Gender disparities and mental health: The Facts
Mental illness is associated with a significant burden
of morbidity and disability.
Lifetime prevalence rates for any kind of
psychological disorder are higher than previously thought, are
increasing in recent cohorts and affect nearly half the
population.
Despite being common, mental illness is underdiagnosed
by doctors. Less than half of those who meet diagnostic criteria for
psychological disorders are identified by doctors.
Patients, too, appear reluctant to seek professional
help. Only 2 in every 5 people experiencing a mood, anxiety or
substance use disorder seeking assistance in the year of the onset
of the disorder.
Overall rates of psychiatric disorder are almost
identical for men and women but striking gender differences are
found in the patterns of mental illness.
Why Gender?
Gender is a critical determinant of mental health and
mental illness. The morbidity associated with mental illness has
received substantially more attention than the gender specific
determinants and mechanisms that promote and protect mental health
and foster resilience to stress and adversity.
Gender determines the differential power and control
men and women have over the socioeconomic determinants of their
mental health and lives, their social position, status and treatment
in society and their susceptibility and exposure to specific mental
health risks.
Gender differences occur particularly in the rates of
common mental disorders - depression, anxiety and somatic
complaints. These disorders, in which women predominate, affect
approximately 1 in 3 people in the community and constitute a
serious public health problem.
Unipolar depression, predicted to be the second
leading cause of global disability burden by 2020, is twice as
common in women.
Depression is not only the most common women's mental
health problem but may be more persistent in women than men. More
research is needed.
Reducing the overrepresentation of women who are
depressed would contribute significantly to lessening the global
burden of disability caused by psychological disorders.
The lifetime prevalence rate for alcohol dependence,
another common disorder, is more than twice as high in men than
women. In developed countries, approximately 1 in 5 men and 1 in 12
women develop alcohol dependence during their lives.
Men are also more than three times more likely to be
diagnosed with antisocial personality disorder than women.
There are no marked gender differences in the rates of
severe mental disorders like schizophrenia and bipolar disorder that
affect less than 2% of the population.
Gender differences have been reported in age of onset
of symptoms, frequency of psychotic symptoms, course of these
disorders, social adjustment and long term outcome.
The disability associated with mental illness falls
most heavily on those who experience three or more comorbid
disorders. Again, women predominate.
Gender specific risk factors
Depression, anxiety, somatic symptoms and high rates
of comorbidity are significantly related to interconnected and co
occurrent risk factors such as gender based roles, stressors and
negative life experiences and events.
Gender specific risk factors for common mental
disorders that disproportionately affect women include gender based
violence, socioeconomic disadvantage, low income and income
inequality, low or subordinate social status and rank and
unremitting responsibility for the care of others.
The high prevalence of sexual violence to which women
are exposed and the correspondingly high rate of Post Traumatic
Stress Disorder (PTSD) following such violence, renders women the
largest single group of people affected by this disorder.
The mental health impact of long term, cumulative
psychosocial adversity has not been adequately investigated.
Restructuring has a gender specific effect on mental
health
Economic and social policies that cause sudden,
disruptive and severe changes to income, employment and social
capital that cannot be controlled or avoided, significantly increase
gender inequality and the rate of common mental disorders.
Gender bias
Gender bias occurs in the treatment of psychological
disorders. Doctors are more likely to diagnose depression in women
compared with men, even when they have similar scores on
standardized measures of depression or present with indentical
symptoms.
Female gender is a significant predictor of being
prescribed mood altering psychotropic drugs.
Gender differences exist in patterns of help seeking
for psychological disorder. Women are more likely to seek help from
and disclose mental health problems to their primary health care
physician while men are more likely to seek specialist mental health
care and are the principal users of inpatient care.
Men are more likely than women to disclose problems
with alcohol use to their health care provider.
Gender stereotypes regarding proneness to emotional
problems in women and alcohol problems in men, appear to reinforce
social stigma and constrain help seeking along stereotypical lines.
They are a barrier to the accurate identification and treatment of
psychological disorder.
Despite these differences, most women and men
experiencing emotional distress and /or psychological disorder are
neither identified or treated by their doctor.
Violence related mental health problems are also
poorly identified. Women are reluctant to disclose a history of
violent victimization unless physicians ask about it directly.
The complexity of violence related health outcomes
increases when victimization is undetected and results in high and
costly rates of utilization of the health and mental health care
system.
For a complete referenced discussion of these issue
please see document on Gender
disparities in mental health.
Women's mental health: The Facts
- Depressive disorders account for close to 41.9% of the
disability from neuropsychiatric disorders among women compared to
29.3% among men.
- Leading mental health problems of the elderly are depression,
organic brain syndromes and dementias. A majority are women.
- An estimated 80% of 50 million people affected by violent
conflicts, civil wars, disasters, and displacement are women and
children.
- Lifetime prevalence rate of violence against women ranges from
16% to 50%.
- At least one in five women suffer rape or attempted rape in
their lifetime.
Depression, anxiety, psychological distress, sexual
violence, domestic violence and escalating rates of substance use
affect women to a greater extent than men across different countries
and different settings. Pressures created by their multiple roles,
gender discrimination and associated factors of poverty, hunger,
malnutrition, overwork, domestic violence and sexual abuse, combine
to account for women's poor mental health. There is a positive
relationship between the frequency and severity of such social
factors and the frequency and severity of mental health problems in
women. Severe life events that cause a sense of loss, inferiority,
humiliation or entrapment can predict depression.
Up to 20% of those attending primary health care in
developing countries suffer from anxiety and/or depressive
disorders. In most centres, these patients are not recognized and
therefore not treated. Communication between health workers and
women patients is extremely authoritarian in many countries, making
a woman's disclosure of psychological and emotional distress
difficult, and often stigmatized. When women dare to disclose their
problems, many health workers tend to have gender biases which lead
them to either over-treat or under-treat women.
Research shows that there are 3 main factors which are
highly protective against the development of mental problems
especially depression. These are:
- having sufficient autonomy to exercise some control in
response to severe events.
- access to some material resources that allow the possibility
of making choices in the face of severe events.
- psychological support from family, friends, or health
providers is powerfully protective.
WHO's Focus in Women's Mental Health
- Build evidence on the prevalence and causes of mental health
problems in women as well as on the mediating and protective
factors.
- Promote the formulation and implementation of health policies
that address women's needs and concerns from childhood to old age.
- Enhance the competence of primary health care providers to
recognize and treat mental health consequences of domestic
violence, sexual abuse, and acute and chronic stress in women.
For more information, please refer to the list of Publications
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