Women in the UK were disproportionately affected by the COVID-19 pandemic, yet little research has examined gender differences in how the pandemic influenced health behaviours and their role in supporting mental health. To address this gap, we analysed Understanding Society data from January 2015 to May 2023.
Background
Health behaviours such as diet, alcohol consumption and physical activity are closely linked to physical and mental health. Despite these benefits, many people (around 30%) in the UK report poor health behaviour. Women usually report healthier dietary habits, and lower alcohol consumption than men, but also less physical activity. Less is known about gender differences in the psychological benefits derived from healthy behaviour.
During the pandemic, women shouldered a greater share of caregiving, housework, and home-schooling, along with more cognitive labour – managing the planning and organisation needed to keep the household running. This likely left them with less time and energy for healthy behaviours. Also, women reported poorer mental health, especially in the early stages of the pandemic, which may have contributed to unhealthy coping behaviours. The significant pressures women faced during the pandemic may have also weakened the protective effect of health behaviours on their mental health.
Using the data
In our main analysis, we compared outcomes in Waves 7 and 9 (2015-2019) to Wave 11 (March 2020 to May 2021). In an additional analysis, we also incorporated data from Wave 13 (January 2021 to May 2023) to understand whether the effects we find persist after the pandemic reduced in severity.
We examined health behaviours including fruit and vegetable consumption, alcohol use (frequency and intensity), and physical activity. Because people often report a mix of healthy and unhealthy behaviours, we also evaluated overall health behaviour using two measures: the total number of positive behaviours (ranging from 0 to 6) and whether a person reported a majority of healthy behaviours. Mental health was assessed using the General Health Questionnaire (GHQ-12). Other questions in Understanding Society allowed us to take into account factors such as age, education, race, and region.
Results
Before the pandemic, women reported an average of 4.1 healthy behaviours, with 70% indicating they maintained a healthy lifestyle (defined as a majority of positive behaviours). Men, on the other hand, reported an average of 3.7 healthy behaviours, with 56.7% indicating a healthy lifestyle.
During the pandemic, women maintained their average of 4.1 healthy behaviours, with 70.5% reporting a healthy lifestyle. Men reported a slight increase to 3.8 healthy behaviours, while the percentage reporting a healthy lifestyle increased to 60.5%.
Women reported poorer overall changes in health behaviours than men during the pandemic compared to the pre-pandemic period. These differences were primarily driven by smaller improvements in women’s behaviours compared to men rather than by absolute declines. Specifically, women reported fewer days of fruit consumption and smaller reductions in alcohol intake. These findings remain consistent even after accounting for factors such as gender-specific trends over time, gender-age interactions, and other factors which don’t vary with time.
Psychological distress increased for both women and men during the pandemic, with women experiencing a greater rise. Before the pandemic, we observed strong correlations between health behaviours and mental health for women and men. These positive health behaviours were linked to lower GHQ-12 scores, indicating better mental health.
During the pandemic, the relationship between health behaviours and mental health weakened significantly for women, with a healthy lifestyle no longer showing a significant association with mental health. For men, these relationships remained statistically unchanged. While overall health behaviours had a stronger protective effect for women before the pandemic, this effect was stronger for men during the pandemic.
Our findings show that the adverse changes in women’s health behaviours compared to men’s persisted through to May 2023. This persistence may be influenced by external factors, such as the higher inflationary pressures in the UK caused by the energy crisis from late 2021 onwards. These pressures may have disproportionately affected women, who generally earn less and are more likely to work in precarious jobs.
Other research has shown that social support could be a buffer against greater distress during the pandemic, and our finding that loneliness is a potential contributor to the relationship between health behaviours and mental health is consistent with those earlier findings.
On a positive note, we observe a partial return of the protective effect of health behaviours on women’s mental health when data from 2022-23 are included. Further research to establish whether these trends continue would be helpful to inform policy development around promoting health behaviours and mental health.
Authors
Karen Arulsamy
Karen Arulsamy is a Research Fellow at DUKE-NUS Medical School, Singapore
Paul McNamee
Paul McNamee is a Professor in the Health Economics Research Unit at the University of Aberdeen
Silvia Mendolia
Silvia Mendolia is a Associate Professor in Economics at the Department of Economics, Social Studies and Applied Mathematics and Statistics at the University of Turin
