The mental health and wellbeing of societies has been severely affected by the coronavirus disease 2019 (COVID-19) pandemic (United Nations, 2020). In Canada, about one quarter of adults reported poor to fair mental health in May 2020 compared to 8% in 2018, with similar changes reported in other countries (Codagnone et al., 2020, Statistics Canada, 2020a, Xiang et al., 2020). Given the global impact of COVID-19, these impacts likely go beyond increased symptomology to include clinically-significant changes in mental health status for some adults. Posttraumatic stress disorder (PTSD) has been reported in response to various epidemics and may be a particular concern during the COVID-19 pandemic (Boyraz & Legros, 2020, Lau et al., 2005, Liu et al., 2020). PTSD symptoms include intrusive recollection of a traumatic event, efforts to avoid stimuli associated with it, negative alterations in cognition or mood, and marked changes in arousal and reactivity (American Psychiatric Association, 2013). A review of emerging evidence found risk factors for increased PTSD symptomology during the pandemic include gender, levels of exposure, hospitalization, loss of a loved one, social isolation, and older age (Boyraz & Legros, 2020). A key rationale for this study was to examine if adults who were more vulnerable to the socioeconomic impacts of the pandemic were more likely to have pandemic-related PTSD symptoms. This examination would provide important information about vulnerable or at-risk groups for targeted mental health interventions (Blumenshine et al., 2008, Boyraz & Legros, 2020, Quinn and Kumar, 2014).

The second rationale was to examine associations between pandemic-related PTSD symptoms and substance use by gender. It is well documented that persons who are isolated and stressed often turn to substances to alleviate negative feelings (Cooper et al., 1995, Volkow, 2020). This is a concern during a pandemic given alcohol and drugs weaken the body’s immune system and ability to cope with infectious disease (Eisenstein et al., 2008, Friedman et al., 2006). Early reports suggest substance use has increased more among women than men during the pandemic; suggesting gender-stratified analyses are needed (Biddle et al., 2020, Lu et al., 2020). In Australia, 23% of women and 18% of men who consume alcohol have reported increased use during the pandemic (Biddle et al., 2020). Common reasons for increased alcohol use among Australian adults were spending more time at home and boredom. However, women were more likely than men to cite stress, anxiety, and worry about COVID-19 as reasons why their alcohol use had increased during the pandemic (Biddle et al., 2020). Building on these findings, a third rationale for this third study was to examine whether pandemic-related PTSD symptoms were statistically associated with increased substance use separately among Canadian women and men during the pandemic. Finally, to inform the resourcing of interventions, this study sought to understand the proportion of population-based adults in Alberta who believed they personally needed supports to address their substance use, stress levels, and/or mental health during the pandemic.

In summary, this study sought to: (1) Examine gender and socioeconomic differences in pandemic-related PTSD symptoms and substance use among adults; (2) examine associations between PTSD symptoms and substance use among adults using gender-stratified models; and (3) understand the supports community-based adults were seeking to address their substance use, mental health, or stress levels during the pandemic.