Sex Differences in Mental Health-Related Work Incapacity Across Occupational Sectors During the COVID-19 Lockdown in Spain

<b>Background</b>: The COVID-19 pandemic has exacerbated mental health challenges across occupational sectors, disproportionately affecting workers in essential and public-facing roles. Objectives: This study ai to identify the occupational sectors in Spain most affected by mental health-related Temporary Work Incapacity due to Common Contingencies during the first COVID-19 lookdown (14 March-21 June 2020) to examine sex-based differences and to analyze the associate economic burden. <b>Methods</b>: A descriptive, retrospective cross-sectional study was conducted using data from salaried workers affiliated with Asepeyo, a major Social Security mutual insurance provider in Spain. The sample comprised 5135 workers granted Temporary Work Incapacity due to mental health diagnoses during the lockdown period. Variables analyzed included sex, age, ICD-10 diagnosis, occupational sector, duration of medically certified leave, and estimated direct economic cost. A focused subsample of 2123 workers from the ten most affected sectors was also examined. <b>Results</b>: Generalized Anxiety Disorder was the most prevalent diagnosis (69.17%), followed by adjustment disorders and depressive episodes. Women accounted for 63.5% of the total sample and 80.6% of the most affected sectors, which included elderly care, retail, education, cleaning, and healthcare. The average cost per episode was EUR 2465.7, with longer leave durations observed in sectors characterized by high emotional and social exposure. <b>Conclusions</b>: Mental health-related disorders during the COVID-19 lockdown revealed marked sex-based disparities and sectoral vulnerabilities. Public-facing and care-related occupations experienced a disproportionate burden. These findings support the need to recognize certain mental health conditions as occupational diseases to develop targeted, gender-informed workplace mental health strategies.