Mental Health Among Spanish Adults During the COVID-19 Pandemic and in the Post-Pandemic Period: A Gender Analysis

<i>Background and Objectives</i>: The COVID-19 pandemic has had severe and far-reaching repercussions for health systems and societies, creating a global mental health crisis that has persisted after the pandemic. This study examined differences in mental health (i.e., psychological distress and well-being) by gender and pandemic period (i.e., lockdown, second and third pandemic waves, the last year of the pandemic, and the post-pandemic period) among Spanish individuals in two stages of adulthood: established adulthood and midlife. The second objective was to identify the risk and protective factors for psychological distress and well-being during the post-pandemic period. <i>Materials and Methods:</i> The study design was repeated cross-sectionally. The non-probability sample included 3677 people (66.2% women) from the general Spanish population, aged 30 to 59 years. Participants were assessed between 1 June 2020 and 23 May 2024 using the following self-reports: the General Health Questionnaire-12 item version, the Scale of Positive and Negative Experience, the Brief Inventory of Thriving, the Satisfaction with Life Scale, the Rosenberg Self-Esteem Scale, the Social Support Scale, the Stressful Events Questionnaire, the Brief Resilience Scale, and the Perceived Vulnerability to Disease Questionnaire. <i>Results</i>: Although rates of psychological distress varied across pandemic periods, women consistently experienced higher rates than men. During the post-pandemic period, the rates of psychological distress were 47.5% for women in established adulthood and 34.7% for midlife women, compared to 28.6% and 22% for men, respectively. Low self-esteem was the main predictor of greater psychological distress and lower well-being for both genders and age groups in the post-pandemic period. Another significant predictor was lower stress resilience. <i>Conclusions</i>: The COVID-19 pandemic threatened women's mental health and well-being more than men's, and this threat persists after the pandemic, especially among women in established adulthood. The study's findings are relevant for the design of policies, programs, and strategies to achieve better mental health and well-being among citizens and greater gender equality.