analytical essay about gender and sexuality as a psychosocial issue

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Open Access

Peer-reviewed

Research Article

The influence of sex, gender, age, and ethnicity on psychosocial factors and substance use throughout phases of the COVID-19 pandemic

Roles Conceptualization, Funding acquisition, Investigation, Methodology, Project administration, Supervision, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliations Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada, Women’s Health Research Institute, Vancouver, Canada

Roles Writing – original draft, Writing – review & editing

Affiliation Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada

Roles Methodology, Project administration, Supervision, Writing – original draft, Writing – review & editing

Affiliation Women’s Health Research Institute, Vancouver, Canada

Roles Data curation, Formal analysis, Investigation, Methodology, Writing – original draft, Writing – review & editing

Roles Methodology, Writing – review & editing

Roles Conceptualization, Investigation, Methodology, Supervision, Writing – original draft, Writing – review & editing

Affiliations Women’s Health Research Institute, Vancouver, Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada

Roles Writing – review & editing

Affiliations Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada, Department of Medicine, University of British Columbia, Vancouver, Canada

Roles Investigation, Methodology, Writing – review & editing

Affiliation Department of Pediatrics, University of British Columbia, Vancouver, Canada

Affiliations Women’s Health Research Institute, Vancouver, Canada, School of Population and Public Health, University of British Columbia, Vancouver, Canada

Roles Conceptualization, Funding acquisition, Investigation, Methodology, Supervision, Writing – original draft, Writing – review & editing

Affiliations Women’s Health Research Institute, Vancouver, Canada, Department of Psychology, University of British Columbia, Vancouver, Canada

• Lori A. Brotto, 
• Kyle Chankasingh, 
• Alexandra Baaske, 
• Arianne Albert, 
• Amy Booth, 
• Angela Kaida, 
• Laurie W. Smith, 
• Sarai Racey, 
• Anna Gottschlich, 

• Published: November 22, 2021
• https://doi.org/10.1371/journal.pone.0259676
• Peer Review
• Reader Comments

The SARS-CoV-2 (COVID-19) pandemic has had profound physical and mental health effects on populations around the world. Limited empirical research has used a gender-based lens to evaluate the mental health impacts of the pandemic, overlooking the impact of public health measures on marginalized groups, such as women, and the gender diverse community. This study used a gender-based analysis to determine the prevalence of psychosocial symptoms and substance use (alcohol and cannabis use in particular) by age, ethnicity, income, rurality, education level, Indigenous status, and sexual orientation.

Participants in the study were recruited from previously established cohorts as a part of the COVID-19 Rapid Evidence Study of a Provincial Population-Based Cohort for Gender and Sex (RESPPONSE) study. Those who agreed to participate were asked to self-report symptoms of depression, anxiety, pandemic stress, loneliness, alcohol use, and cannabis use across five phases of the pandemic as well as retrospectively before the pandemic.

For all psychosocial outcomes, there was a significant effect of time with all five phases of the pandemic being associated with more symptoms of depression, anxiety, stress, and loneliness relative to pre-COVID levels ( p < .0001). Gender was significantly associated with all outcomes ( p < .0001) with men exhibiting lower scores (i.e., fewer symptoms) than women and gender diverse participants, and women exhibiting lower scores than the gender diverse group. Other significant predictors were age (younger populations experiencing more symptoms, p < .0001), ethnicity (Chinese/Taiwanese individuals experiencing fewer symptoms, p = .005), and Indigenous status (Indigenous individuals experiencing more symptoms, p < .0001). Alcohol use and cannabis use increased relative to pre-pandemic levels, and women reported a greater increase in cannabis use than men ( p < .0001).

Conclusions

Our findings highlight the need for policy makers and leaders to prioritize women, gender-diverse individuals, and young people when tailoring public health measures for future pandemics.

Citation: Brotto LA, Chankasingh K, Baaske A, Albert A, Booth A, Kaida A, et al. (2021) The influence of sex, gender, age, and ethnicity on psychosocial factors and substance use throughout phases of the COVID-19 pandemic. PLoS ONE 16(11): e0259676. https://doi.org/10.1371/journal.pone.0259676

Editor: Kimberly Page, University of New Mexico Health Sciences Center, UNITED STATES

Received: May 31, 2021; Accepted: October 24, 2021; Published: November 22, 2021

Copyright: © 2021 Brotto et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Data cannot be shared publicly because of ethical restrictions. Data are available from the the UBC Research Ethics Board (contact via [email protected] ) for researchers who meet the criteria for access to confidential data.

Funding: Funding for this project was from a Michael Smith Foundation for Health Research Grant (19055) and a BC Women's Health Foundation Grant (LRZ30421) both awarded to Dr Lori Brotto and Dr. Gina S. Ogilvie.

Competing interests: The authors have declared that no competing interests exist.

Introduction

In the first eighteen months of the SARS-CoV-2 (COVID-19) pandemic, there have been over 150 million cases and over 3 million deaths attributable to the upper respiratory virus [ 1 ]. More specifically, Canada has reached a stark milestone of one million cases and over 20,000 deaths in a little over a year (May 2021) [ 2 ]. Although the physical health effects of the virus tend to dominate the literature and the media, it is well established that outbreaks, including the current pandemic, have significant impacts on the mental health of those involved. For example, healthcare workers and patients affected by previous outbreaks such as SARS-CoV-1 [ 3 ], H1N1 influenza [ 4 ], and Ebola [ 5 ] have poorer psychosocial outcomes during the onset of societal alarm.

Public health measures put in place due to the COVID-19 pandemic have had a negative impact on the mental health of peoples worldwide [ 6 , 7 ]. Levels of depression [ 8 ], anxiety [ 8 ], loneliness [ 9 ], alcohol use [ 10 , 11 ], and cannabis use [ 12 ] have all increased relative to pre-pandemic levels. Additionally, there is mounting evidence highlighting the secondary effects of public health measures on specific populations during the pandemic [ 13 ]. For example, younger populations [ 14 ] and those of lower income [ 14 ] have experienced disproportionate psychosocial outcomes because of the COVID-19 pandemic.

There is a growing realization that a gender lens needs to be applied to COVID-19 research, not only regarding biomedical outcomes, but for psychosocial outcomes as well [ 15 ]. This aligns with increasing efforts, across North America, to include sex and gender based analyses in all research. Sex is defined as birth assignment and is usually established by genital anatomy at birth with female, male, and intersex as typical response options in queries about sex. Gender identity is defined as one’s personal feelings about being a woman, man, transgender, gender-diverse individual, or another expression of gender that does not align with that person’s birth assigned sex. When sex is considered in the context of psychosocial issues, it is well established that females are more likely to present symptoms of depression and anxiety in general [ 16 ], and face greater job losses than males during the COVID-19 pandemic [ 17 ]. Thus, it is not surprising that studies to date have found that females reported more anxiety, depressive symptoms, and post-traumatic stress symptoms relative to males during the COVID-19 pandemic [ 14 , 18 – 20 ]. Age also plays a large role in sex differences in the risk for neuropsychiatric disorders [ 21 ], but thus far the interaction between age and sex has received little attention with regards to how age may interact with sex to impact psychosocial outcomes throughout COVID-19.

In addition to the paucity of sex-based analyses, studies examining psychosocial outcomes from the standpoint of participants’ self-identified gender are sparse. Most of the research on gender and the COVID-19 pandemic have compared responses between women and men, while ignoring the experiences of individuals who experience gender on a spectrum, beyond the binary classification of man and woman. A recent cross-sectional survey by Hawke et al. [ 22 ] found that despite no clear significant differences in mental health between cisgender, transgender and gender diverse youth before the pandemic, those identifying as gender diverse were two times more likely to report experiencing mental health challenges relative to the cisgender group during COVID-19. These findings were associated with an unmet need for mental health and substance use services. However, this study was limited to those aged 14–28, thereby reducing the generalizability of the findings to the larger population. To our knowledge, no studies have taken a gender-based approach to understanding the mental health sequelae of COVID-19 pandemic control measures across a general population sample. Given the current data as well as previous findings on the poor mental health outcomes of gender diverse individuals [ 23 ], focused empirical attention on this population is critical.

Other social determinants of health, including education, ethnicity, and income, impact physical and mental health outcomes [ 24 ] and have shaped the risk and consequences of COVID-19 in communities across North America [ 25 ]. Additionally, minority stress theory has posited that those who are part of more than one marginalized societal group may experience even greater health disparities [ 26 ]. Given this, we posited that it would be crucial to explore how gender interacted with these social determinants to influence mental health, in particular also because these social factors might moderate the effects of gender.

Many governments have tailored public health interventions throughout the pandemic based on infection incidence and hospitalization rates, resulting in a series of lockdowns (and prescribed regulations), followed by periods of relaxed restrictions, which have generated defined “phases” of the pandemic. While it is now widely known that lockdowns impact mental health [ 27 ], what remains unclear is how the tightening and easing of these social restrictions impacts psychosocial factors, by gender. As such, we sought to assess our psychosocial outcomes, cross-sectionally, across various phases of the pandemic retrospectively aligned with provincial changes in public health orders.

We were particularly interested in self-reported symptoms of depression, anxiety, stress, and loneliness, given recent reports of how these have worsened over the pandemic [ 8 , 9 ], and in addition to our primary interest in how gender impacted these outcomes, we also examined the interaction of gender with age, ethnicity, income, education, rurality, and sexual orientation. We predicted higher scores (i.e., more symptomatic) on depression, anxiety, stress, and loneliness in women and gender diverse individuals compared to men, and that this would be influenced by age, ethnicity, and income. We also hypothesized that during phases of increased social restriction psychosocial symptoms would increase. Our secondary interest was in self reports of alcohol and cannabis use, again given data on the pandemic’s effects of substance use behaviors [ 10 – 12 ], and again, we explored the impact of gender, as well as how gender interacted with various social variables, on alcohol and cannabis use. Our analyses of gender and alcohol and cannabis use were exploratory. Using a large cohort of the general population in British Columbia (BC), we assessed participants cross-sectionally, and asked them to retrospectively report on these outcomes across different phases of the pandemic, which again corresponded to stages of pandemic control changes in the province of BC.

Materials and methods

Participant recruitment and study design.

Participants, aged 25–69 years, were invited to participate in this study from previously established cohorts from research teams at the Women’s Health Research Institute, representing both general and priority populations of BC who had consented to being contacted for future research [ 28 ]. The original cohorts represented healthy women aged 25–65, women living with HIV/AIDS, men and women over age 18 living with a complex chronic disease, and individuals over age 18 with pelvic pain and/or endometriosis [ 28 ]. The largest cohort was recruited to reflect a broad and representative sample of BC women. Participants were stratified into nine five-year age strata, and using a SARS-CoV-2 population seroprevalence of 2% (±1, 95% CI), the target recruitment for each stratum was 750. The seroprevalence statistic was used to target recruitment for analyses in a separate manuscript.

Those identified as potentially eligible from the established cohorts ( Index Participants) were sent an email invitation to participate via an online survey. To improve the sample size and gender diversity of the study sample, Index Participants were asked to pass the invitation on to one household member who identified as a different gender as the respondent (Household Participants) . All potential participants were sent up to three email reminders to participate in the study. The inclusion criteria were: current residents of BC, aged 25–69, any gender, and able and willing to fill out the online survey in English. Ethics approval was obtained from the BC Children’s and Women’s Research Ethics board, and all participants provided consent to participate. Survey responses were collected anonymously, with the exception of three-digit postal codes, which were used to determine rurality for analyses.

After two months of data collection from existing research cohorts, recruitment was expanded in order to meet our target sample of n = 750 per age cohort. This expanded recruitment included participants obtained from public recruitment through the REACH BC platform, social media (i.e., Facebook, Twitter and Instagram), posts on the Women’s Health Research Institute website ( www.whri.org ) and engagement of community groups who are affiliated with the Women’s Health Research Institute, a provincial research institute focused on gender and women’s health. All respondents in the study were invited to enter a draw to win a $100 e-gift card for completing the survey. Recruitment was continued until a target of n = 750 was reached for each of the nine age-based strata, with the exception of the 25–29 year age group. Recruitment was open from August 20, 2020 –March 1, 2021.

Survey design and measures

The survey was tested for face validity, pilot tested, and a final version was designed using REDCap (Research Electronic Data Capture) [ 29 ]. While the survey consisted of multiple modules, this study focuses solely on the outcomes from the psychosocial module, which included questions about mental health outcomes such as depression, anxiety, stress, loneliness, alcohol use, and cannabis use.

Demographic information was collected from all respondents including age, sex, gender, sexual orientation, ethnicity, Indigenous status, income, education level, if the participant was currently a student and rurality by postal code. Sex referred specifically to the sex assigned at birth and included the option of male, female or intersex. Gender referred to the respondent’s current gender identity and included the options man, woman, or another option grouping non-binary, transgender, GenderQueer, agender or any other similar identity together. Sexual orientation options included asexual, bisexual, demisexual, gay/lesbian, heterosexual, or pansexual. Participants were given the option to identify as the following ethnicities: White, Chinese/Taiwanese, Black (African, Caribbean, or Other), South Asian (e.g., Indian, Bangladeshi, Pakistani, Punjabi, and Sri Lankan), and several other ethnicities who were analyzed an “Other” category. Indigenous status was assessed separately from ethnicity. Self-reporting of Indigenous status provided participants the option to identify as First Nation, Metis, Inuit, non-status First Nations, other Indigenous or not Indigenous, and they were then asked about Two Spirit identity. Rurality was determined based on three-digit postal codes and were classified into one of the follow categories: census metropolitan area, strong metropolitan influence zone, moderate metropolitan zone, or weak to no metropolitan influence zone.

The study design was cross-sectional in nature, whereby participants completed the survey at one time point. However, several questions asked participants to retrospectively refer to different periods of time: pre-pandemic (before March 2020) as well as across five different phases of the pandemic in BC that corresponded with changes in the public health orders regarding social distancing in the province of BC. In the original version of the survey, Phase 1 lasted from mid-March 2020 to mid-May 2020, Phase 2 lasted from mid-May 2020 to mid-June 2020, and Phase 3 lasted from mid-June 2020 until the end of November 2020. Given that data collection continued past November 2020, we added Phases 4 and 5, as well as modified dates for Phases 2 and 3 (mid-May to end of August 2020; denoted by Phase 2/3_2). Phase 4 lasted from September 2020 to the end of October 2020 and Phase 5 lasted from November 2020 to the date our survey closed (March 1, 2021). We have included a S1 Table that explains the public health recommendations in more detail, through every phase of the pandemic in BC.

Depression.

Depression was measured across the phases of the pandemic using the Patient Health Questionnaire (PHQ-9). The PHQ-9 questionnaire was used to measure self-reported symptoms of depression on a Likert scale from zero (not at all) to three (nearly everyday). Scores for this questionnaire range from 0–27 with a score of 0–4 indicating minimal depression, 5–14 indicating mild to moderate depression and 15–27 indicating moderately severe to severe depression [ 30 ]. The PHQ-9 has been validated across age and gender, as well as among diverse populations [ 30 , 31 ]. Internal consistency across data collection and Cronbach’s alpha for the PHQ-9 in the current sample was very good at α = 0.848.

Anxiety was measured across the phases of the pandemic using the Generalized Anxiety Disorder questionnaire (GAD-7). The GAD-7 was provided to respondents to self-report feelings of anxiety on a Likert scale from zero (not at all) to three (nearly everyday). Scores for this questionnaire range from 0–21 with scores above 10 indicating a clinical diagnosis for anxiety [ 32 ]. The GAD-7 has been validated in the general population and is frequently used in primary care settings to screen for anxiety symptoms[ 33 ]. Internal consistency across data collection and Cronbach’s alpha for the GAD-7 questionnaire in the current sample was very good at α = 0.889.

Pandemic stress.

General pandemic stress was measured across the phases of the pandemic using the CoRonavIruS Health Impact Survey (CRISIS) V0.3. This survey was developed and validated early in the COVID-19 pandemic to provide a general measure of mental distress and resilience [ 34 ]. The CRISIS is found to have strong validity and reliability, and has been recommended for use in population-based studies of mental health during COVID-19. Participants were asked to self-report feelings of stress on a Likert scale from one (not at all) to five (extremely). Scores for this questionnaire range from 10–50 with higher scores indicating greater COVID-related stress. Internal consistency across data collection and Cronbach’s alpha for CRISIS in the current sample was very good at α = 0.882.

Loneliness.

Loneliness was also measured across the phases of the pandemic where respondents were asked to self-report feelings of loneliness on a Likert scale from one (not lonely at all) to five (extremely lonely). This item was taken from the validated Coronavirus Health and Impact Survey (CRISIS), where individual items on the CRISIS have been found to have high Intraclass Correlation Coefficients [ 34 ]. Previous studies have found loneliness to be positively correlated with both PHQ-9 and GAD-7 scores [ 35 ] and to be a significant predictor of suicide [ 36 , 37 ].

Alcohol use.

Change in alcohol use was asked for all post-COVID time points (i.e., Has your consumption of alcohol changed since March 2020?). Change in alcohol use was defined as “none” (which included no alcohol use, decreased alcohol use, and same alcohol use) vs. increased alcohol use. Therefore, a single, non-time-varying alcohol change variable was created and used to compare the retrospective responses across the different time points, with time.

Cannabis use.

Change in cannabis use was asked for all post-COVID time points (Has your consumption of cannabis changed since March 2020?). As with alcohol, change in cannabis use was defined as “none” (which included no cannabis use, decreased cannabis use, and same cannabis use) vs. increased cannabis use. A single, non-time-varying cannabis change variable was created and used in a longitudinal model with time.

Statistical analyses

Analyses were carried out using R v.4.0.3. Analyses of psychosocial outcomes across the pandemic control phases were conducted using mixed-effects linear regression models with individual and household IDs as random effects. This allows for correlations among individuals in the same household, and separately, correlations over time among responses within the same individual, allowing for a longitudinal assessment. We included pairwise interactions to assess non-additive effects between age and gender, and age and ethnicity, sexual orientation, income, and Indigenous status. Significance was assessed using likelihood-ratio tests, and interactions were removed from the models if non-significant at p < .05. Post-hoc pairwise tests were conducted to further explore main or interaction effects with Bonferroni correction for multiple tests.

To explore associations between increase in alcohol and cannabis use with sex/gender and other demographic variables we used mixed-effects logistic regressions with household ID as a random effect. We also examined increase in alcohol and cannabis use and psychosocial outcomes across the phases as described above. Interactions and post-hoc tests were handled as above. Missing data were excluded from analyses.

Survey participants

Between August 2020 and March 2021, 16,056 survey invites were emailed to prospective Index Participants and 1,872 participants were recruited from the public, for a total of 17,928 prospective participants. Of these participants, a total of 5,415 responded to the invitation to participate in the study and met the analysis inclusion criteria ( Fig 1 ). Of these participants, 1,434 forwarded the survey invitation to a household member of a different sex or gender and we received 661 participants via this method. The present analyses includes the 6,076 Index and Household participants who completed psychosocial measures of anxiety, depression, stress, and loneliness.

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https://doi.org/10.1371/journal.pone.0259676.g001

Demographic characteristics of participants

A total of 6,426 individuals responded to the question about sex; there were n = 820 males (12.7%) and n = 5,606 females (87.1%). A total of 6,076 responded to the question about gender; including men (n = 750; 12.3%), women (n = 5,254; 86.4%), and gender diverse (n = 72; 1.2%) individuals. Table 1 presents the demographic characteristics of the sample by gender, according to women, men, and gender diverse.

https://doi.org/10.1371/journal.pone.0259676.t001

Effect of pandemic phase, age, ethnicity and gender and sex on psychosocial outcomes

Controlling for household income, we found no significant interactions between age and gender, age and sex, age and ethnicity or rurality on any of the psychosocial measures. For all psychosocial outcomes, there was a significant relationship with pandemic phase (all p < .0001, Table 2 ), with the greatest increases in mental health symptoms in Phase 1 compared to pre-COVID. The scores in all subsequent phases remained significantly higher (i.e., more symptoms) than in the pre-COVID phase across all outcomes (Figs 2 – 5 , Table 2 ). Gender was significantly associated with all outcomes (all p < .0001, Figs 2 – 5 , Table 2 ), and pairwise comparisons showed that men had lower scores than both women and gender-diverse participants, while women had lower scores than the gender-diverse participants. Age was significantly negatively associated with all the outcomes, with older participants having lower scores on average (i.e., fewer psychosocial symptoms) ( p < .0001, Table 2 ). Finally, there was a significant relationship between ethnicity and all outcomes (GAD-7 and PHQ-9 p < .0001, CRISIS and Loneliness p = .005, Table 2 ), with scores lower in Chinese/Taiwanese participants compared to the White, South Asian, and Other ethnicity participants. When sex was included in the model in place of gender, there were no differences to the findings, indicating the overlap in our participants self-reported sex and gender. Given our intention to explore outcomes separately for gender-diverse individuals, all subsequent analyses were done by gender (not sex).

Data points refer to mean scores of the given psychosocial measure, error bars refer to the standard error. Pre-COVID: Prior to mid-March 2020; Phase 1: Mid-March 2020 to mid-May 2020; Phase: 2/3: Mid-May 2020 to November 2020; Phase 2/3_2: Mid-May 2020 to August 2020; Phase 4: September 2020 to October 2020; Phase 5: November 2020 to March 1, 2021.

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Psychosocial outcomes by indigenous status

Controlling for household income, there was no significant interaction between Indigenous status and age or gender. There was a significant interaction between Indigenous status and time for all four psychosocial outcomes ( p < .0001, Table 2 ) and follow-up post-hoc pairwise tests suggest that at all time points except pre-COVID, those who identified as Indigenous had significantly higher GAD-7, PHQ-9, CRISIS, and loneliness scores (i.e., more mental health symptoms) than those who did not identify as Indigenous.

Psychosocial outcomes by sexual orientation

Across all outcomes, the non-heterosexual group (which included asexual, bisexual, demisexual, gay/lesbian, pansexual, and other) had significantly more mental health symptoms than the heterosexual group for all phases, and the magnitude of the difference between the groups was largest in Phase 1 of the pandemic.

Associations between psychosocial outcomes and alcohol by gender

A total of 23.3% of the sample reported an increase in alcohol use. Increased alcohol use was negatively associated with age ( p < .001, Table 3 ), with older participants having lower odds of increased alcohol use. There was no significant difference among genders in the odds of increased alcohol use, but there was a trend of increasing odds as household income increased. Additionally, those residing in census metropolitan areas were found to have increased their alcohol use relative to those outside of these dense urban areas ( p = .03, Table 3 ).

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Controlling for household income, and across all psychosocial outcomes, there was no interaction between gender and increased alcohol use, suggesting that the differences among genders in these psychosocial variables was the same between those who did and did not increase alcohol use since the start of the pandemic ( Table 4 ). There was a significant interaction between increased alcohol use and pandemic phase (all p < .0001, Table 4 ). Pairwise tests indicated that at all phases, with the exception of pre-COVID, those who reported increased alcohol use had significantly more psychosocial symptoms on all measures ( p < .0001, Table 4 ).

https://doi.org/10.1371/journal.pone.0259676.t004

Associations between psychosocial outcomes and cannabis use by gender

A total of 5.9% of the sample reported an increase in cannabis use since the start of the pandemic. Increased cannabis use was negatively associated with age ( p < .001, Table 3 ), with older participants having lower odds of increased use. There was a significant relationship with gender ( p = .02, Table 3 , Fig 6 ), where women had a significantly higher odds of increased cannabis use compared to men, and there was no significant difference between men and gender diverse, and women and gender diverse groups.

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Controlling for household income, there was a significant interaction between change in cannabis use and pandemic phase ( p < .0001 for GAD-7, PHQ-9, and CRISIS, p = .04 for Loneliness, Table 5 ). Post-hoc pairwise tests suggest that across all phases, including pre-COVID, those who increased cannabis use had significantly higher anxiety, more depressive symptoms, and higher COVID-stress scores than those who did not have increased cannabis use. Loneliness scores were significantly higher across all phases of the pandemic for those who increased cannabis use compared to those who did not. There was no interaction between gender and increased cannabis use for GAD-7, PHQ-9, or CRISIS scores. However, there was a significant interaction between gender and increased cannabis use on Loneliness ( p = .008, Table 5 ). For both men and women, those who increased cannabis use had more loneliness symptoms than those who did not have increased cannabis use. Conversely, among the gender-diverse participants, there was no difference in loneliness between those who increased cannabis, and those who did not.

https://doi.org/10.1371/journal.pone.0259676.t005

This large Canadian study recruited 6,076 women, men, and gender diverse people across the province of British Columbia. Our main findings indicated that age, sex, gender, ethnicity, Indigenous status, sexual orientation, and phase of the pandemic have distinct effects on psychosocial outcomes. Across outcomes, women had more symptoms of depression, anxiety, loneliness, and stress than men, regardless of their age or ethnicity, while the gender diverse group (n = 72) had even more symptoms than women. An analysis by sex revealed the same findings as for gender, except that the gender diverse group was now absorbed into one of the two binary sex categories and obscuring their findings.

Our results highlight the greater negative outcomes on all psychosocial variables in gender diverse individuals, which would have been obscured in an analysis by sex alone and adds to the literature highlighting the value in analyzing data by gender. It is important to underscore that being a woman was a significant factor that determined higher anxiety, depression, stress, and loneliness—a finding mirrored in the literature across all continents [ 38 , 39 ]. The novelty of this study, however, is that this effect of being a woman was not impacted by participants’ age, ethnicity, or other sociodemographic variables. In other words, having a woman gender was sufficient to place individuals at higher risk for depression, anxiety, stress, and loneliness over the pandemic. Given that women and gender diverse individuals are more likely to be diagnosed with mood disorders or score lower on mood surveys outside of a pandemic [ 16 , 40 , 41 ], it is not surprising that these populations are experiencing mental health inequities during COVID-19. However, our results should be interpreted with some caution as our gender-diverse cohort accounted for only 1% of the sample. Nonetheless, our results are striking and consistent with many other studies focused on gender using larger cohorts [ 42 , 43 ].

Our study also benefited from examining the effects of other sociodemographic variables, such as age, to determine how they might play a role in the effect of sex and gender on mental health. Across all the psychosocial measures, younger participants were more likely to have anxiety, depression, pandemic stress, and loneliness, irrespective of their gender. These findings are consistent with others in smaller cohort studies that indicated younger ages were associated with more psychosocial symptoms [ 44 ]. There may be several reasons for these findings such as restricted social engagements, barriers to employment, and living conditions. Lockdowns across the globe have resulted in restricted social gatherings, closing of restaurants, bars and clubs, as well as recreational sporting activities (gyms, sports clubs, exercise classes, yoga and dance). In addition, younger adults are more likely to either live on their own, or with unrelated roommates and have greater perceived lack of social support. Indeed, findings from a larger cohort in China found that greater loneliness was associated not only with younger age (16–29) but also in unmarried individuals [ 36 ]. Physical activity is another important factor as a large survey across fourteen countries found that decreased physical activity during restrictions and lockdowns, as well as high physical activity pre-pandemic, were associated with poorer mental health scores [ 45 ]. Other studies have also noted that suicide and suicidal ideation have increased during the pandemic in younger adults [ 46 ], related partially to job losses. Taken together, the underlying reasons for this significant effect of age are of great importance and require further study. At a minimum, these findings suggest that mental health resources tailored to younger individuals are required in any pandemic relief measures taken by government. It might not be sufficient to increase all mental health supports, but rather have tailored ones to young adults that are cost effective and accessible.

In addition to age, ethnicity was associated with psychosocial outcomes with Chinese/Taiwanese participants reporting significantly lower scores (i.e., fewer psychosocial symptoms) on anxiety, depression, pandemic stress, and loneliness. These data are consistent with findings from other studies, such as a survey of more than 46,000 Canadians which found that Chinese individuals were less likely to report symptoms consistent with moderate to severe generalized anxiety disorder than other visible minority groups during the COVID-19 pandemic [ 47 ]. It is possible that the lower rates of mental disorders seen in Asian or Chinese immigrants [ 48 ] may be due to cultural stigma associated with mental illness leading to lower rates of disclosure of psychological symptoms [ 48 , 49 ]. It is also possible that the lower rates of psychological symptoms may be due to differences in the validity of these measures cross culturally [ 34 , 50 ], leaving open the possibility of a measurement bias [ 51 ], although it was concluded to be a reliable measure across some cultural groups [ 51 , 52 ]. In sum, our findings suggest that our Chinese/Taiwanese sample experienced fewer psychosocial symptoms throughout the pandemic relative to other groups, and of note, ethnicity did not interact with gender or income to impact these outcomes. Similarly, gender did not interact with income to impact these outcomes.

We found that those who self-identified as Indigenous had significantly more psychosocial symptoms than non-Indigenous participants across all four scales for all phases of the pandemic in BC. Importantly, there was no difference in psychosocial outcomes between Indigenous and non-indigenous groups pre-COVID, which underscores the disproportionate impact of the pandemic on this community. While investigations on the mental health impacts on Indigenous peoples during the COVID-19 pandemic have been limited, our results are consistent with the available data. For example, other data from Australia (Aboriginal or Torres Strait Islander) [ 53 ] as well as Canada [ 54 ] showed more psychosocial symptoms among Indigenous respondents during the COVID-19 pandemic. The lack of interaction between Indigenous status and gender suggests that the higher psychosocial symptoms occur regardless of an Indigenous persons’ gender, standing in contrast to another study finding that Indigenous women were particularly impacted by mental health issues (severe generalized anxiety, worse mental health, and stress) during COVID-19 [ 54 ]. Future studies should explore the extent to which variables such as rurality (which can contribute to barriers accessing care) and income may account for these higher rates of psychological symptoms among Indigenous communities [ 44 ]. In the meantime, these findings point to the need for culturally-safe mental health resources being made available to Indigenous communities in any COVID relief efforts.

Findings on the relationship between anxiety, depression, pandemic stress, and loneliness, with increased alcohol and cannabis use, align with previous studies [ 12 ]. Given the poorer self-reported mental health among younger populations, it was not surprising to observe an increase in alcohol and cannabis use among this group, which suggests that alcohol use may be a form of coping for younger persons. We cannot attribute directionality to this association, nor eliminate the possibility that increased alcohol and cannabis use may be contributing to the increased psychosocial symptoms observed among younger populations during the pandemic. The lack of a gender difference in increased alcohol use is in contrast with a previous American study [ 55 ] which found that females had increased their alcohol use compared to males. It may be that differences in the samples accounts for these contrasting findings. It is also possible that the increase seen in men in our sample was higher than in previous studies, thus rendering the gender difference void. In contrast, we saw a gender effect on increased cannabis use, which was expressed by women, but not by men or gender diverse persons. In recent surveys, 28% of British Columbians had engaged in cannabis use in the past twelve months, compared to the Canadian average of 11%, suggesting that British Columbians are more likely to engage in cannabis use, and therefore may be more likely to use cannabis as a form of coping [ 56 , 57 ]. Although cannabis use has been associated with male typicality and may go against gender norms typical to women [ 58 ], it may be that the social isolation disrupted these social norms and facilitated women’s more active engagement in additional cannabis use, relative to pre-pandemic levels.

Our findings align with the global trend of increased substance use, as recent studies have demonstrated that alcohol, cannabis, and opiate use changed during and post-lockdown [ 59 ]. Alcohol use has remained elevated relative to pre-pandemic levels, and though opiate use seemed to have dropped during lockdowns, a return to regular dosage post-lockdown has helped to drive overdoses, due to diminished tolerance [ 59 ]. It is possible that deteriorated mental health could be attributed to overuse of certain substances, though studies with multiple follow-up points are needed to determine a causal pathway for the increase in psychosocial symptoms demonstrated in our study. Future studies should aim to elucidate potential mechanisms by which substance use can influence mental health in the context of a pandemic and lockdowns to mitigate the consequences of public health interventions on well-being.

As predicted, psychosocial symptoms worsened over the course of the pandemic, with some of the highest symptoms observed early on, aligning with previous studies that found a higher prevalence of mental health disorders during the initial COVID-19 lockdown in March 2020 [ 60 , 61 ]. Phases 2 and 3 of COVID restrictions in BC were characterized by an easing of restrictions, permitting outdoor gatherings and small social events, and the summer season. This loosening of public health measures was associated with a slight improvement in mental health, more than likely due to an increase in perceived social support and optimism regarding the state of the pandemic. Mental health outcomes then worsened in Phases 4 and 5 as BC entered wave 2 of the pandemic and public health orders tightened once again. It is important to note the average PHQ-9 and GAD-7 scores did not meet the criteria for clinical depression or anxiety, but that these levels increased relative to pre-pandemic levels as well as over time.

Strengths and limitations

Our study benefitted from a large, population-based sample size, and, despite known mental health disparities by gender, as far as we are aware, was one of the few that sought to explore findings from a gender lens by including gender-diverse groups as well, given known mental health disparities by gender [ 17 ]. That said, our sample size for gender diverse individuals was still limited [ 17 ]. Future studies should further investigate mental health in the gender diverse community during the COVID-19 pandemic with a focus on people of all ages, in contrast to previous studies [ 22 ]. Another limitation of the present study was the retrospective, cross-sectional nature of the survey, where participants completed the survey at only one time point, and were asked to retrospectively recall their mood and anxiety during different time points. This may have increased the likelihood of recall bias and reducing our capacity to examine causality and directionality of poor mental health outcomes. Finally, this study was confined to the general population of BC, and only individuals who had access to email and internet, and therefore results may only be generalizable to the Canadian population, and populations with similar demographics to the present study, and to individuals who have access to email and internet.

Implications

Our study has important implications for public health policy. These findings illustrate that government policies and interventions for future pandemics should place on emphasis on young adults, low-income populations, women, Indigenous, and gender diverse communities. Additionally, our study was one of the first to measure mental health outcomes across different phases of the pandemic, directly examining the effect of increased public health measures on mental health. At the time of writing, the vaccine rollout is well underway in BC with experts predicting an end to the pandemic in the months ahead, however, it is unclear whether mental health will return to pre-pandemic levels, or when life will return to “normal.” Moving forward, policy makers and leaders need to consider our findings when planning future public health measures. In future pandemics, the mental health of marginalized populations needs to be considered proactively. As vaccination efforts continue and case counts fall, it will also be critical to monitor the health status of these populations to ensure that they are not left behind. Additionally, for future pandemics and outbreaks, mobilizing resources to these communities early on can aid in mitigating these inequities from the beginning, rather than as an afterthought.

Supporting information

S1 table. public health measures during different phases of the covid-19 pandemic in british columbia..

Measures listed are not exhaustive.

https://doi.org/10.1371/journal.pone.0259676.s001

Acknowledgments

We wish to thank Falla Jin and Shanlea Gordon (both at the BC Children’s Research Institute) for their assistance with data collection.

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Introduction to Gendering and Sexualities

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• Volume 38 , pages 239–242, ( 2021 )

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The terrain of both gender and sexuality are complex and increasingly interrogated and deconstructed domains. I have deliberately used the word ‘gendering’ rather than gender in the title because of the way in which gender is and continues to be constructed and re-constructed by individuals, couples, families and communities. Gendering and Sexuality are constantly being mediated and “constructed through and within other relations of power such a class, ‘race’/ethnicity or imperialism/colonialism” and ongoing coloniality [ 1 ]. Assumptions about sex, heteronormativity, gender binaries are increasingly being contested, re-articulated and re-imagined. It is within this ever evolving and growing field that The International Conference on Gender and Sexuality (G&S) aims to explore, highlight, reflect on, engage with, develop and lead. Hence, challenging and re-imagining historical assumptions and constructions of gendering and sexualities and how they manifest in people’s lives and communities are critical to explore and understand. This special edition is based on paper presentations from the G&S conferences. To tackle the problems of gender inequality, gender-based violence, misogyny and/or heteronormativity effectively or firmly, more spaces for serious intellectual engagement and the opening of conversations, amongst scholars, practitioners, policy makers and most importantly those of us who embody various gender identities and sexualities across all divides and disciplines, is needed. The G&S conference opens the space to share views and ideas and consider values and experiences to build strong relationships among delegates. The conference is aimed at achieving mutual objectives for transforming the way genders and sexualities are perceived and constructed, through creating collaborative initiatives for the expansion of theorising about and harnessing innovative practice in the fields of gender and sexuality. It is also a space for understanding and theorising about how these two fields intersect for the co-creation of theories and practices that are appropriate and ground-breaking.

The contribution to knowledge building in the domains of gendering and sexualities is couched in the exciting and ground-breaking work of young and emerging scholars both during the conference and in these and other publications. The work of young, free thinkers who are unafraid to enter new domains of knowledge, being and doing [ 2 ] are reflected in the articles of this issue. Orth in her analysis of social media posts on Facebook develops a powerful argument on how rape culture manifests in South African societies. Analysis of social media is an important location for understanding unmediated social views, social interactions and mainstream opinions on important social, political and economic issues [ 4 ]. It often highlights contested terrains and reflects deep fissures on social, political and economic matters. At the same time, it has also been an effective domain for political organising and transformative education on issues of gendering and sexualities.

The sex trade, sex work, transactional sex are not uncommon across the world, yet individuals who sell sex remain highly stigmatised, discriminated and vulnerable. The article by Sternerson et al., highlights the heterogeneity of individuals who sell sex in Thailand and thus account for the experiences of not only women, but male and transgender individuals who sell sex. This study also considers foreigner attitudes towards women, men and non-binary individuals who sell sex, and shows how these attitudes are influenced by both gender and previous engagement of these individuals themselves in transactional sex. These types of studies are critical to inform policy and practice that creates safer environments for individuals who sell sex and increases their access to resources.

Discourses and beliefs about vulnerable groups have emerged as central to both professional and community responses to individuals, at risk of violence and stigmatisation as evidenced in the previous two articles. The third article in this special edition also highlights the role of the discourse of “the whole story” in the response of informal networks to survivors of women abused by men. The article by Mwatsiya and Rasool shows how violence against women in intimate partner relationships is justified under certain conditions and particularly when women violate expected gendered norms, especially by male support systems. Violence against women was not in itself condemned by many of the male participants, if they felt that the women concerned violated established socio-cultural norms. This article again highlights the necessity to work in communities to challenge gender norms and stereotypes that allow for violence against women to flourish and be sustained [ 7 ].

The gendered nature of violence in situations of conflict is another area of important consideration. Rape as a weapon of war is evident throughout history and the impacts are wide-ranging [ 6 ]. Habib specifically documents the vulnerabilities of disadvantaged women who are living in Kashmir. She reiterates the importance of having the voices of vulnerable women heard, so that they can tell their stories and the impact of violence and war on their lives and livelihoods. The sense of helplessness and lasting impacts of violence on their lives left an inedible mark on my psyche. Issues of access to care and services that are gender sensitive and appropriate remain a concern for these Mohajir women even post- conflict. Nevertheless, these women find ways to carve new future for themselves and their families. This article provides some valuable options for intervention including education, which could be implemented to assist Mohajir women and other women post-conflict on their journeys to recovery.

Education has been shown internationally to be a game changer, and critical for development [ 3 ]. Sharma and Dev [ 5 ], point out that policy interventions related to education were most likely to have multiplier effects on progress for all development goals. The article by Iddy et al. points to the disjuncture between policy on girl child education and practice in Tanzania. Whilst it is clear that both at international and national levels, critical policies have been developed to facilitate the education of the girl child. Not enough work is being done at community level with regards to the daily obstacles and challenges that girls face in accessing and engaging in education. Hence, policies alone are not enough, grassroots work that engages socio-cultural and religious attitudes and practices that impact on the education of the girl child is essential.

Evidence of the disjuncture between laws and practices is again highlighted by Haffejee in the final article of this edition. The very important narrative of a transgender youth from a resource poor rural community in South Africa, shows how resilience in the face of discrimination, violence and abuse, is necessary even in a context of progressive laws. There remains a multitude of systemic obstacles for non-binary communities in accessing health care and other resources that are gender affirming and responsive. The role of religions, cultural practices, and gender norms in perpetuating discrimination and abuse was evident in Zee’s experiences. Nevertheless, Haffejee contends that “Zee is neither consistently resilient nor is she in constant distress.” In essence the binary is not useful in considering adversity and resilience, as these co-exist. Despite high levels of resilience, these various systems contribute to the Othering and violation of queer bodies and identities. Nevertheless, the ongoing adversity faced by queer bodies can often be mitigated by strong support systems.

Violence seems to be a core themes that emerged throughout the various papers in this edition:- violence against women due to ethnic conflict, violence against women due to cultural norms and stereotypes, violence in intimate partner relationships, violence against queer people, violence against sex workers, and violence experienced by school-girls. Hence, any analysis of gendering and sexuality needs to recognise that these experiences and identities are mediated through various forms of historical and contemporary power structures. Socio-cultural context and norms are also critical for navigating gendering and sexualities. Policies and laws are often not enough to address these violations, when community attitudes and responses are still enmeshed in stereotyped and remain limited notions of gender and sexualities. These contexts and the informal networks that operate within them can on the one hand be a source of increased adversity. On the other hand, they could challenge entrenched notions of gender and sexuality and enable resilience and transformation. Community education and working with socio-cultural norms and practices that contribute to discrimination, violence and marginalisation need to be challenged and re-constructed. In conclusion, this ever-evolving field of gendering and sexualities has over the years pushed many boundaries, met with resistance by some and enthusiasm by others, but will nevertheless be a space for re-creating, imagining and transformation.

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Rasool, S. Introduction to Gendering and Sexualities. Gend. Issues 38 , 239–242 (2021). https://doi.org/10.1007/s12147-021-09287-2

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D iscover Society

Measured – factual – critical.

• Covid-19 Chronicles
• Policy & Politics

Focus: Looking Critically at Gender and Sexuality

• By discoversociety
• December 06, 2016
• 2016 , Focus , Issue 39

Susan F. Frenk and Mark McCormack

Societies across the world have experienced large-scale social change related to gender and sexuality. For example, despite some intensification of homophobic attitudes and laws in a number of countries, the global trend has been towards increasing legal rights for gay, lesbian and bisexual people (Smith, 2011). Transgender issues continue to be a cultural battleground, but a growing movement, connected through social networks, recognizes the importance of combatting transphobia as a human rights issue. Experiences in other parts of the world are radically diverse but too often marginalised in research in the global north.

When we think about gender and sexuality, we recognize these aspects not just as personal characteristics that individuals maintain but as some of the multiple modes of power that stratify and structure our social relationships. A focus on gender inequality, for example, that examines how men and women interact problematically, must include an analysis of the institutionalized and implicit ways in which some social groups are privileged over others. Similarly, a study of sexuality is not limited to the experiences of sexual minorities but extends to the freedoms people maintain to engage in sexual pleasure, and the ways in which social policy can both protect and harm people, depending on the specific dynamics of sex, sexual desire and sexuality in any society. While binary models of gender persist widely, there are ‘third gender’ exceptions, with long (pre-colonial) histories, surviving in some locations and a contemporary re-assertion of gender fluidity, particularly (but not exclusively) amongst young people.

The interdisciplinary study of gender and sexuality produces a constant flow of critical, innovative and complex ways of thinking about these issues. Scholars from Michel Foucault to Gayle Rubin have questioned how and why formulations and typologies of gender and sexuality exist at specific times and places. This is not to argue for an approach that excludes the value of biological and sexological research into gender and sexuality – such an approach is never truly interdisciplinary, failing to engage with the full scope of human knowledge – but it compels us to appreciate the forcefield that social and cultural norms exert on how we experience and understand gender and sexuality in our everyday lives and throughout the life course.

A key component is theorizing how power is maintained and exerted in society. Much scholarship has used Gramsci’s notion of hegemony to understand the ways in which oppressive practices are reproduced, including by those who suffer from them. Poststructuralists have drawn upon Foucault’s theory of power to contest categorical approaches and seek a queer politics of transgression. There are myriad other ways to approach the issue. Yet regardless of theoretical or disciplinary tradition, one constant was summarised powerfully by Hannah Arendt (1973), who argued that power “is never the property of an individual; it belongs to a group and remains in existence only so long as the group keeps together”—offering an understanding both of why inequalities can be so hard to contest and the possibilities for radical transformation.

These theoretical explorations are not removed from the tangible effects that oppressions related to gender and sexuality can have on people’s lives. Rubin (2013: 32) reminds us that there are “real material, cultural, and emotional stakes to these intense social conflicts over morals and values.” A fundamental tenet of feminist research is that people’s, and particularly women’s, lives, and experiences, need to be foregrounded in order to understand how gender inequality is lived and felt. Focusing on gender and sexuality together, alongside a broader intersectional approach, produces research that explores diverse lives, develops theorizing about their connections to wider social processes, and contributes to a new understanding of gender and sexuality in society.

In this Special Issue of Discover Society we are delighted to host a broad spectrum of research that, in different ways, enhances our understanding of these issues. The articles were selected from papers presented at our annual Summer School, a centrepiece of the work of the Centre for Sex, Gender and Sexualities at Durham University. Each year, over two days, we provide a range of training and intellectual activities for postgraduate and early career researchers interested in sex, gender and sexuality in society. The second day takes the form of a conference where people across the career span contribute in a warm and inclusive environment.

We begin with an exciting On The Frontline article by Simon Forrest about his research on sex education and how young people engage with this vital yet undervalued form of learning. Drawing out the historical persistence of adult anxieties around young people’s sexualities and desire, he captures both their own widespread dissatisfaction with current approaches and the extensive evidence that current sex ed. increases the likelihood of unpleasurable, unhealthy, unequal and socially problematic sexual experiences.  Calling for a serious engagement with alternative responses that will shift the focus from polarisation between a liberal model of empowerment that is often ignorant of its own class biases, and a socially conservative moralising model that simultaneously denies and seeks to contain young people’s sexuality, he delineates the dangers inherent in the prescriptive social policy proposed by the Minister for Education and Equalities.

Both in implicit socialisation and in its more recent forms, Sex Ed has played its own role in producing and sustaining binary gender. The impact of gendered identities emerged powerfully at the Summer School, in Sue Scott’s personal history of her experiences in academic sociology, as a female scholar writing on issues of gender and sexualities evoking strong resonances with Ken Plummer’s keynote from the year before on the importance of telling sexual stories. In her Viewpoint she draws on long experience of researching and writing about gender and sexuality to examine key aspects through the lens of consumption. Exploring the ways in which gendered bodies are both consumed and are the terrain over which consumption practices are played out, Sue is particularly interested in the ways in which women’s bodies are utilized – objectified – in the context of gendered power relations.  Focussing on late modern society’s contradictory positioning of childhood as, on the one hand, a special realm in which children should be ‘innocent’ and on the other where children are exposed to the full gamut of consumerism, which can expose them to adult sexual mores that they don’t fully understand, Sue argues that some of the ways in which we seek to protect children and young people from sexualisation and sexual risk can render them more vulnerable.

Of course, social policy is a vital area in the study of gender and sexuality. Policy interventions are necessary to protect vulnerable and marginalized groups, yet so often with gender and sexuality in particular, policy can become divorced from an evidence base and contribute to inequality and oppression. The double-edged nature of policy intervention is particularly pertinent in debates about sex work and its regulation. Maggie O’Neill crystallises her long engagement with the ongoing issues related to the regulation of sex work in the U.K. in this Policy Briefing with Alison Jobe on the history of Sex Work. From the Victorian era to the current globalised trade in sex, sex work is analysed through the shifting and often contradictory representations of sex workers. Highlighting how legislation both regulates and criminalises sex work while simultaneously fixing sex workers in a deviant identity or as objects of moral ‘rescue’, they trace the remarkable persistence of key discourses and social relations into our own time.  Through the voices of sex workers now embedded in participatory research and drawing on troubling evidence of shortcomings in supposedly progressive Scandinavian contexts, decriminalisation emerges as a pressing policy need, framed by a call to recognise and address wider sexual and social inequalities.

Inequalities in healthcare on the other hand are often discussed in relation to socio-economic positioning, with some attention to gender, but may overlook the impact on wellbeing of key cultural factors.  In his study of doctor-patient relationships in health care, Michael Toze examines the importance of coming out. Drawing on 36 interviews with Lesbian, Gay, Bisexual and Transgender (LGBT) people, Toze documents a real diversity in relationships of LGBT patients with their doctors. While coming out can be vital for some, it can have little relevance for others. Highlighting the significance of changes in the organization and everyday practice of doctors’ surgeries, Toze argues that the move away from a regular doctor can have a particular impact on LGBT patients, some of whom find it difficult to disclose personal information about their sexuality to strangers. Recognizing how healthcare has become more inclusive for many minority groups, Toze calls for greater recognition of the relationships between patients and practitioners, ensuring that patients both have the opportunity and feel able to discuss aspects of their sexuality and gender identity in the context of their health.

William Potter’s article takes us from work and medicalisation to the possibilities of leisure, focusing on retreats for gay men—periods of time away from everyday routine to provide a space to engage in reflexive introspection and consideration of your place in the world. Potter uses observation and interview data from two gay male retreats to argue that these places do not conform to popular images of “the hedonism of the health spa or the austerity of the monastic cell”. He foregrounds aspects of adult play, and sees play as having a social use that enabled these men to transcend their daily routine while developing strong friendship bonds. Much has been written about the changing nature of gay spaces (e.g. Ghaziani, 2014), and Potter’s research documents one of the ways in which this shifting landscape is influencing behaviour: a landscape where gay men seek a space and a community outside the bonds of the traditional, that are frequently rooted in alcohol consumption or sexual intercourse. Eschewing these pursuits, gay retreats serve as a new way to explore gay identity in society.

The importance of play also emerges in Liam Wignall’s exploration of the emerging kinky practice known as pup play or puppy play. Drawing on interviews with 30 gay and bisexual young men who practice pup play, Wignall charts the social and community aspects of this kink activity. In contrast to Potter’s study, the motivation of many participants was to develop friendships and connections within a sexual context. Yet to focus on the sexual aspects is to miss the ways in which pup play remains deeply social. Indeed, Wignall shows how a subculture has developed related to pup play, moving from a sexual activity between individuals to a much broader community that attends Pride events, sees “pups” communicating semi-publically on sites such as Twitter, and has been commodified by porn studios and kink shops. Wignall situates pup play within broader debates about the emergence of kink communities in a context where the gay scene is radically evolving, and pup play may constitute a community in which young adults find an introduction to gay subcultures beyond the gay bar or the LGBT+ Students Union Society.

Although represented as ‘leisure’, M.F. Ogilvie offers a glimpse into what is actually the highly structured world of competitive sport. Drawing on a year-long ethnography of elite male athletes at a British University, Ogilvie documents the homosocial behaviours of these men from the intimacy of the changing room to the public venues of nights out clubbing. Following other research, he finds high levels of intimacy and tactility between these men, who will cuddle and spoon and dance and kiss each other on a night out. As an openly bisexual player on the team, Ogilvie witnesses the nonchalance of these behaviours for his teammates, even though many were newly arrived from the U.S. He also explores the ways in which his heterosexual teammates appreciate men’s bodies, deploying the ‘homoerotic gaze’ to understand how men view, discuss and compliment each other’s bodies. These positive comments occur in the wider context of bromances common among many young men today.

The complex interplay of bodies in sport and play cannot ignore the commodification of bodies and Charlotte Rhian Jones traces a fascinating comparison between the experiences of wet nurses in the early modern period and their contemporary counterparts in the ‘Body Bazaar’ of late capitalism.  Defying the stigma and, in some cases, health risks attached to the practice, permitted women with limited options to sustain themselves and their own families. Jones argues that they enjoyed a level of control over the use of their body and sometimes also emotional bonds, which are denied to women donating or selling breast milk in the online marketplace today. It seems that they also maintained a positive image of their work, despite the social scripts of the moralists who condemned them.

This capacity to question and re-frame oppressive gender scripts written onto and into our bodies emerges movingly in Elham Amini’s work with menopausal women in Iran. While some of the responses suggest social reward – ‘being taken care of’ – can lead some women to accept the limitations their society places on them, others expressed bitter disappointment. Their stories of key events in both their ‘gender discovery’ and the framing of female desire and sexuality as ‘risky’ and ‘polluted’ reveal the ways in which language can shape and contain lived experience. Yet these accounts are often complex and ambivalent, recalling the thrill of desire and bodily freedom and moving from sadness to anger at the constraints. For some, their initial desire to have a male child, because of the possibilities he would enjoy, shifts to an emphasis on educating their daughters and enabling them to flourish, although the cycle is not yet broken as one respondent repeats her own mother’s history of wishing she were a boy. Amini’s article provides an important insight into a group of people about whom many assumptions are made but with whom there is little academic research.

Social narratives of gender difference can play out as powerfully in social policy as in individual experience, as Kate Butterworth notes in the policing of partner abuse in same-sex relationships in the UK. While the types of crime recorded for men and women are broadly similar, which challenges the notion that men are ‘naturally’ more violent than women, the outcomes suggest that this idea persists, despite the counter-evidence, and underlies how police assess who is most at risk of further violence or harassment. Equally, the notion that women are ‘naturally’ more vulnerable, may influence police assessments of risk for both men and women, even as the criminal justice system seeks to improve its standing amongst LGBT+ individuals and communities.

Janet Weston takes us ‘inside’, as she uncovers the history of male same-sex activity, from 19 th century anxiety about ‘unnatural acts’, through the legalisation of homosexuality, but the denial of the right to sex in the supposedly ‘public’ space of the prison.  Ironically, the then deadly new disease of HIV in the 1980s enabled some access to condoms and a tacit acknowledgement that same-sex activity was and would occur in prisons. However, Weston shows how this medical model sidestepped key questions of human rights while the ‘prescribing’ of condoms varied widely according to the personal decisions of individual doctors and sex continued to be prohibited by some prison governors. The paper concludes by highlighting, through the lens of healthcare, the contradictions that permeate our broader approach to criminal justice.

This is echoed in Emily Setty’s research into sexting. She shows how policy responses risk criminalising large numbers of young people, without regard for their rights to sexual expression and to privacy, under the banner of preventing moral and physical harm. Setty’s subtle analysis takes us into a much more complex reality, where young people often debate the ethics of sexting in different contexts and critique breaches of consent and trust even where their attempts to navigating oppressive social norms can lead to ‘victim blaming’. She calls for a social conversation with young people about empowered consent and responsibility towards others, to counter the pressure from some quarters to withdraw from the digital world and their own sexual exploration, rather than re-shaping their engagement with it.

Finally, Valeria Quaglia reminds us that social change around sexual identities is still uneven across Europe as she explores the experiences of LGBQ parents and heterosexual parents of LGBQ people, in Italy. Negotiating complex paths of visibility and invisibility, disclosure and silence, the persistence of stigma and powerful generational obligations, requires constant reflection and reframing by all the parents who speak to us here. However, the many moving personal narratives, such as the father of a gay son who shifts from disappointment and rejection to activism, renew the urgency and optimism with which Quaglia invites us all to continue the quest for inclusive societies.

This thread runs through the work of all our authors, creating a rich, colourful, tapestry of shifting, complex patterns.  Movement towards a greater ease with more fluid and plural identities, an ethic of sexual knowledge, empowerment and shared responsibility, and a focus on social justice, requires acknowledging the persistence of powerful counter-narratives and understanding the anxieties of those who inhabit them. In an increasingly polarised global political landscape the importance of having these conversations around policy and everyday life is more pressing than ever.

Susan Frenk is Principal of St. Aidan’s College, Durham University, Co-Director of the Centre for Sex, Gender and Sexualities and a member of the Steering Group of the Centre for the Study of Jewish Culture, Society and Politics

With a background in Latin American Studies, she previously taught and researched on gender and sexualities across a range of contexts in the School of Modern Languages and Cultures at Durham, following her BA, MPhil and PhD at Cambridge University, with periods of research in Berkeley (California) and Sussex Universities.    

Mark McCormack is a Senior Lecturer in Sociology at Durham University, and Co-Director of its Centre for Sex, Gender and Sexualities. His research examine how social trends related to decreasing homophobia influence the gender and sexual identities and the everyday practices of young people in the UK and the US. He has published on these themes in many leading journals, including Sociology, British Journal of Sociology, Archives of Sexual Behavior and Sex Roles. See also his books: McCormack, M. (2012). The Declining Significance of Homophobia: How Teenage Boys are Redefining Masculinity and Heterosexuality . New York: Oxford University Press and Anderson, E. & McCormack, M. (2016). The Changing Dynamics of Bisexual Men’s Experiences: Social Research Perspectives . New York: Springer.

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Home — Essay Samples — Sociology — Sex, Gender and Sexuality — Gender and Sexuality

Gender and Sexuality

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Published: Jan 29, 2024

Words: 463 | Page: 1 | 3 min read

Table of contents

Definitions and concepts, historical perspective on gender and sexuality, intersections of gender and sexuality, impact on individuals and society, current debates and challenges.

• Butler, J. (1990). Gender Trouble: Feminism and the Subversion of Identity. Routledge.
• hooks, b. (2000). Feminism is for Everybody: Passionate Politics. South End Press.
• Crenshaw, K. (1989). Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics. University of Chicago Legal Forum.

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Literary Theory and Criticism

Home › Gender Studies › Psychoanalysis and Gender

Psychoanalysis and Gender

By NASRULLAH MAMBROL on November 20, 2018 • ( 0 )

While many theories of subjectivity pay little attention to the productive role of gender in the formation of the subject, psychoanalysis , for all its limitations, has always been interested in gender as primary in the production of subjects. Freud articulated the Oedipus complex to understand the process of becoming a subject, of taking up gendered subjectivity, or, put more simply, the road to becoming a woman or a man. For Freud , this complex is a useful story to explain how an infant comes to deal with its incestuous desires – both erotic and destructive – for its parents. The Oedipus complex plays a fundamental part in the structuring of the personality, and in the orientation of human desire.

Freud imagined the libido (human desire) as a great reservoir of psychic and sexual energies which were channelled through particular drives (sometimes called ‘impulses’ or ‘pulsions’). Like many writers of his day, he used modernist metaphors of industrial production in his theories; Freud’s libido resembles a hydraulic power plant which sends out and receives great flowing gushes of libido. These metaphors of hydraulics outline how the flow of sexual energy is regulated through apparatuses, production processes and mechanisms (Ferrell 1996). Through a process called ‘cathexis’ we channel our libidinal energy to one object or another; we choose the object of our affections and direct the flow of our desire to it, him or her. This process of object choice is crucial to Freudian theory , as it is one of the mechanisms that seems to explain the operation of compulsory heterosexuality at an individual and unconscious level.

Freud argued that infant sexuality is unchannelled and ‘polymorphously perverse’. Its ‘libidinal economy’ is unstructured. That is, the infant loves everything and everyone: grabs all fingers; enjoys farting; believes that breasts are part of the giving universe; plays with him/herself; thinks peeing is fun; and, generally, is not quite sure where his or her own body leaves off and others begin. Breasts, fingers, toes – these are all part of the extension of the infant’s body. In other words, many (‘poly’) forms (‘morph’) of pleasure (perverse) appeal to the infant. How then to turn this squeezing, farting, peeing good-time baby into a proper girl or boy and, subsequently, a heterosexual, ‘well-adjusted’ adult?

The Oedipus complex describes the psychic operation of a complex of attraction, desire, love, hatred, rivalry and guilt that the child feels towards his or her parents. It takes place around the age of three to five years and explains how the child comes to identify with the same-sex parent.

In the pre-Oedipal phase children of both sexes are one with their mother. In this state of ‘polymorphous perversion’ there is no formation yet of sexual desire; the child experiences primarily oral and anal drives (impulses, forces of desire, needs and wants). When the child separates from its mother and breaks out of this close unity with her, the path for each gender differs.

The little boy takes the road through the positive Oedipus complex, where he desires his mother and identifies with his father. (At the end of a positive Oedipus complex the love object is the opposite sex; the negative Oedipus complex produces a same-sex object of desire. The normative beliefs of his society operate in the names Freud gave his complexes.) Freud speculates that when the boy child becomes aware of sexual difference, he is concerned with the mother’s lack of a penis and assumes that she has been castrated by the father (the castration complex). According to Freud, because of its visibility, the penis is the most important reference in the organisation of sexuality; in contrast, the female genitalia lie hidden, which is the cause of male castration anxiety: ‘the fear of nothing to see’. The young boy goes through a twofold motion: he discovers the absence of the penis and consequently fears that the father will punish him for his forbidden love for his mother by taking away his penis, too. He gives up his love for the mother, and his rivalry with the father, and identifies with his father, thereby taking on a masculine identification. By repressing his desire for his mother, he forms a strong and strict superego. His drives change from oral and anal to phallic or genital drives. Freud posited this story as a way of explaining how the boy child grew psychically and consolidated the functions of the ego and superego.

The little girl takes a different route after the pre-Oedipal stage; she too enters the genital/phallic stage in which she loves her mother actively. In this stage her drives are focused on the clitoris, which is considered by Freud to be an inferior sort of penis. When the young girl makes the dramatic discovery that she has no penis, she develops a castration complex, which involves self-hate and resentment towards the mother. The castration complex results in penis envy, which forces the girl to enter the positive Oedipus complex. According to Freud, the girl substitutes a yearning for a baby for this penis envy. For the girl, the Oedipus complex involves giving up the fiercely desired penis and replacing it with the desire for a baby; to do this, she redirects her desire towards her father. Freud adds that only by bearing a (male) child does a woman achieve full access to mature femininity.

Freud argues that the route to femininity is more tortuous; the little girl is initially a little man but becomes passive when she discovers that she is castrated. Feeling wounded and resentful at her lack of a penis, she turns away from the mother as a love object and towards the father with the desire to bear a child of her own to compensate for her lack of a penis. In the Oedipal stage, then, the young girl has to make two libidinal shifts: she replaces the erotogenic zone of the (‘phallic’) clitoris with the (‘female’) vagina, and she shifts the object of her love from the mother to the father. For the girl, the psychological consequences of the Oedipus complex are permanent: penis envy gives her a sense of being castrated and therefore injured. The psychological scar of this wound to her self, this narcissistic wound, will leave the girl with a permanent sense of inferiority.

Because the girl’s Oedipus complex is not destroyed by castration anxiety as it is in the young boy, the Oedipal stage is never wholly resolved and, as a consequence, the girl has a weaker need for repression. As a result of this, says Freud , the girl scarcely develops a superego and remains morally defective. Repression leads the subject to the need for sublimating his/her drives, just as artists sublimate their desires and aggression through the creation of works of art. Castration anxiety is a precondition for sublimation which, according to Freud, explains the limited participation of women in culture.

Source: Cranny-Francis, Anne et al. Gender Studies . 4th ed. Basingstoke: Palgrave Macmillan, 2011. Abelove, Henry, Barale, Michèle Aina and Halperin, David (1993) The Lesbian and Gay Studies Reader, Routledge, New York. Adam, Barry D. (1995) The Rise of a Gay and Lesbian Movement (rev. edn) Twayne, New York. Adkins, Lisa (1995) Gendered Work: Sexuality, Family and the Labour Market, Open University Press, Buckingham. Alloway, Nola (1995) Foundation Stone Benveniste, Emile (1971) Problems in General Linguistics (trans. M.E. Meek) University of Miami Press, Coral Gables, FL. Benjamin, Jessica (1988) The Bonds of Love: Feminism, Psychoanalysis, and the Problem of Domination, Virago, London. Butler, Judith (1990) Gender Trouble: Feminism and the Subversion of Identity, Routledge, New York. Cranny-Francis, Anne (1995) The Body in the Text, Melbourne University Press, Melbourne de Beauvoir, Simone (1972) The Second Sex (trans. H.M. Pashley) Penguin, Harmondsworth. Foucault, Michel (1979) Discipline and Punish: The Birth of the Prison, Vintage, New York. Woodhouse, Annie (1989) Fantastic Women: Sex, Gender and Transvestism, Palgrave Macmillan, Basingstoke.

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Categories: Gender Studies

Tags: Freudian Psychoanalysis , Gender , Gender Studies , Gender Trouble , Judith Butler , Lacanian Psychoanalysis , Literary Theory , Nasrullah Mambrol , Oedipus complex , Psychoanalysis , Psychoanalysis and Gender , Sigmund Freud

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Introduction

• Published: January 2018
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Since its inception, inquiry into gender, sex, and sexualities has produced knowledge that has changed psychologists’ ways of understanding human behavior. Much of this knowledge has had practical import, influencing law and public policy, schools, clinical and counseling psychology practice, and, in the general public, norms, attitudes, and practices related to gender and sexualities. For example, psychologists’ research has played a role in Supreme Court decisions protecting women’s reproductive rights, addressing workplace discrimination and harassment, and upholding the civil rights of lesbians and gay men. It has shaped public policies regarding sexual assault, domestic violence, pay equity, and educational access. Feminists in psychology have designed and evaluated educational practices aimed at closing the gender and ethnic gaps in science, technology, engineering, and mathematics (STEM) participation. Indeed, many of the psychologists who study topics pertaining to sex, gender, and sexualities came to the field because they had a commitment to social change and activism.

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