Sex differences and psychological stress: responses to the COVID-19 pandemic in China

Shiyan Yan, Rui Xu, Terry D. Stratton, Voyko Kavcic, Dan Luo, Fengsu Hou, Fengying Bi, Rong Jiao, Kangxing Song, Yang Jiang

Research output: Contribution to journalArticlepeer-review

75 Scopus citations


Background: About 83,000 COVID-19 patients were confirmed in China up to May 2020. Amid the well-documented threats to physical health, the effects of this public health crisis - and the varied efforts to contain its spread - have altered individuals’ “normal” daily functioning. These impacts on social, psychological, and emotional well-being remain relatively unexplored – in particular, the ways in which Chinese men and women experience and respond to potential behavioral stressors. Our study investigated sex differences in psychological stress, emotional reactions, and behavioral responses to COVID-19 and related threats among Chinese residents. Methods: In late February (2020), an anonymous online questionnaire was disseminated via WeChat, a popular social media platform in China. The cross-sectional study utilized a non-probabilistic “snowball” or convenience sampling of residents from various provinces and regions of China. Basic demographic characteristics (e.g., age and gender) – along with residential living arrangements and conditions – were measured along with psychological stress and emotional responses to the COVID-19 pandemic. Results: Three thousand eighty-eight questionnaires were returned: 1749 females (56.6%) and 1339 males (43.4%). The mean stress level,as measured by a visual analog scale, was 3.4 (SD = 2.4) - but differed significantly by sex. Besides sex, factors positively associated with stress included: age (< 45 years), employment (unsteady income, unemployed), risk of infection (exposureto COVID-19, completed medical observation), difficulties encountered (diseases, work/study, financial, mental), and related behaviors (higher desire for COVID-19 knowledge, more time concerning on the COVID-19 outbreak). “Protective” factors included frequent contact with colleagues, calmness of mood comparing with the pre-pandemic, and psychological resilience. Males and females also differed significantly in adapting to current living/working, conditions, responding to run a fever, and needing psychological support services. Conclusions: The self-reported stress of Chinese residents related to the COVID-19 pandemic was significantly related to sex, age, employment, resilience and coping styles. Future responses to such public health threats may wish to provide sex- and/or age-appropriate supports for psychological health and emotional well-being to those at greatest risk of experiencing stress.

Original languageEnglish
Article number79
JournalBMC Public Health
Issue number1
StatePublished - Dec 2021

Bibliographical note

Funding Information:
This study was funded by the National Natural Science Foundation of China (81973713), State Administration of Traditional Chinese Medicine of China Support Project (2017ZX10106001), Logistics Research Project (ALB18J002, BHJ15J003), and Chinese Medical Scientific Development Foundation of Beijing City (JJ2018–101), Project of Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences (Z0652, Z0608). The funder had no role in the study design, data collection, data analysis, data interpretation, or writing the manuscript.

Publisher Copyright:
© 2021, The Author(s).


  • COVID-19
  • Psychological resilience
  • Psychological stress
  • Sex differences

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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