Daniel M. Mwanga ^1,2* Henry O. Odero ¹ Damazo T. Kadengye ^1,3 Sally A. Odunga ¹ Eva Muluve ⁴ Bylhah Mugotitsa ¹ Ruth Nanjekho ⁴ Karen Austrian ⁴ Sylvia Kiwuwa-Muyingo ¹

• ¹ African Population and Health Research Center (APHRC), Nairobi, Kenya
• ² Department of Mathematics, Faculty of Science, University of Nairobi, Nairobi, Kenya
• ³ Department of Economics and Statistics, Kabale University,, Kabele, Uganda
• ⁴ Population Council Nairobi, Kenya, Nairobi, Kenya

COVID-19 pandemic had devastating socio-economic and health effects, including mental health. This study examines the intersectionality between gender and mental health outcomes among Kenyan adults in informal settlements of Nairobi, Kisumu, and Kilifi Counties during the COVID-19 crisis. This is necessary to inform mental health response in case of another pandemic. We analyzed data collected in a longitudinal survey between July 2020 (fourth round) and February 2021 (fifth round). The data covered COVID-19-related effects on job loss, food insecurity, access to health services, and mental health. Participants were randomly sampled from existing cohorts at the Population Council. The outcomes of interest were depressive and anxiety disorders, combined into a binary composite outcome variable. Descriptive statistics included means for continuous variables and frequencies and proportions for categorical variables. Chi-square tests were used to examine the differences between groups. The relationship between the gendered COVID-19 socio-economic effects and participants' mental health was examined using modified Poisson regression. A total of 4050 participants were interviewed, 66% female and median age 38 (interquartile range (IQR): 29-46). Complete income loss was strongly associated with negative mental health outcomes in multiple intersections with varied magnitudes. The association was larger among older females (≥ 50 years) (PR=1.33, 95% CI=1.17-1.51, p<0.001) than older males (PR=1.22, 95% CI=1.17-1.27, p<0.001). Partial loss of income was protective against negative mental health outcomes among young males (18-29 years) (PR=0.81, 95% CI=0.76-0.87, p<0.001) but linked to negative outcomes among middle-aged males (30-49 years old) (PR=1.14, 95% CI=1.12-1.16, p<0.001). Skipping meals was associated with negative mental health outcomes for both genders particularly the married (married male: PR=1.49, 95% CI=1.22-1.83, p<0.001; married female: PR=1.42, 95% CI=1.26-1.60, p<0.001). We observed significant gender differences in the prevalence of depressive symptoms and anxiety disorders during the COVID-19 pandemic, underscoring the importance of socioeconomic factors and health services access in shaping mental health outcomes. Interventions targeting pandemic-related mental health issues should be gender-sensitive and address economic vulnerabilities such as job losses and food insecurity. Policies to mitigate these effects, especially for at-risk groups are crucial for reducing mental health burden in future crises.