Why do so many women suffer from mental disorders?

In most  European countries, statistics constantly show that, compared to men,  women are more affected with mental disorders such as: depression, anxiety,  eating disorder.

Depression syndromes prove to be the most prevalent mental disorders type in women , in any stage of their life.

Women become affected by, or receive a mental – type diagnosis (particularly of depression syndromes), between 2  and 3 times more frequently than men.

More often than men, women go to the general practitioners for psychic symptomatologies or physical problems which are later diagnosed as being caused by psychic or psychosomatic troubles and are more often hospitalized. (“A European women is  more likely to suffer from depression and turn increasingly to psychotropic drugs”  Highlights on women’s health in Europe, WHO, 1995).

Women are the highest users of  both the public and private health-care services, and  use anti-depressive and anxiolitic drugs more than men.

Regarding the aetiology of depression syndromes in women, current research agrees on  singling out 3 main determinants:

(a)     endogenous biological factors;

(b)     endogenous psychological factors;

(c)     exogenous factors such as life events.

                 These strikes of  research did not carry out  exhaustive etiological hypotheses, therefore it is very difficult  to adopt efficient strategies and guidelines for depression preventing.

Indeed, regarding female depression:

§                     biological and hormonal endogenous factors  cannot be changed (menopause, only partially) without side-effects, very often dangerous for general health. All this clearly creates additional costs for people and  the community.

§                     Psychological endogenous factors are considered pre-determined and, therefore, not changeable.

§                     Psycho-social exogenous factors, consisting of life events such as loss or mourning, are neither controlled,  predictable nor  changeable.

An account of the above, we believe that female depression syndrome cannot be approached by an efficient prevention strategy.  At the moment  costs for this shortcoming are very high.

The main  researches carried out  hither into depression can help to specify and organize actions of cure only after the disorders have already revealed themselves through psychic and physic symptoms.

Current medical practice only carries out kind of actions based, mainly, on the  giving  drugs with the purpose of modifying brain neurotransmitters activity to improve mood  tone and, thus, the state of  depression. Such practice does not take sufficient consideration of those environmental factors that have lead to or caused the onset of depression  problems,  and do not bring about  any change in life style.

Current psycho-social research and interventions focus, in contrast, on female life conditions through a wider perspective. But, we have also to say that, most of this research, has come up with  contrasting results. For example, factors such as being a housewife, having an out-of-home job, being married, being a single women, presence or absence of children  are all considered, some times, as risk factors and, other times, as protection factors.

These contrasting evaluations do not help to define univocal factors  for depression and do not give any element  on which to  base forms treatment which are alternative and less risky for health than  the dispensing of drugs.

          For these reasons it is necessary to focus on the bias of the research and to promote and new strategies for prevention.

           The answer to gaps in research and in prevention is the innovation of  our proposal .

The specific innovation aspects  are expressed by the following objectives:

1)      to surpass etiological hypotheses  associated with psycho-biological events;

2)     to define interventions which would be unchangeable or practicable for prevention;

3)     to single out, through  meta-analysis, contradictions in current research into  different psycho-social factors which  lead to female depression;

4)     to equate research activities, into female depression risk factors with those regarding  the male population;

5)     to develop socio-environmental and behavioural analysis of depressive states by paying attention to global female  work (family and outside-family) as the main risk factor in depression pathology;

6)     to carry on a comparison among various European countries and focus on the diversities and similarities of  research into risk factors, relating them to the social and environmental conditions of different geographical areas;

7)     to go beyond aetiological hypotheses associated with psycho-biological events that cannot be changed or cannot be used for prevention activities;

8)     to set up effective strategies for prevention,  valid in all the different European countries taking part in this project;

The answer from the traditional medical  world

¨                  In terms of research, even though it is difficult to prove genetic, hormonal and personality structure hypotheses the research is mainly oriented to evaluate the correlation among women's mental pathologies, particularly depression, hormonal, biological and personality factors.

These research projects are carried out with large financial support and with the contribution of pharmaceutical industries, which are profit oriented. The out comes of psychosocial research lead to a different explanation of the higher morbidity in women compared to men, but this kind of research does not have  adequate financial support.

The traditional projects do not yet study the interconnection of many relevant factors: being married and having children; lack of trust toward the partner; lack of social support; low self-esteem; violence, battering and dependency.

¨                  In clinical practice we find sexual prejudices: the fact that mental illness, particularly depression is more widespread among women, is considered by the majority of psychiatrists  as related to female biology (hormonal fluctuation and so on) and personality traits (passivity, low self-esteem, dependency).

Treatments for women, compared to those for men, are more traditional: pharmaceutical treatment is prevalent, at times associated with psychotherapy.

Treatments in a mixed environment (both in or out clinic) do not fulfil women’s needs: often they are involved in an abusive relationship with a violent male, for they do not appreciate sharing a common therapeutic space with men.

Women, compared to men, are objects of longer medical and pharmaceutical treatments, and run a high risk of becoming chronic cases.

This data on longer therapies for women might be due to a lower effectiveness of pharmaceutical treatment, which seems to miss the goal more frequently compared to men in terms of improving women’s health.

¨                  About prevention, existing studies have not developed indications for acknowledging risk factors and protective factors in everyday life, to be used in prevention campaigns.

Prevention should have priority in any health system, for any pathology, yet in the field of mental illness we notice a lack of interest in developing studies and indications toward primary prevention. Such a lack of interest damages women in a special way, since they  get mentally ill more frequently than men and are much more exposed to risk factors in their environment.

Inappropriate prevention (often overlapping treatment) is connected to the recommendation to begin drugs assumption as early as possible, i.e., at the first symptom, even during adolescence; to avoid interruptions and to continue psychodrugs assumption for long periods of time.

¨                  As for the organization of services few Mental Services are focused on women: most services ignore women’s health needs in this field and are not equipped to deal with them. In health programmes there are no indications to lower female rates of mental illness; there are no gender-oriented health activities for risk groups such as adolescent girls or employed women with family commitments and children (overload).

In synthesis: mental health services seem to correspond to men’s needs. They are oriented toward “returning the person to his activities, in order to take up interrupted activities” without observing if these interrupted activities are the very cause of discomfort and disease.

Gender based Analysis (GBA) Proposal

v      Mental Health Research

In the field  of Mental Health Research the GBA highlights  the necessity of:

-          collecting data by sex, and showing the results according to this distinction;

-          using case-control samples;

-          including patients of both sexes;

-          relating the different variables to the sample divided by sex.

In the field of pharmacological research, it is necessary to acknowledge the biological difference between women and men.

In the field of clinical research it is necessary to set up new and specific therapeutical tools for women focusing on the link between illness and  everyday life.

v      Clinical Practice

It is necessary to integrate and modify the traditional ways of working by the elaboration of :

-          diagnostic protocols able to point out the pathogenic pathway which leads to mental illness.

-          Sex specific protocols for pharmacological treatment and recommendations that suggest caution in dosages for women. Particular Recommendations against psychodrugs assumption in the years of growth.

-          Treatment protocols apt to:

-        guide health care providers in singling out the causes undervalued by women themselves;

-    give suggestions apt to help women to lighten the burden of responsibilities and to assume styles of behaviour more suitable to individual wellbeing.

v      Prevention

According to GBA, primary prevention should focus on environmental and social-relational factors. These are factors on which it is possible to intervene before the overload of "pressure" becomes a psychic pathology.

Prevention should be gender sensitive and mainly addressed to the most vulnerable subjects: female adolescents and women (in the range 15-44).  

ü       Prevention in Age 15 - 44  

1. In Adolescents

·         Early adult role playing for supporting mother

·         Study and hobbies lowering

·         Peer relationship reduction

·         Trust only in parents

·         Skills unrecognised

·         Conditioned planning for the future

·         Feeling unwell.

2. In adult women

§         Increasing family work (work characterised by care for others and lack of self-care) connected to lack of “gratitude”

§         Unrecognised tiredness as connected  to family work

§         Decreasing personal interests and activities

§         Decreasing/lack of support

§         Lack of confidence in extra-family relations

§       Low self-esteem connected to undervaluation by others (family-social context).

v      Mental Health Services

                It is necessary to direct health services towards:

-          prevention and therapeutic activities for women;

-          offering women specific services.

Three types of activity or services for women:

1.                    The first type relates to preventing specific situations of distress.

2.             The second type of service is addressed to women who have already begun to develop an illness and manifest symptoms, and who have already had psychiatric treatment.

3.             The third type relates to setting up "women's refuges" (women in distress and violence situations).

Strategies for GBA Implementation

Until now we have evidenced bias and gaps in the mental health field (research, clinical, prevention, services)  and we have also evidenced in the light of GBA the corrective actions for women friendly psychiatry and psychotherapy. 

                Really the actions to modify scientific theories and clinical practice cannot be led by single persons, alone, or by gender oriented single groups. It is necessary involve in this plan Women Associations, University Researchers,  professionals who treat women  with mental disorders in different European Countries.

For these reasons we propose a new European network on women mental health made up of gender oriented technical groups and women/consumers associations.

These groups will be able:

•  to collect in each country and exchange epidemiological and clinical data, critical observations on gender bias, sexual prejudices and inequalities  presently in existence in research and clinical practice (medical, psychological and psychiatric);

• to analyse the data pointed out by each group, and to elaborate the synthesis on which the consensus will be reached;

• to develop  Indications, Recommendations, Guide-lines, for the inclusion of gender point of view in research and clinical practice in the field of  mental health;

• to exert pressure on mental health orientation of decision making European Institutions;

• to propose to E.C. (European Commission) the funding  a project on the network's organization.