The level of education is associated with an anxiety-depressive state among men and women – findings from France during the first quarter of the COVID-19 pandemic

CONTEXT: It is widely recognised that the COVID-19 pandemic has negatively impacted individuals’ mental health. However, little emphasis has been put on the possible influence of socio-economic factors in the relationship. In the context of the COVID-19 pandemic, our objectives were (i) to assess the relationship between education level and mental health in French adults, and (ii) to study the influence of the economic, social, health and the COVID-19-related factors in men and women respectively. METHOD: Data are from 32,581 individuals representative of the French population who responded to the weekly survey “Baromètre COVID-19” between April 7(th) and May 31(st) 2020. Education level was self-reported (university degree, high school qualification, vocational certificate/qualification, no diploma). Anxiety-depressive state was derived from four items related to the frequency of occurrence of depressive and anxiety symptoms, and summarized in an overall validated anxiety-depressive score. Multivariate linear regression analyses were carried out with nested adjustments of variables related to economic, social, health and COVID-19 contexts to assess the relationship between education and anxiety-depressive state. RESULTS: In total, 45% of individuals reported symptoms of anxiety-depressive state (53% in women versus 36% in men). Among men, those with a vocational certificate/qualification and those with no diploma had a greater risk of having a higher anxiety-depressive state compared to those with a university degree (β(Vocational certificate/qualification) = 0.16 [0.04; 0.27]; β(No diploma) = 0.75 [0.43; 1.07]) while among women, the risk of anxiety-depressive state increased as education level decreased (β(Baccalaureate) = 0.37 [0.25; 0.49]; β(Vocational certificate/qualification) = 0.41 [0.28; 0.54]; β(No diploma) = 0.8 [0.49; 1.12]). For both men and women, economic, health, and COVID-19 factors partly attenuate these associations while social factors marginally modified the relationship. After accounting for confounders and intermediate variables, the absence of a diploma remained associated with anxiety-depressive state among men, while the whole educational gradient of anxiety-depressive state persisted among women. CONCLUSION: In France, at the end of the first wave of COVID-19, individuals with a lower level of education had a higher risk of anxiety-depressive state. This association was more pronounced for women, highlighting a process of social inequality in health possibly related to gender. This should be considered in future prevention and public health interventions.