COVID-19 is a devilishly versatile disease, attacking all manner of body systems and doing all manner of damage—to the lungs, the heart, the liver, the kidneys. Though it doesn’t attack the mind directly, the pandemic the virus has caused has been devastating to mental health, and in many cases, the most vulnerable group is women.

In a new study conducted by CARE, a non-profit international aid organization, investigators have found that while almost nobody is spared from the anxiety, worry and overall emotional fatigue of the coronavirus pandemic, women are almost three times as likely as men to report suffering from significant mental health consequences (27% compared to 10%), including anxiety, loss of appetite, inability to sleep and trouble completing everyday tasks.

The study was ambitious, involving surveys of 10,400 women and men in 38 countries including the U.S., as well as others in Latin America, Asia and the Middle East. The investigators explored two different avenues of inquiry, first asking respondents about their emotional state and then looking into what might be behind the problems.

“We had a lot of qualitative data from women about stress, fear, anxiety, worry for the future,” says Emily Janoch, director of knowledge management and learning at CARE, who led the study. “Then we dug into those responses and looked for the causative factor.”

Weathering Economic Blows

Time and again, what Janoch and her colleagues found was that women were subjected to specific stressors men were more likely to be spared, and overwhelmingly, those stressors were economic. In the U.S., for example, from February to May, 11.5 million women were laid off compared to 9 million men. And those job losses took place in a system in which women already make up 66.6% of the workforce in the country’s 40 lowest paying jobs.

The division of labor in the home places a heavier emotional burden on women too. In the U.S., 55% of employed women do housework compared to 18% of men, and women tend to spend twice the amount of time with their children than men do. When schools close and children are left with only remote learning, the burden to keep them focused and check their assignments falls disproportionately on women. In Latin America, the CARE study found, this disparity is even worse, with 95% of schools in the region shuttered and entrenched social practice putting virtually all of the childcare burden on women.

Things are even harder in the developing world. In Bangladesh, where women are six times likelier than men to have been laid off during the coronavirus recession and where an astounding 100% of 542 women surveyed reported increased mental health problems, the emotional toll is exacerbated by lack of mobility—either due to religious strictures that forbid women from leaving home without the accompaniment of a male family member or because of lack of access to public transportation. Either way, this limits their access to services like mental health care—and in many cases, they sorely need it.

“When you ask women if their anxiety has gone up, they say ‘Yes, and here’s why: I’m not sure how many more days I can feed my family. I’m afraid I’m going to lose my job, and I have no back-up plan,’” reports Janoch.

High-Risk Work

Similar problems showed up in the Middle East, with 49% of women in Lebanon reporting job losses compared to 21% of men. In Palestinian communities, women who do have jobs tend to be employed in high-risk fields, with 44% of them working as teachers, nurses or other front-line positions. And if they begin to suffer emotionally from the strain, they often have little recourse: only 8% of women said they have access to adequate mental health care, compared to 67% of men.

“Often,” Janoch says, “women are only allowed to go to women healthcare professionals, and many fewer doctors are women. Also, women are often expected to go to healthcare with a male family member accompanying them, which is not always possible—especially during COVID.”

Elsewhere across Asia, women also tend to work in fields that expose them to greater risk of contracting the coronavirus, including crowded factory work, the hospitality industry and the sex trade. Across the world, women are overwhelmingly likelier than men to be employed as housekeepers as well, and when lockdowns hit, many were faced with a terrible choice: they could quarantine with their employer’s family and hold on to their job, or quarantine with their own family, and lose the source of income that made it possible to support them.

Broader economic structures play a role too. In general, more women than men are employed in the informal economy or so-called gray markets—outdoor stalls and bazaars that are often unlicensed and unregulated but that provide an income for millions. In a typical recession, it’s formal businesses that tend to suffer while the ones at the fringes keep operating. The coronavirus recession has played out the opposite way, with social distancing making the typically crowded markets no-go zones.

“The informal economy got completely devastated by the restrictions,” says Janoch.

“Devastated” is a fair description of so much else that has been touched by the pandemic. Shuttered businesses, shattered economies, families grieving lost loved ones—all have been the most visible consequences of the global plague. Less visible, but no less terrible, is the quieter emotional pain of so many millions of people—too many of whom are paying a higher price simply because of their gender.