Changes in sex differences in mental health over time: the moderating effects of educational status and loneliness

Limited evidence exists regarding how sex differences in mental health are changing over time, especially in the context of recent health and economic adversities. To examine the temporal shifts in mental health issues among males and females, and explore the influence of education and loneliness on these trends. Data were utilized from the 2020 to 2023 Monitor study, a repeated cross-sectional survey of adults 18 years and older in Ontario, Canada. The study employed a Qualtrics-based web panel survey (<i>n</i> = 5,317). Mental health was assessed using Kessler-6 questionnaire, and analyses were performed using Generalized Linear Model (GLM) with gamma distribution. The results showed that there was a significant three-way interaction effect between sex, time and education with psychological distress (<i>p</i> = 0.014), suggesting that psychological distress increased between 2020 and 2023 among males who had less than college education. However, it remained stable among males with college/university degrees and females overall. Interaction between sex and feeling lonely on psychological distress was also evident (<i>p</i> = 0.004). Mental health issues remained a significant public health challenge among adults, especially psychological distress increasing among males with less than a college education. This underscores the importance of targeted interventions addressing males’ mental health.