and 91% men), avoiding going out (87% women vs. 71% men, p-value: <0.001), avoiding 1 8 0 crowded areas (96% women and 92% men, p-value: 0.003), refraining from going to hospital or 1 8 1 clinic (78% women and 71% men, p-value: <0.001), avoiding to go to work (72% women and 1 8 2 57% men, p-value: <0.001), avoiding social events (97% women and 93% men, p-value: 0.046), 1 8 3 and avoiding domestic travel (93% women and 86% men, p-value: <0.001). (Table 4 .) Information about COVID-19 provided by the doctor was considered reliable by significantly 1 8 6 more women compared to men (very reliable/reliable: 91% women and 88% men, p-value:
CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) 1 3 0.041). Most of the respondents (very reliable/reliable: 81% women and 82% men) thought that 1 8 8 the information provided through official websites such as those run by the government is 1 8 9 reliable. Significantly more men than the women believed that the radio (very reliable/reliable: 1 9 0 46% women vs. 55% men, p-value: 0.014), and family or friends (very reliable/reliable: 46% 1 9 1 women vs. 55% men, p-value: 0.003) are reliable sources for gaining information about COVID-1 9 2 19. Furthermore, television (very reliable/reliable: 57% women vs. 61% men), newspaper (very 1 9 3 reliable/reliable: 56% women vs. 58% men), magazine (very reliable/reliable: 39% women and 1 9 4 44% men), social media such as Facebook, WhatsApp, Instagram (very reliable/ reliable: 28% 1 9 5 women vs. 32% men) and unofficial websites (very reliable/reliable: 22% women and 31% men) were considered as reliable information sources by more men than women. (Table. 5) 1 9 7 1 9 8 Table 6 demonstrates the predictors of anxiety. Gender, age, and household income had a 1 9 9 significant positive association with anxiety. Women were nearly two times more likely to be 2 0 0 anxious than men (aOR: 1.70, 95% CI: 1.26-2.28). Moreover, respondents of a younger age (25-2 0 1 34 years) (aOR 2.30, 95% CI: 1.26-4.18) were nearly two times more likely to have anxiety than 2 0 2 respondents above 55 years of age. Respondents with a household income between PKR 60,000 2 0 3 and PKR 120,000 were more likely to have anxiety than respondents with a household income of 2 0 4 >PKR 120,000 (aOR: 1.84; 95% CI: 1.27-2.67). Table 7 shows the predictors of depression. Only household income was found have a household income of PKR 60,000 -PKR 120,000 were more likely to have anxiety in 2 0 9
. CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) 1 4 comparison with respondents who had a household income of >PKR 120,000 (aOR: 1.99; 95% 2 1 0 CI: 1.38-2.87).
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This study assessed how gender roles in Pakistan can impact anxiety levels and behavioural 2 1 4 responses among men and women during the COVID-19 pandemic. Both men and women were 2 1 5 found to be mildly anxious due to the COVID-19 pandemic. However, compared to men, more 2 1 6 women perceived the disease to be fatal, and were more likely to engage in preventive behavior. These results highlight a greater need to develop gender-responsive policies in the fight to Overall, fewer women than men responded to the questionnaire. This may be due to a prominent 1 8 exiting from the labor market. These developments are concerning, and emphasize the urgent 2 7 8 need to develop labour policies which protect women in the workforce. Women were more likely to report that they avoid going to hospitals. Furthermore, they were 2 8 0 also more likely to perceive that doctors were a reliable source of information. It may be too 2 8 1 soon to estimate the impact of COVID-19 on maternal and child health services, but one study 2 8 2 estimates that a modest decline of 10% in coverage of pregnancy-related and newborn health pandemic. Clinics operated by Marie Stopes International, which is the largest private provider 1 9 radio could be explained by the significantly larger proportion of men who came from smaller 3 0 0 cities and towns. Furthermore, men in this study were more likely to trust friends and family than 3 0 1 women. Pakistanis are considered to be a collectivistic society, with an emphasis on men 3 0 2 engaging in commitments to the members of their 'group', friends and family (56). Similarly, 3 0 3 men were more likely to trust social media sources than women. The lockdown enforced due to 3 0 4 COVID pandemic has resulted in online activity substituting social activity between families, by the state and its opponents, meant that Syrians were very distrustful of official news sources 3 1 0 (38). Facebook users were much more likely to share official news sources. Therefore, radio 3 1 1 content, as well as shareable social media content might be an appropriate avenue to provide In this study, women depicted higher levels of anxiety and depression in comparison with men, 3 1 6 which suggests that they hold a greater psychiatric burden of the COVID-19 pandemic. One 3 1 7 study conducted in India found that 33% of the respondents had experienced either depression or respondents suffered some psychological impact from the outbreak (58). In both studies, women 3 2 0 were found to have suffered a greater psychological impact due to the pandemic as compared to 3 2 1 men. Similarly, our findings corroborate with data from Turkey, where women had significantly
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The copyright holder for this preprint this version posted November 1, 2020. Psychiatry. 2020;0020764020927051. Abbottabad, Pakistan. Gen Psychiatry. 2020;33(5). . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this preprint this version posted November 1, 2020. Available from: https://www.mariestopes.org/covid-19/stories-from-the-frontline/ Oct 22]. Available from: https://www.thenews.com.pk/tns/detail/652596-lost-protection Pandemic. World Bank; 2020.
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