daily intake) at wave 3 in women and men.

RESULTS

Women who remained socially isolated between waves 1 and 2 had 85% higher odds of non-daily vegetable intake (OR 1.85 [95% CI: 1.32, 2.59]) and over twofold higher odds of non-daily fruit intake (2.23 [1.58, 3.14]), compared to reference (not isolated at waves 1 and 2). Higher odds of non-daily F/V intake were also observed for women who changed from isolated at wave 1 to not isolated at wave 2. Women and men who had less diverse social participation at waves 1 and 2 had 28-64% higher odds of non-daily F/V intake, compared to their counterparts with diverse social participation at both waves. Higher odds of non-daily fruit were also seen for women who had diverse social participation at wave 1 but reduced their diversity at wave 2 (1.35 [1.12, 1.62]).

CONCLUSIONS

Results showed persistent social isolation impacted changes in F/V among women only, while limited breadth of social participation affected F/V intake in both genders. Further longitudinal research on the complexities of social engagement and eating behavior is warranted.

Biopsychosocial Correlates of Resting and Stress-Reactive Salivary GDF15: Preliminary Findings

Growth differentiation factor 15 (GDF15) is a biomarker of energetic stress related to aging, disease, and mitochondrial defects. We recently showed that GDF15 is quantifiable in saliva and acutely inducible by psychosocial stress. To date, the associations between GDF15 and biopsychosocial factors and individual characteristics remain unknown. Here, in a sample of healthy working adults (n = 198, 70% females), we first confirmed that salivary GDF15 reacts to acute psychosocial stress, peaking 10 min following a socio-evaluative stress paradigm (+28.3%, g = 0.50, p < 0.0001). We then explored associations between i) baseline GDF15 and ii) GDF15 stress reactivity and a variety of trait- and state-level biopsychosocial factors including sex and gender characteristics; measures of mental health, stress, and burnout; physical health and health behaviors; and anthropometric and blood-based metabolic biomarkers. Baseline salivary GDF15 was higher in men than in women and was positively correlated with testosterone, while negatively correlated with estrogen and traditionally feminine gender roles. Of the psychosocial factors examined, we found that work-related stress variables were most consistently related to GDF15, with work-related cynicism, burnout, and emotional exhaustion predicting higher GDF15 reactivity, while job-related autonomy and utilization of competence predicted smaller GDF15 responses. Consistent with GDF15's induction in metabolic and renal diseases, baseline GDF15 was also positively correlated with indirect markers of metabolic disease including waist-to-hip ratio, creatinine, and albumin. Finally, participants with greater GDF15 reactivity also exhibited greater cortisol reactivity, consistent with the role of GDF15 in stress regulation and energy mobilization. Together, this exploratory analysis of salivary GDF15 suggest new biological and psychosocial correlates, calling for large-scale studies connecting human experiences with biological markers of energetic stress.

Aesthetic Gynecology and Mental Health: What Does It Really Mean for Women?

Body image, a complex interplay of perceptions, thoughts, and feelings about one’s physical appearance, has been a subject of extensive research. It is a dynamic construct that evolves throughout a woman’s lifespan, influenced by a multitude of biological, psychological, and sociocultural factors. From adolescence, marked by the onset of puberty and societal pressures to conform to specific beauty standards, to adulthood and the physical changes associated with aging, women’s body image undergoes significant transformations. Aging is a universal process that affects all organs, including the female genitalia. The vaginal tract undergoes significant atrophy due to declining estrogen levels, particularly during and after menopause. Aesthetic gynecology offers a range of procedures to address both functional and aesthetic concerns related to aging genitalia. Aesthetic gynecology, a burgeoning field within women’s health, provides various procedures aimed at enhancing genital appearance and function. It also helps balance the hormonal and anatomical changes that every woman experiences over time. The goal is to strengthen each patient’s intimate well-being and self-esteem, enabling them to experience intimacy peacefully. While often driven by concerns about physical attractiveness and sexual satisfaction, the psychological implications of these procedures are complex and multifaceted. It is crucial to recognize the interplay between psychological factors and the decision to undergo these procedures. Collaboration between surgeons and mental health professionals can ensure that candidates are psychologically prepared and have realistic expectations. By adopting a patient-centered approach and conducting rigorous research, healthcare providers can ensure that aesthetic gynecology is used as a tool for empowerment rather than exploitation. This article explores the intricate relationship between psychological well-being and aesthetic gynecology, examining how these procedures can impact body image, self-esteem, and overall quality of life.

Social and economic impacts of non-communicable diseases by gender and its correlates: a literature review

BACKGROUND

Tackling social impacts derived from gender disparities is a pathway to universal health coverage (UHC). Gender intersects with other factors behind social and health inequalities, exacerbates them and influences health systems' performance. However, there is scarcity of gender-based studies that assess the social and economic impacts of non-communicable diseases (NCDs). This study aims to identify economic and social impacts of NCDs by gender and its correlates.

METHODS

Following the guidelines proposed in the Cochrane Manual for Systematic Reviews of Interventions and the PRISMA Statement, we conducted a narrative and structured literature review to identify the economic (direct medical and non-medical, and indirect costs) and social (right to health, employment, poverty, social exclusion, and others) impacts of NCDs by gender, and its structural, sociodemographic, health conditions, political and health systems correlates, for the period 2002-2022, in English and Spanish. Reviewed studies were described according to country and research context, temporal evolution, gender, impacts of NCDs and correlates.

FINDINGS

Five thousand five hundred fifty-one publications by title and abstract were reviewed, and 185 articles were selected. There is limited evidence with gender perspective addressing the social and economic impacts of NCDs (around 10% of publications) that helps to better understand the difference in the burden of these conditions between men and women. We identified that the social burden primarily affects women in their quality of life, where gender inequities are observed in aspects such as: health care, employment status and living conditions. In addition, a greater responsibility falls on them as caregivers. On the other hand, the economic burden affects more to men, both in terms of direct medical costs and indirect costs. Among the factors that most influenced the identified impacts, we found gender, age, and socioeconomic level. We also identified that access to health insurance that offers financial protection against these conditions is essential to reduce these impacts.

CONCLUSIONS

NCDs pose a significant social and economic burden due to their impact on the health of the population, healthcare systems, and the economies of households and nations, which will likely increase over time. This impact is closely related to gender, although it has been scarcely documented. Public policies aimed at enhancing access and achieving UHC are essential to guarantee effective financial protection in health, especially for the most vulnerable sectors of the population.

Exploring the Impact of Sex and Gender in Brain Function: Implications and Considerations

INTRODUCTION

Sex and gender are crucial variables in understanding brain development and disease. Biological sex is determined by genetic and hormonal factors, whereas gender is a multidimensional construct shaped by social and cultural influences. The interplay of these factors contributes to sex-specific susceptibilities and disease progression in psychiatric and neurological disorders. However, sex and gender are often considered as a single variable, which can lead to biased data analysis and interpretation. This commentary aims to analyze how sex and gender influence brain structure and function, with implications for personalized medicine, research, and the development of gender-sensitive clinical guidelines.

METHODS

Findings from various studies employing neuroimaging techniques and animal models are discussed, as well as the impact of biological sex, gender, environmental, cultural, and social factors on brain development, organization, and behavior.

RESULTS

Evidence suggests that sex differences in brain structure and function are not only genetically determined but are also influenced by gender-related experiences and societal contexts. Importantly, discrepancies between male and female brains are reduced in gender-equal societies. Preclinical studies play a pivotal role in determining the influence of biological sex, independent of gender, in different disease models.

CONCLUSION

The findings underscore the need to consider both sex and gender in research and clinical practice to avoid biases and promote equitable health outcomes. Moving forward, we advocate for gender-sensitive approaches to be integrated into brain research and in clinical guidelines to achieve personalized and precision medicine.

A sociodemographic index identifies sex-related effects on insomnia in the Hispanic Community Health Study/Study of Latinos

Study Objectives

Sex differences are related to both biological factors and the gendered environment. We constructed measures to model sex-related differences beyond binary sex.

Methods

Data came from the baseline visit of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). We applied the least absolute shrinkage and selection operator penalized logistic regression of male versus female sex over sociodemographic, acculturation, and psychological factors jointly. Two "gendered indices," the gendered index of sociodemographic environment (GISE) and gendered index of psychological and sociodemographic environment, summarizing the sociodemographic environment (GISE) and psychosocial and sociodemographic environment (GIPSE) associated with sex, were calculated by summing these variables, weighted by their regression coefficients. We examined the association of these indices with insomnia, a phenotype with strong sex differences, in sex-adjusted and sex-stratified analyses.

Results

The distribution of GISE and GIPSE differed by sex with higher values in male individuals. In an association model with insomnia, male sex was associated with a lower likelihood of insomnia (odds ratio [OR] = 0.60, 95% CI [0.53, 0.67]). Including GISE in the model, the association was slightly weaker (OR = 0.63, 95% CI [0.56, 0.70]), and weaker when including instead GIPSE in the association model (OR = 0.78, 95% CI [0.69, 0.88]). Higher values of GISE and of GIPSE, more common in the male sex, were associated with a lower likelihood of insomnia, in analyses adjusted for sex (per 1 standard deviation of the index, GISE OR = 0.92, 95% CI [0.87, 0.99], GIPSE OR = 0.65, 95% CI [0.61, 0.70]).

Conclusions

New measures such as GISE and GIPSE capture sex-related differences beyond binary sex and have the potential to better model and inform research studies of sleep health.

Inclusion of Sex and Gender to Improve the State of the Science in Women's Health

ABSTRACT

The influence of sex and gender-related factors on health and disease at all levels of scale, across all health conditions, and throughout the entire life course is increasingly clear. A series of policies instituted by the National Institutes of Health (NIH) that require researchers to include appropriate populations and to analyze the data accordingly have strengthened the evidence base around the health of women. Translating these advances to the entire research ecosystem can catalyze rigorous biomedical discovery that can improve health. We encourage journals, publishers, and funders to align their policies and expectations regarding sex and gender considerations in research with those of the NIH and other international funding agencies.

Patterns of Health-Risk Behaviours and Their Associations With Anxiety and Depression Among Chinese Young Adults by Gender: A Latent Class Analysis

This study investigated gender differences in health-risk behaviour patterns among young adults and assessed the associations of anxiety and depression with these patterns. A cross-sectional survey was conducted with 1740 young Chinese adults aged 18-24 years. Latent class analysis (LCA) and multinomial logistic regression were conducted to identify the clusters of health-risk behaviours and their associations with anxiety and depression. Three common patterns were found for both genders: physical inactivity, substance use, and insufficient fruit intake (5.7% for males [M] and 11.6% for females [F]); a sedentary lifestyle only (48.4% for M and 48.9% for F); and a sedentary lifestyle, substance use, and an unhealthy diet (7.6% for M and 20.0% for F). Additionally, two additional unique patterns were found: physical inactivity and unhealthy diet in males (38.3%) and physical inactivity and insufficient fruit intake in females (19.6%). Sociodemographic variables exert different effects on health-risk behaviour patterns as a function of gender. Lower anxiety levels (odds ratio [OR]: 0.892; 95% confidence interval [CI]: 0.823-0.966) and greater depression levels (OR: 1.074; 95% CI: 1.008-1.143) were associated with a sedentary lifestyle, substance use, and unhealthy diet class only in female young adults compared with a sedentary-only class. These findings underscore the need for the implementation of targeted interventions based on gender differences.

Emotional reactivity linking assaultive trauma and risky behavior: Evidence of differences between cisgender women and men

Accumulating evidence suggests that trauma exposure is positively associated with future engagement in risky behavior, such as substance misuse, aggression, risky sex, and self-harm. However, the psychological factors driving this association and their relevance across gender groups require further clarification. In a community sample of 375 adults with a high rate of trauma exposure (age range: 18-55 years, M = 32.98 years, SD = 10.64; 76.3% assaultive trauma exposure), we examined whether emotional reactivity linked lifetime assaultive trauma exposure with past-month risky behavior. We also explored whether this model differed for cisgender women (n = 178, 47.6%) and men (n = 197, 52.5%). As hypothesized, assaultive trauma was positively related to emotional reactivity, β = .20, SE = 0.03, t(369) = 3.65, p < .001, which, in turn, partially accounted for the association between assaultive trauma and past-month risky behavior, indirect effect: β = .03, SE = 0.01, 95% bootstrapped CI [0.01, 0.06]. Gender moderated this association such that assaultive trauma was indirectly associated with risky behavior via emotional reactivity for women but not for men, index moderation: B = -0.03, SE = 0.02, 95% bootstrapped CI [-0.07, -0.01]. Cross-sectional results suggest that emotional reactivity may be a proximal target for clinical intervention to aid in the reduction of risky behavior among women.

A sociodemographic index identifies non-biological sex-related effects on insomnia in the Hispanic Community Health Study/Study of Latinos

Background

Sex differences are related to both biological factors and the gendered environment. To untangle sex-related effects on health and disease it is important to model sex-related differences better.

Methods

Data came from the baseline visit of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a longitudinal cohort study following 16,415 individuals recruited at baseline from four study sites: Bronx NY, Miami FL, San Diego CA, and Chicago IL. We applied LASSO penalized logistic regression of male versus female sex over sociodemographic, acculturation, and psychological factors jointly. Two "gendered indices", GISE and GIPSE, summarizing the sociodemographic environment (GISE, primary) and psychosocial and sociodemographic environment (GIPSE, secondary) associated with sex, were calculated by summing these variables, weighted by their regression coefficients. We examined the association of these indices with insomnia derived from self-reported symptoms assessed via the Women Health Initiative Insomnia Rating Scale (WHIIRS), a phenotype with strong sex differences, in sex-adjusted and sex-stratified analyses. All analyses were adjusted for age, Hispanic/Latino background, and study center.

Results

The distribution of GISE and GIPSE differed by sex with higher values in male individuals, even when constructing and validating them on separate, independent, subsets of HCHS/SOL individuals. In an association model with insomnia, male sex was associated with lower likelihood of insomnia (odds ratio (OR)=0.60, 95% CI (0.53, 0.67)). Including GISE in the model, the association was slightly weaker (OR=0.63, 95% CI (0.56, 0.70)), and weaker when including instead GIPSE in the association model (OR=0.78, 95% CI (0.69, 0.88)). Higher values of GISE and of GIPSE, more common in male sex, were associated with lower likelihood of insomnia, in analyses adjusted for sex (per 1 standard deviation of the index, GISE OR= 0.92, 95% CI (0.87, 0.99), GIPSE OR=0.65, 95% CI (0.61, 0.70)).

Conclusions

New measures such as GISE and GIPSE capture sex-related differences beyond binary sex and have the potential to better model and inform research studies of health. However, such indices do not account for gender identity and may not well capture the environment experienced by intersex and non-binary persons.

Training in the implementation of sex and gender research policies: an evaluation of publicly available online courses

BACKGROUND

Recently implemented research policies requiring the inclusion of females and males have created an urgent need for effective training in how to account for sex, and in some cases gender, in biomedical studies.

METHODS

Here, we evaluated three sets of publicly available online training materials on this topic: (1) Integrating Sex & Gender in Health Research from the Canadian Institutes of Health Research (CIHR); (2) Sex as a Biological Variable: A Primer from the United States National Institutes of Health (NIH); and (3) The Sex and Gender Dimension in Biomedical Research, developed as part of "Leading Innovative measures to reach gender Balance in Research Activities" (LIBRA) from the European Commission. We reviewed each course with respect to their coverage of (1) What is required by the policy; (2) Rationale for the policy; (3) Handling of the concepts "sex" and "gender;" (4) Research design and analysis; and (5) Interpreting and reporting data.

RESULTS

All three courses discussed the importance of including males and females to better generalize results, discover potential sex differences, and tailor treatments to men and women. The entangled nature of sex and gender, operationalization of sex, and potential downsides of focusing on sex more than other sources of variation were minimally discussed. Notably, all three courses explicitly endorsed invalid analytical approaches that produce bias toward false positive discoveries of difference.

CONCLUSIONS

Our analysis suggests a need for revised or new training materials that incorporate four major topics: precise operationalization of sex, potential risks of over-emphasis on sex as a category, recognition of gender and sex as complex and entangled, and rigorous study design and data analysis.

Sex and Gender Publications in Brain Health: A Mapping Review of the Asia-Pacific Region

INTRODUCTION

Reporting of sex and gender analysis in medical research has been shown to improve quality of the science and ensure findings are applicable to women and men. There is conflicting evidence on whether efforts by funding agencies and medical journals to encourage reporting of sex and gender analysis have resulted in tangible improvements. This study mapped the inclusion of sex and gender analysis in stroke and dementia research conducted in the Asia-Pacific region.

METHODS

A systematic search for Asia-Pacific stroke and dementia research was conducted in PubMed and papers included from the period 2012 to 2022. Eligible studies were reviewed for inclusion of a primary sex or gender focus and categorized by type of sex and gender analysis. Author gender was determined using an algorithm and its associations with inclusion of sex and gender analysis were examined.

RESULTS

Total Asia-Pacific publications increased from 109 in 2012 to 313 in 2022, but the rate of studies with a primary sex or gender focus did not increase significantly (R2 = 0.06, F(1, 9) = 0.59, p = 0.46). Australia, China, India, Japan, and South Korea produced the most publications over the study period and were the only countries with at least 50 publications. The impact of author gender was mixed, with female first authorship associated with inclusion of sex or gender analysis and last female authorship associated with studies having a primary sex or gender focus.

CONCLUSIONS

In the Asia-Pacific, brain health research is currently centred around high-income countries, and efforts are needed to ensure research findings are applicable throughout the region. While there was a general increase in brain health publications over the last decade, the rate of sex and gender analysis was unchanged. This demonstrates that even with efforts in some countries in place, there is currently a lack of progress in the Asia-Pacific region to produce more research focussing on sex and gender analysis.

Barriers and facilitators for recruiting and retaining male participants into longitudinal health research: a systematic review

BACKGROUND

Successfully recruiting male participants to complete a healthcare related study is important for healthcare study completion and to advance our clinical knowledgebase. To date, most research studies have examined the barriers and facilitators of female participants in longitudinal healthcare-related studies with limited information available about the needs of males in longitudinal research. This systematic review examines the unique barriers and facilitators to male recruitment across longitudinal healthcare-related research studies.

METHODS

Following PRIMSA guidelines, MEDLINE, Embase, CINAHL and Web of Science databases were systematically searched using the terms recruitment and/or retention, facilitators and/or barriers and longitudinal studies from 1900 to 2023 which contained separate data on males aged 17-59 years. Health studies or interventions were defined longitudinal if they were greater than or equal to 12 weeks in duration with 3 separate data collection visits.

RESULTS

Twenty-four articles published from 1976-2023 met the criteria. One-third of the studies had a predominantly male sample and four studies recruited only male participants. Males appear disinterested towards participation in health research, however this lack of enthusiasm can be overcome by clear, non-directive communication, and studies that support the participants interests. Facilitating factors are diverse and may require substantial time from research teams.

CONCLUSIONS

Future research should focus on the specific impact of these factors across the spectrum of longitudinal health-related studies. Based on the findings of this systematic review, researchers from longitudinal health-related clinical trials are encouraged to consider male-specific recruitment strategies to ensure successful recruitment and retention in their studies.

REGISTRATION

This systemic review is registered with the PROSPERO database (CRD42021254696).

Parenting and Gender as Impact Factors for Social Participation, Quality of Life, and Mental Health in Long COVID

OBJECTIVES

This study aims to investigate the impact of gender and parental tasks on social participation, health-related quality of life (hrQoL), and mental health in persons with long COVID.

METHODS

A mixed-methods approach was followed including a cross-sectional web-based survey and semi-structured interviews. Multivariable linear regressions were used to quantify the effect of gender and parenting tasks on social participation, hrQoL, and mental health. Qualitative data from interviews with participants experiencing long COVID symptoms was analyzed using content analysis.

RESULTS

Data from 920 participants in the quantitative study and 25 participants in the qualitative study was analyzed. Parenting tasks were associated with increased impairments in family and domestic responsibilities in persons with long COVID compared to lower impairments in persons without long COVID (P = .02). The qualitative data indicate that coping with long COVID and pursuing parenting tasks limit participants' ability to perform leisure activities and attend social gatherings. In long COVID, men had higher anxiety symptoms than women, and in those without long COVID, the opposite was observed (P < .001). In the qualitative study, participants expressed feelings of dejection and pessimism about their future private, occupational, and health situations. No differences between the genders could be observed.

CONCLUSIONS

Long COVID is associated with impairments in family and domestic responsibilities in individuals who have parenting tasks. Among participants with long COVID, anxiety symptoms are higher in men than women.