In-Person Social Interactions and Anxiety During the COVID-19 Pandemic: Exploring the Role of Household Size and Virtual Social Contact Among Midlife and Older Black South African Adults

Objectives The current study investigates how physical distancing during the COVID-19 pandemic was associated with increased anxiety among a cohort of midlife older Black South African adults and the extent to which household size and virtual social contact modify this association for men and women. Methods We analyze data from a phone survey conducted from July 2021 to March 2022 as part of Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (n=2,080). We employ logistic regression to estimate the association between changes in in-person social interactions and anxiety symptoms and examine whether the association is modified by household size and changes in virtual social contact. We perform analyses separately for women and men. Results Declines in in-person social interactions were associated with increased anxiety for women and men (OR=2.52, p<0.001). For women only, declines were greater for those living in larger households (OR=1.11 p=0.032). Declines were buffered by increased virtual social contact for both women (OR=0.55 p=0.025) and men (OR=0.45 p=0.019). Discussion Although the anxiety symptoms of women and men were similarly impacted by declines in in-person social interaction, the modifying influence of household size is unique to women, likely due to gender-specific social roles. For women, living in larger households may mean greater caregiving burden, exacerbating the detrimental association between physical distancing and anxiety. On the other hand, both women and men may have used virtual means to connect with friends and family living outside their homes, buffering against increased anxiety.