Healthcare workers (HCWs) were at increased risk for mental health problems during the COVID-19 pandemic, with prior data suggesting women may be particularly vulnerable. Our global mental health study aimed to examine factors associated with gender differences in psychological distress and depressive symptoms among HCWs during COVID-19. Across 22 countries in South America, Europe, Asia and Africa, 32,410 HCWs participated in the COVID-19 HEalth caRe wOrkErS (HEROES) study between March 2020 and February 2021. They completed the General Health Questionnaire-12, the Patient Health Questionnaire-9 and questions about pandemic-relevant exposures. Consistently across countries, women reported elevated mental health problems compared to men. Women also reported increased COVID-19-relevant stressors, including insufficient personal protective equipment and less support from colleagues, while men reported increased contact with COVID-19 patients. At the country level, HCWs in countries with higher gender inequality reported less mental health problems. Higher COVID-19 mortality rates were associated with increased psychological distress merely among women. Our findings suggest that among HCWs, women may have been disproportionately exposed to COVID-19-relevant stressors at the individual and country level. This highlights the importance of considering gender in emergency response efforts to safeguard women's well-being and ensure healthcare system preparedness during future public health crises.

2nd Faculty of Medicine Charles University Prague Czech Republic

Centre for Addiction and Mental Health Toronto ON Canada

Centro de Investigación Biomédica en Red de Salud Mental Carlos 3 Health Institute Madrid Spain

Clinical Neuro and Developmental Psychology Amsterdam Public Health Institute Vrije Universiteit Amsterdam Amsterdam The Netherlands

Czech Society for Emergency and Disaster Medicine Czech Medical Association of J E Purkyně Prague Czech Republic

Dalla Lana School of Public Health University of Toronto Toronto ON Canada

Departamento de Salud Pública Facultad de Medicina Universidad Nacional de Colombia Sede Bogotá Bogotá Colombia

Department of Biostatistics Mailman School of Public Health Columbia University New York NY USA

Department of Child and Adolescent Psychiatry New York University Langone Medical Center New York NY USA

Department of Clinical Epidemiology and Biostatistics Pontifical Xavierian University Bogotá Colombia

Department of Epidemiology Columbia University Mailman School of Public Health New York NY USA

Department of Epidemiology Harvard T H Chan School of Public Health Boston MA USA

Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy

Department of Mental Health Graduate School of Medicine The University of Tokyo Tokyo Japan

Department of Oral and Maxillofacial Surgery University College Hospital Ibadan Nigeria

Department of Psychiatric Nursing Graduate School of Medicine The University of Tokyo Tokyo Japan

Department of Psychiatry and Clinical Psychology Faculty of Medicine University of Balamand Beirut Lebanon

Department of Psychiatry and Clinical Psychology St George Hospital University Medical Center Beirut Lebanon

Department of Psychiatry and Neuropsychology School for Mental Health and Neuroscience Maastricht University Medical Centre Maastricht The Netherlands

Department of Psychiatry Clinical Psychology and Mental Health La Paz University Hospital Madrid Spain

Department of Psychiatry Universidad Autónoma de Madrid Madrid Spain

Department of Psychiatry University College Hospital Ibadan Nigeria

Department of Psychiatry University of Ibadan Ibadan Nigeria

Department of Psychology Koç University Istanbul Turkey

Department of Public Health and Family Medicine Pontificia Universidad Católica de Chile Santiago Chile

Department of Public Health School of Medicine University of Valparaíso Valparaiso Chile

Department Psychiatry A Razi Hospital La Manouba Manouba Tunisia

Departments of Health Policy and Management and Epidemiology and Biostatistics Downstate Health Sciences University Brooklyn NY USA

Dirección de Investigación Ciencia y Tecnología Universidad San Francisco Xavier de Chuquisaca Sucre Bolivia

Emergency Department Motol University Hospital Prague Czech Republic

Epidemiology Group National School of Public Health University of Antioquia Medellín Colombia

European University of Madrid Madrid Spain

Faculty of Health and Social Work University of Applied Sciences Emden Leer Emden Germany

Faculty of Medical Sciences University of San Carlos of Guatemala Guatemala City Guatemala

Faculty of Medicine of Tunis University of Tunis El Manar Tunis Tunisia

Faculty of Medicine Santa Marcelina São Paulo Brazil

Faculty of Medicine University of São Paulo São Paulo Brazil

Hospital La Paz Institute for Health Research Madrid Spain

Institute for Development Research Advocacy and Applied Care Beirut Lebanon

Institute of Health Sciences Universidad de O'Higgins Rancagua Chile

Instituto de Investigación Sanitaria del Hospital Universitario La Princesa Madrid Spain

Maestría en Epidemiología División de Postgrados El Bosque University Bogotá Colombia

National Institute of Health Named After Academician S Avdalbekyan Yerevan Armenia

National Institute of Psychiatry Ramon de la Fuente Muñiz Mexico City Mexico

New York State Psychiatric Institute New York NY USA

Parnassia Psychiatric Institute Parnassia Groep The Hague The Netherlands

Population Health Research Section King Abdullah International Medical Research Center Riyadh Saudi Arabia

Question Driven Design and Analysis Group New York NY USA

School of Behavioral and Brain Sciences Ponce Research Institute Ponce Health Sciences University Ponce Puerto Rico

School of Medicine and Psychiatric Institute Federal University of Rio de Janeiro Rio de Janeiro Brazil

School of Public Health University of Chile Santiago Chile

Social and Community Academic Unit University of Chubut Chubut Argentina

Unidad de Investigación Consultora Salud Global Bolivia Sucre Bolivia

University Hospital Federal University of Rio Grande Rio Grande Brazil

University Medical Center Groningen University Center of Psychiatry University of Groningen Groningen The Netherlands

WHO Collaborating Centre for Research and Dissemination of Psychological Interventions Amsterdam The Netherlands

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