Social unrest and pandemic take a toll on HK women’s mental health

Exposure to social unrest and the coronavirus disease 2019 (COVID-19) pandemic may increase depressive and post-traumatic stress disorder (PTSD) symptoms among women in Hong Kong, according to a study by the Queen Mary Hospital and University of Hong Kong (HKU).

The researchers collected data between May and September 2020 from an online self-help health and psychoeducation tool for women in Hong Kong developed by the Department of Psychiatry, HKU. The respondents (n=751) were asked to complete a questionnaire about their PTSD symptoms, exposure to social unrest–related traumatic events (TEs), pandemic-related traumatic events (PEs) and personal stressful life experiences (SLEs). [J Affect Disord 2022;300:263-268]

Results revealed that 38.4 percent of women had moderate-to-severe depressive symptoms (ie, Depression Subscale of the Depression and Anxiety, and Stress Scale 21-item version [DASS-D] score ≥15) – a 3-fold increase from the reported rate of probable depression among women during the 2019 Hong Kong Anti-Extradition Law Amendment Bill Movement. Almost a quarter of women (23.8 percent) were found to have probable PTSD (ie, Trauma Screening Questionnaire [TSQ] score ≥6) – nearly doubling the rate of suspected PTSD among women during the social movement in 2019.

The most common TEs, PEs and SLEs were witnessing violent acts through the media (61.5 percent), lack of outdoor socialization due to the COVID-19 pandemic (64.6 percent), and serious physical health problems (33.0 percent), respectively. “[Of note], the women in our study did not report active participation in the social unrest in Hong Kong, which could be due to the fact that the sample was mostly middle-aged or older [aged 30–49 years, 56.5 percent; aged ≥50 years, 18.9 percent] … Nonetheless, more than half were exposed to trauma indirectly through the media,” pointed out the researchers.

When SLEs were present, the population-level stressors (ie, TEs or PEs) were associated with increased risk of probable PTSD (high SLEs and TEs: adjusted odds ratio [aOR], 9.70; 95 percent confidence interval [CI], 2.75 to 34.13; p<0.001) (high SLEs and PEs: aOR, 9.47; 95 percent CI, 2.57 to 34.94; p<0.001). The effects on PTSD risk was the greatest when all three stressors were high (aOR, 14.54; 95 percent CI, 4.36 to 48.43; p<0.001), while presence of both high TEs and high PEs yielded the smallest positive yet still significant odds (aOR, 5.74; 95 percent CI, 1.64 to 20.13; p<0.01).

Significant risk factors for moderate-to-severe depressive symptoms included high SLEs only (aOR, 4.89; 95 percent CI, 1.60 to 14.93; p<0.01), high TEs only (aOR, 4.03; 95 percent CI, 1.62 to 10.01; p<0.01), and high PEs only (OR, 2.90; 95 percent CI, 1.18 to 7.13; p<0.05).

“This study showed clear associations between stressful events, at both the population level [ie, witnessing violent acts through the media or lack of outdoor socialization] and individual level, and women’s mental health status, and these associations are evident for both depressive and PTSD symptoms,” the researchers noted.

“These findings suggest that comprehensive community screening and monitoring, as well as timely treatment and care, are required to address women’s psychological needs when society is subjected to a series of large-scale stressors,” they remarked.