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. Author manuscript; available in PMC: 2024 Nov 1.
Published in final edited form as: J Women Aging. 2023 Mar 26;35(6):505–512. doi: 10.1080/08952841.2023.2188039

Psychological health among older adult women in the US during the COVID-19 pandemic

Victoria B Marshall a,b,*, Savannah C Hooper a,b, Carolyn Black Becker c, Pamela K Keel d, Lisa Smith Kilpela a,b,e
PMCID: PMC10520218  NIHMSID: NIHMS1913874  PMID: 36966441

Abstract

This study examined differences in mental health in older adult women before versus during the COVID-19 pandemic. Participants who were community dwelling (N = 227) included n = 67 women aged 60–94 in the pre-pandemic group and n = 160 women aged 60–85 in the peri-pandemic group who completed self-report measures assessing mental health and quality of life (QOL). We compared mental health and QOL indices across the pre- and peri-pandemic groups. Results indicated that the peri-pandemic group reported higher anxiety (F = 4.94, p = .027) than the pre-pandemic group. No other significant differences emerged. Given the differential effects in this pandemic across SES, we conducted exploratory analyses investigating differences by income group. Controlling for education and race, within the pre-pandemic group, women with lower income reported worse physical function compared to the mid- and high-income groups. Within the peri-pandemic group, women with lower income reported worse anxiety, poorer sleep, and poorer QOL (physical function, role limitations due to physical problems, vitality, and pain) than high-income individuals. Overall, women who reported lower income reported worse mental health and QOL than those with high-income, especially during the pandemic. This indicates that income might act as a buffer for older women against negative psychological outcomes of the COVID-19 pandemic.

Keywords: COVID-19, older adults, mental health, quality of life, psychological wellbeing

Since the World Health Organization declared the coronavirus disease 2019 (COVID-19) a pandemic in March of 2020, the global population has been substantially impacted. Not everyone has been affected equally, however. For instance, older adults have been at considerably higher risk for severe morbidity and mortality from COVID-19 (Yanez, et al., 2020) due to age-related lowered immunity and frequent comorbid medical conditions (Ishikawa, 2020). Thus, the older adult population has been disproportionately impacted. Although data consistently indicate that older adults with medical multimorbidity are among the most vulnerable to the physical consequences of COVID-19 (Logar, 2020; Niu et al., 2020), the psychological effects of the COVID-19 pandemic for older adults are less clear.

It is important to examine the mental health effects of this pandemic on older adults, as many strategies to reduce community spread of the virus were socially isolating in nature (e.g., quarantine, stay-at-home orders, community center closures, etc.). Notably, while these measures were more strongly recommended for older adults due to increased disease risk, they may constitute an elevated risk for emotional strain among this population (Armitage & Nellums, 2020). Indeed, older adults, and older women in particular, reported worse insomnia, depression, and anxiety symptoms following COVID-19 lockdown (García-Prado et al., 2022; Gonçalves Ferreira et al., 2021; Robb et al., 2020). Similarly, pre-COVID-19 research found that perceived social isolation predicted higher rates of depression and anxiety among older adults (Santini et al., 2020).

Older women may be especially vulnerable to the negative psychological effects of the pandemic. Research suggests that women are more susceptible to anxiety and depression in general (Altemus et al., 2014; Rubinow & Schmidt, 2019), including during the pandemic (García‐Fernández et al., 2021; Xiong et al., 2021; Zheng et al. 2021). Pre-pandemic, women also reported higher rates of loneliness than men, and these gender differences have increased since the COVID-19 outbreak began (Wilson-Genderson et al., 2022), signifying a potential gender-specific risk for worse emotional health under pandemic circumstances (García-Fernández et al., 2021). Yet, more research is needed to better understand the emotional toll of the pandemic on older women.

It is important to recognize that aging also may confer psychological benefits. Indeed, research has demonstrated psychological resilience (i.e., ‘the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress’; American Psychological Association [APA], 2020) among older adults. Data in the context of the COVID-19 pandemic are more equivocal. On the one hand, older adults reported lower stress and negative emotions in comparison to younger adults during COVID-19 quarantines (Sterina et al., 2021). Even in studies that showed elevated rates of distress in older adults, signs of resilience existed. On the other hand, García-Portilla and colleagues (2021) found high prevalence of emotional distress during the pandemic among Spanish adults aged 60+, with older women reporting greater emotional distress. However, this older sample also displayed lower risk of developing depressive and stress responses than did younger individuals.

Importantly, other sociodemographic factors likely played a role in worsening emotional health among some older women during the pandemic. For instance, older adults in García-Portilla et al. (2021) reported a more comfortable socioeconomic status (SES) than did younger adults. Similarly, among older adults in England, those with lower SES reported worse mental health both before and during the pandemic (Zaninotto et al., 2022). Older women also reported poorer mental health indices during the pandemic compared to older men. However, the specific role of SES within older women was not examined. Nonetheless, in general adult samples, research examining mental health after the start of the pandemic indicates that individuals of lower SES were more likely to report greater deterioration in mental health during the pandemic (Jenkins et al., 2021; Zheng et al. 2021), suggesting higher income may be a protective factor against negative mental health consequences of COVID-19. Presently we have insufficient data for older women. Therefore, research is needed to further investigate the degree to which age and SES confer elevated protective or risk status for older women during the pandemic.

Given that: 1) the literature on the psychological effects of the COVID-19 pandemic on older adults is equivocal (García-Portilla et al., 2021; Robb et al., 2020; Zaninotto et al., 2022), 2) women are at higher risk factor for vulnerability to mental health problems generally (Altemus et al., 2014; Rubinow & Schmidt, 2019), and 3) some data indicate that older adults exhibit greater psychological resilience in the face of adversity, research is needed to examine the intersection of age, gender, and emotional wellbeing during pandemic versus before the pandemic, as well as relevant sociodemographic risk factors for mental health. Thus, the current study examined differences in mental health indices in a sample of older women collected before (i.e., pre-pandemic) versus during the COVID-19 pandemic (i.e., peri-pandemic). We hypothesized that the peri-pandemic group would report worse mental health than the pre-pandemic group.

In line with research highlighting the disparate impact of COVID-19 on lower SES households in general (Jenkins et al., 2021; Zheng et al. 2021), we examined income (i.e., a proxy for SES) as a risk factor for negative psychological outcomes both pre- and peri-pandemic. We predicted that income status would be more relevant in the peri-pandemic group than the pre-pandemic group, such that older women living with lower income would report poorer mental health during the pandemic.

Methods

Participants

Participants (N = 227) included n = 67 women aged 60–94 (M = 69.42, SD = 7.55) who completed measures before the COVID-19 pandemic in the United States (pre-pandemic group). The peri-pandemic group consisted of n = 160 women aged 60–85 (M = 68.59, SD = 6.05) who completed surveys after the pandemic began (March 13, 2020-May 2021). Of note, most of the peri-pandemic data were collected when COVID-19 preventive measures were instituted and widespread knowledge of the pandemic existed in the US, but prior to vaccines becoming widely available. All participants were community-dwelling. Demographics are presented in Table 1. Regarding race/ethnicity, our sample endorsed predominantly non-Hispanic White race (pre = 79.1%; peri = 78.8%); a minority of participants endorsed Hispanic ethnicity (pre = 11.9%; peri = 15.0%). The sample was highly educated; over half (pre = 58.2%; peri = 71.9%) reported a bachelor’s degree or higher. Approximately half (pre = 47.8%; peri = 57.5%) reported ‘married’ or ‘living with someone in a partnership,’ and most were retired (pre = 55.2%; peri = 61.9%).1

Table 1.

Participant demographics and baseline characteristics (N = 227)

Measures Pre-COVID (N = 67) Peri-COVID (N = 160)
M (SD) or N (%) M (SD) or N (%)
Age 69.55 (7.54) 68.59 (6.05)
Race
 White 62 (92.5%) 146 (91.3%)
 Black or African American 1 (1.5%) 4 (2.5%)
 Asian -- 2 (1.3%)
 Native American/Alaskan Native 1 (1.5%) --
 Other or mixed race 2 (3%) 4 (2.5%)
Ethnicity
 Hispanic/Latina 8 (11.9%) 24 (15%)
 Non-Hispanic/Latina 56 (83.6%) 133 (83.1%)
Relationship Status
 Married/living with partner 32 (47.8%) 92 (57.5%)
 Single 6 (9%) 19 (11.9%)
 Divorced/Separated 13 (19.4%) 32 (20%)
 Widowed 16 (23.9%) 17 (10.6%)
Education
 Graduated high school or GED 6 (9%) 9 (5.6%)
 Some college 13 (19.4%) 19 (11.9%)
 Graduated 2-year or 4-year college 21 (31.4%) 53 (33.2%)
 Some graduate school 7 (10.4%) 18 (11.3%)
 Graduate school degree 17 (25.4%) 58 (36.3%)
Employment
 Full time 16 (23.9%) 31 (19.4%)
 Part time 10 (14.9%) 23 (14.4%)
 Disabled 3 (4.5%) 2 (1.3%)
 Retired 37 (55.2%) 99 (61.9%)
Income
 Under 20k 4 (6%) 12 (7.5%)
 20k – 35k 8 (11.9%) 18 (11.3%)
 35k – 50k 7 (10.4%) 11 (6.9%)
 50k – 75k 9 (13.4%) 34 (21.3%)
 75k – 100k 7 (10.4%) 20 (12.5%)
 100k and above 23 (34.3%) 47 (29.4%)
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Procedure

The University of Texas Health Science Center San Antonio Institutional Review Board (IRB) deemed this study as IRB-exempt (i.e., no more than minimal risk to study participants). Data presented in this report were collected within a study investigating behavioral health among older women, which began prior to the pandemic and continued through May 2021. Using data from all participants in the main study, we conducted secondary analyses related to mental health and wellbeing among women who participated before and during the COVID-19 pandemic, which occurred part-way through the main study.

Women aged 60 years and older were recruited via internet advertising using a multi-pronged approach. We recruited publicly online (e.g., posting on social media sites among interest groups for older adult women, local senior centers, and institutional research websites), as well as employing internet snowball sampling (i.e., asking women to forward the survey link to their social or professional networks that included older adult women), postings within social networking groups (e.g., local Meet-up group online forums), advertising on Amazon Mechanical Turk, and announcing by word of mouth (e.g., Community Advisory Board meetings). All flyers and online postings advertised the study as a survey study on aging and women’s health, and recruitment materials asked that participants forward the survey to their personal networks. Following informed consent, participants completed self-report measures online. Upon completion, participants could opt into a raffle for a US$50 Amazon e-gift card.

When we initially launched the survey, all participants could receive a US$10 Amazon e-gift card following survey completion. We experienced an influx of artificial responses (i.e., “bots”) and restarted study efforts using a raffle to reduce the likelihood of invalid responses (e.g., men, younger women, bots). All responses were carefully monitored; we embedded validation questions throughout the survey, dummy pathways for potential respondents under age 60 or male gender, and Captcha Verification to screen for non-human attempts. All responses filtered through dummy pathways were discarded. Entries included in the final dataset underwent careful scrutiny for any suspicious or invalid response patterns (e.g., unreasonably short completion time, invalid/nonsensical text, repeated entries, inconsistent values entered on validation questions, and response biases indicating inattention or not reading).

Measures

We used the 10-item Center for Epidemiologic Studies – Depression Scale (CES-D; Lewinsohn et al., 1997; current sample Cronbach’s α = .866) to measure depression; higher scores indicate greater depressive symptoms. The Geriatric Anxiety Inventory Short Form (GAI; Pachana et al., 2007; α = .926) measured anxiety symptoms; higher scores signify higher anxiety. The Pittsburgh Sleep Quality Index (PSQI; Buysse et al., 1989; α = .726) measured sleep quality; higher scores indicate poorer sleep. We used the RAND 36-Item Short Form Health Survey (SF-36; Hays et al., 1993; α range = .79 to .91) to assess eight domains of quality of life (QOL): physical functioning, bodily pain, role limitations due to physical health problems, role limitations due to emotional problems, emotional well-being, social functioning, vitality, and general health. Higher SF-36 scores indicate better QOL. We collected demographic data (e.g., race/ethnicity, education, annual household income, relationship status, employment status).

Results

We conducted one-way analyses of variance (ANOVAs) to compare mental health constructs between older women pre-pandemic (n = 67) versus peri-pandemic (n = 160). Results indicated that the peri-pandemic group reported significantly higher anxiety (F(1,200) = 4.94, p = .027) than the pre-pandemic group. No significant differences emerged for any other measures.

To examine potential differences in mental health constructs based on income status pre- and peri-pandemic, we divided both the pre-pandemic and peri-pandemic samples into three income subgroups: lower income (≥50k/year; pre n = 19; peri n = 41), middle-income (50–100k/year; pre n = 16; peri n = 54), and high-income (>100k/year; pre n = 23; peri n = 47). Within each pandemic group, we conducted ANOVAs comparing income group on each outcome variable, controlling for education and race, using a Bonferroni correction to account for multiple tests (.05/11 = .005). Within each ANOVA, we conducted (k-1) planned contrasts, comparing 1) the lower- and mid-income groups, and 2) the lower- and high-income groups. Based on existing literature documenting disparate outcomes among individuals with lower income status, we anchored contrasts to examine the effects of the lower-income group versus the middle- and higher-income groups. We did not explore differences between middle- and higher-income groups. Following guidelines detailed by Furr and Rosenthal (2003), we present results from a priori planned comparisons versus the omnibus F tests. Of note, for all significant contrasts, the omnibus F tests were statistically significant using the Bonferroni-corrected alpha (p ≤ .005).

For the pre-pandemic group, planned contrasts indicated that women with lower-income reported worse physical function compared to the mid-income group (t(52) = 3.22, p = .002) and the high-income group (t(52) = 3.97, p < .001). No other significant group differences emerged.

For the peri-pandemic group, women with lower-income reported worse anxiety (t(123) = 4.37, p < .001) and poorer sleep (t(117) = 4.35, p < .001) than did the high-income group. Additionally, the lower-income group reported poorer physical function (t(128) = 3.72, p < .001), greater role limitations due to physical problems (t(127) = 3.59, p < .001), lower vitality (t(129) = 3.43, p < .001), and more pain (t(130) = 2.85, p = .005) than did the high-income group. No planned contrasts between lower- and middle-income groups were significant.

Discussion

The current study sought to compare mental health indices between older adult women before and during the COVID-19 pandemic. Findings indicated that women in the peri-pandemic group reported significantly higher anxiety symptoms than those in the pre-pandemic group; no other significant differences between groups emerged. These findings partially support our hypothesis and should be considered in the context of sample demographics.

Of note, more than half of participants reported an annual household income of ≥$50,000, and two-thirds of our peri-pandemic group were retired. Thus, many participants were financially stable, likely providing some protection from pandemic-related income disruption. Previous research highlights that job loss and decreased financial stability exacerbate the negative psychological consequences of the COVID-19 pandemic (Iob et al., 2020; Posel et al., 2021; Samuel et al., 2022). This was reflected in our results as well. Peri-pandemic women with lower annual household income reported significantly worse psychological outcomes and poorer QOL than those with higher income.

Additionally, minority groups have been disproportionately impacted by COVID-19. Pre-existing inequities, such as health care disparities/lack of access and low wage employment, increase stress and were only exacerbated during the pandemic (Fortuna et al., 2020). This aligns with research suggesting that non-Hispanic Whites experienced lower hospitalization and mortality rates from COVID-19 compared to minorities (Boserup et al., 2020; Rogers et al., 2020). Ethnic and racial minorities occupied a larger portion of essential workers throughout the pandemic and comprise a higher percentage of those in poverty in the US, increasing potential exposure to COVID-19 and potentially increasing stress (Tai et al., 2021). Thus, in our majority non-Hispanic White sample, pandemic-related psychological distress may have been softened due to sociodemographic protective factors.

Other demographic factors likely had a protective effect for our sample as well. Under non-pandemic circumstances, older adults are at increased risk of social isolation versus younger adults (Courtin & Knapp, 2017). Zaninotto and colleagues (2022) found that non-partnered individuals experienced worse mental health changes during the pandemic. Approximately half of our sample cohabitated, which likely buffered against negative social effects of pandemic-related lockdowns. Similarly, peri-/postmenopausal women living with others during COVID-19 confinement reported significantly higher QOL versus those living alone (Coronado et al., 2021).

Our findings might also be explained by older adults’ psychological resilience, although this study had no formal measurement of resilience. Because older adults potentially experience more adversity as a function of time over the life course, these exposures cultivate effective coping strategies (Southwick et al., 2014). For instance, research indicates that older adults utilize coping strategies, especially emotion regulation and problem-solving (Gooding et al., 2012), to weather adverse events in positive ways (Fontes et al., 2015; Silva et al., 2019). Additionally, pre-pandemic research suggests that adults experience lower frequencies of negative emotions with age (Carstensen et al., 2000). These factors might have affected pandemic coping in our sample of older adult women.

Limitations to the current study include the use of self-report measures exclusively, a cross-sectional study design, and a small non-White sample which limits our ability to investigate potential differences across racial/ethnic groups. Our sample was demographically homogeneous, which prohibits generalization to other older adult populations (e.g., minority populations, low/very low SES, or lower education levels). Not including type of employment in the inferential statistics is an additional limitation, as employment has also been affected by the pandemic. Of note, our understanding of the impact of vaccines on the mental health and QOL of older adults is limited as our data werè collected before vaccines were widely available to the general public. A strength of this study includes our ability for pre- and peri-pandemic comparison, where the majority of recent research on the impact of COVID-19 has focused primarily on peri-pandemic samples. However, a limitation of this study is that we cannot assess change over time within subjects, as these data are not longitudinal but are independent samples collected before and after the pandemic began.

As this pandemic is ever changing with new and more virulent variants of the virus and less frequent engagement in strategies to reduce the spread of infection along with the availability of vaccines, the impact on older adult women may also continue to change. Future research should utilize longitudinal designs to better understand the psychological effects of the COVID-19 pandemic on older adults and to track trajectories of emotional distress before, during, and after the pandemic. Efforts to include a more diverse sample are imperative in understanding psychological risk and potential protective factors for older adults during this time. Additionally, use of clinical interviews would provide deeper, qualitative data on the psychological experiences of older adults.

Acknowledgments

This work was supported by funding from the National Institute on Aging (NIA) under Grant [K76AG060003-A1]. The authors do not have any conflict of interest related to this article. The data and analytic methods used for this manuscript are available to other researchers upon request from the corresponding author. Neither this study nor the analyses presented in this manuscript were preregistered.

Footnotes

1

No significant differences in demographic variables between groups

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