Gender differences in depression and associated factors during the COVID-19 pandemic in Kazakhstan

Background

Depression increased during the COVID-19 pandemic, with potential gender differences in both prevalence and determinants. Evidence from Central Asia remains limited. This study assessed gender differences in depression and associated factors in the general population of Kazakhstan.

Methods

We analyzed cross-sectional survey data collected in 2021 among 991 adults (524 women, 467 men). Depression was assessed using the PHQ-4 depression subscale. Modified Poisson regression with robust standard errors was used to estimate adjusted prevalence ratios (aPRs) separately for women and men. Covariates included socioeconomic factors, health status, COVID-19 exposure, and behavioral changes.

Results

Depression prevalence was higher among women than men (14.9% vs. 8.8%, p = 0.003). Among women, food insecurity (aPR=1.82; 95% CI: 1.14–2.92; p = 0.012), healthcare access problems (aPR=1.97; 95% CI: 1.24–3.13; p = 0.004), COVID-19 exposure (high: aPR=2.05; 95% CI: 1.24–3.39; p = 0.005; medium: aPR=2.28; 95% CI: 1.40–3.72; p = 0.001), and increased alcohol use (aPR=2.05; 95% CI: 1.07–3.94; p = 0.031) were associated with higher depression. Among men, rural residence (aPR=2.08; 95% CI: 1.14–3.79; p = 0.017) and chronic illness (aPR=2.57; 95% CI: 1.42–4.65; p = 0.002) were associated with higher depression. No significant associations were observed for employment, physical activity, or smoking.

Conclusions

Depression was more prevalent among women during the COVID-19 pandemic, but determinants differed by gender. Among women, depression was linked to socioeconomic and pandemic-related stressors, whereas among men, it was primarily associated with structural and health-related factors. These findings highlight the need for gender-sensitive mental health strategies during public health crises.

Key messages

• Women’s mental health is more sensitive to socioeconomic and pandemic-related stressors: Interventions during crises should prioritize food security, access to healthcare, and psychosocial support.

• Men’s depression is driven by structural and health factors: Public health strategies should target rural populations and integrate mental health care with chronic disease management for men.