Role of Gender in Mental Health

Gender is a critical determinant of mental health. However, it hasn’t received more attention. It is the fact finding component which determines

· Psychosocial Factors

· Cultural Factors

· Environmental factors

which are so salient to women’s mental health. Before we speak of women’s mental health, we need to understand the concerns of women’s health. Concerns that are more prevalent in women and issues that are prevalent in both women and men, because, women display different symptoms compared to men who have the same condition and respond differently to interventions.

Importance of Gender in Mental Health

Earlier, views of women’s health focused exclusively on reproductive health, Present days there is a broader multidisciplinary approach that encompasses all organ system. Women’s mental health includes biological, psychological and social-cultural aspects of health and illness across her life span. Women’s health also includes issues of access to care, quality of care and prevention of disease. Many women experience barriers to good health care, including limited access, intensive attitudes in the medical profession, and poorly coordinated referral systems. Psychosocial factors also play an important part in the mental health of women. Mental health problems were found to be one of the largest causes for loosing years of quality life, accounting for 10.5% of all disability among women.

One of the most consistent findings in epidemiological research is that the Unipolar depression is about twice as common in women as in men. Women are also more likely to experience many anxiety disorders and over 90% of cases of eating disorders occur in women. Rates of bipolar disorders are similar in men and women however, women are more likely to develop depressive episodes of bipolar disorder and a rapid-cycling course.

Although alcoholism is much more prevalent in men, mortality rates among individuals with alcoholism are considerably higher in women. Mental disorders in women are most common during the childbearing years and often reproductive events may act as triggers for the onset or exacerbation of symptoms. Gender differences in socializing processes and rates of traumatic abuse, as well as the various social roles of women as wives, mothers, caretakers of elderly parents and workers, all deserve consideration in understanding risk factors of mental illness and the effects of these disorder on women and their families.

Let us look at the psychiatric aspect of women concerns:

Women’s Psychobiology and reproductive cycle

· Some reproductive hormones, particularly estrogen and androgen increases the Psychiatric symptoms, like increase vulnerability of women to anxiety disorders and depression.

· Another example factor is, women with low serotonin levels may experience increase rather than decrease in anxiety and irritability in the premenstrual phase of the cycle.

Psychiatric aspects of the menstrual cycle

Many women in their reproductive years, from menarche to menopause have clinically significant menstrual-related emotional as well as physical symptoms. Social beliefs about menstruation, however, vary among different cultures and can influence expectations about the menstrual cycle. Age also influence the reporting of premenstrual symptoms as it has been observed that older adolescent (16-18 years) have significantly more intense symptoms than younger teens (13-15 years). Onset of distressing symptoms occurs typically when women are in their late 20's to mid-30's. There is some evidence of worsening premenstrual symptoms following childbirth. Women with higher levels of education have been shown to report more severe symptoms as well as more psychological complaints of premenstrual symptoms. Thus, it is important to consider that many factors- beliefs, age and levels of education may influence women’s premenstrual experiences.

Psychiatric aspects of pregnancy

Although pregnancy is typically considered a time of emotional well-being for many women, pregnancy is not protective for women who suffer from a mental health condition. Research has shown that 1 to 2 women suffer from depression during their pregnancy. Pregnancy can act as a stressor e.g. –relapse of mood disorder and psychosis. Pregnancy can cause postpartum psychosis and depression. Postpartum Depression describes four syndromes namely,

· Maternity or Postpartum Blues

· Postpartum Psychosis

· Adjustment Disorder of the Postpartum Period

Major Depression in the Postpartum (Postpartum Depression)

Psychiatric aspects of menopause

Menopause is considered as the end of womanhood in many cultures. It affects about 70% of women approaching menopause. Typical menopause symptoms, such as hot flashes or night sweats, are caused by changing hormonal levels in the female reproductive system.

Almost all women notice early symptoms also called peri-menopause while still having periods. This stage often begins in the early 40s and last for the whole menopause transition (until the mid 50s), but some women may experience them for the rest of their lives. The most common symptoms are: Hot Flashes, Night Sweats, Irregular Periods, Loss of Libido, and Vaginal Dryness.

Gender biased Individual Mental ill-Health

In women, rates of new-onset schizophrenia reach a peak between ages 20 and 29 years, around a decade later than in men. They have bimodal curve for onset. A number of large epidemiological studies have consistently found that women are more likely than men to experience depressive disorders. The increased prevalence of depression in women begins in adolescence and is a cross-cultural phenomenon. Although most stressors influence the risk for depression similarly in both women and men, women appear to be more likely to become depressed in response to interpersonal difficulties. Anxiety disorders are more prevalent in women than in men, and women with anxiety disorders are more likely than men to experience co-morbid depression. Panic with agoraphobia and generalized anxiety disorder (GAD) are two to three times more common in women than in men. Social phobia is three to four times as common in women as in men. With regard to PTSD, women may be culturally primed to experience traumatic events differently than men, rather than having an increased biological vulnerability.

Bipolar disorder

Women with bipolar disorder are approximately two times as likely as men with the disorder to experience rapid cycling, defined as four or more affective episodes per year. It has generally been accepted that women with the disorder appear to experience more depressive episodes than do men with the disorder.

Sleep Disorders

The risk for sleep-related difficulties rises during certain reproductive phases of women’s lives: premenstrual bloating and cramping frequently disrupt sleep. The discomfort women experience in the third trimester of pregnancy, and night sweats produce sleep impairment in approximately one-third of peri-menopausal women.

Domestic Violence

Women are more likely to be assaulted and injured by a current or former male partner than by all other assailants combined. Often feel that their lives are in danger, and these fears may persist after the assault. Victims of domestic violence are at risk for depression, anxiety, eating disorders, and alcoholism.

Children of battered women are at risk for substance abuse, suicide, school problems, violent and aggressive behavior, sleep disorders, enuresis, and chronic somatic disorders.

Depression, anxiety, psychological distress, sexual violence, domestic violence and escalating rates of substance use affect women to a greater extent than men. 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.

Sexual Violence

Women need to speak up about sexual violence. Rape, Incest, Marital sexual violence, prostitution and trafficking should be assessed. 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.

Special Aspects and consideration during treatment of mental illnesses among women

Due to women specific life events like pregnancy or lactation , sometimes the treatment needs to be stopped or modified accordingly. Women specific side-effects like Hirsuitism, Amenorrhoea, or Dysmenorrhea, excessive weight gain etc may also affect the treatment response and treatment strategy, including choice of medication and treatment outcome. Socio-cultural aspects like the paternalistic society, prevalent in India, may also affect the treatment adherence, either due to medication side effects ( sedation-Women are supposed to wake up before men and, do household chores), or the mental illness and treatment considered as a taboo, leading to stopping of treatment or hiding the treatment before marriage.

Conclusion

Women have different needs than men in a mental health condition. There are issues related to reproductive health that needs extra attention. The security of women brings in a lot of challenges and due to the patriarchal nature of the society, the risk of abandonment is high. Having said all this, we cannot always identify the cause of a woman’s mental health condition, however we can recognize the signs and symptoms to seek support and timely help.

Don’t struggle in silence, please speak up. Seeking help is a sign of strength, not weakness.

To all the women out there make “Mental Health your priority for a quality life.”