GENDER
DISPARITIES IN
MENTAL HEALTH
MSc. Psychology
• males: alcohol use disorder, conduct disorder, ADHD, and antisocial
personality disorder, to name a few.
females: major depression, many anxiety disorders, eating disorders,
borderline personality disorder, histrionic personality disorder,
(American Psychiatric Association, 2013; Cosgrove & Riddle, 2004).
• Critics of the current DSM have argued that some diagnostic categories
are biased toward pathologizing one gender more than the other.
Premenstrual Dysphoric Disorder
Feminist groups in particular have opposed its inclusion as an official
disorder in the DSM.
represents a form of gender bias likely to over pathologize women,
especially since there is no parallel diagnosis for men despite the fact that
men also experience some degree of hormonal fluctuations.
• physical or gynecological problems rather than a form of mental
illness
• they last a short time and subside on their own without treatment.
• Opponents of the proposed PMDD diagnosis criticized the quality and
quantity of the research on PMDD, concluding that it does not
substantiate PMDD as a distinct form of mental illness
(Alevizou, Vousoura, & Leonardou, 2018; Caplan, 1992, 1995; Caplan &
Cosgrove, 2004; Eriksen & Kress, 2005).
• low-prevalence and severe mental disorders, no consistent gender
differences in prevalence rates have been found
high-prevalence disorders of depression and anxiety ,large gender
differences in rates have been consistently reported
0.1% to 3% for schizophrenia and from 0.2% to 1.6% for bipolar
disorders (Piccinelli & Homen 1997) and no significant gender
differences have been reported.
Men typically had an earlier onset of symptoms than women and
poorer premorbid psychosocial development and functioning
women experience a higher frequency of hallucinations or more
positive psychotic symptoms than men.
rapid cycling form of the illness, exhibit more comorbidity
• A Finnish study on gender differences in living skills, found that half
the men but only a third of the women lacked these skills that are so
important for independent living.
• Gender and Depression
• A comprehensive review of almost all general population studies
conducted to date in the United States of America, Puerto Rico,
Canada, France, Iceland, Taiwan, Korea, Germany and Hong Kong,
reported that women predominated over men in lifetime prevalence
rates of major depression (Piccinelli & Homen, 1997).
• Depression may also be more persistent in women (Bracke, 2000) and
female gender is a significant predictor of relapse (Kuehner, 1999).
• The most common disorders were major depression and alcohol
dependence and these disorders are often co–morbid for men with
alcohol dependence
• completed suicide rates are higher in men, a nine country study reported
that women had consistently higher rates for suicide attempts
(Weissman, Bland, Canino et al, 1999).
• Gender-based violence is a significant predictor of suicidality in women,
with more than 20% of women who have experienced violence attempting
suicide
• Gender and Comorbidity
• Depression and anxiety are common comorbid diagnoses and women have
higher prevalence than men of both lifetime and 12 month comorbidity of
three or more disorders (Kessler et. al., 1994, WHO & ICPE, 2000).
• The multi-country WHO study on Psychological Problems in General
Health Care also found that current panic attacks and a diagnosis of
panic disorder were frequently associated with the presence of a
depressive disorder. Women predominate in all three disorders- panic
attacks, panic disorder and depressive disorder.
GENDER BIAS
Research
• Gender bias has skewed the research agenda. The relationship of women’s
reproductive functioning to their mental health has received intense scrutiny over
many years while other areas of women's health have been neglected.
• contribution of men’s reproductive functioning to their mental health has ignored.
men are emotionally responsive to many of the same events as women.
men as well as women experience depression following the birth of a child and
there is a high level of correlation between parents regarding depressive
symptoms (Soliday, McCluskey-Fawcett and O’Brien, 1999).
Treatment
• Gender bias and stereotyping in the treatment of female patients and the diagnosis
of psychological disorders has been reported since the 1970’s(Broverman, Vogel,
Broverman et al., 1972).
• Recent research findings are less consistent.
Some have found that 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 identical symptoms (Callahan, Bertakis, Azari et al, 1997;
Stoppe, Sandholzer, Huppertzet al, 1999).
However, no gender difference in the detection of depression and anxiety disorders by
doctors was found in the multi country WHO study of psychological problems in
general health care (Gater et al, 1998).
• It has been reported that women are 48% more likely than men to use any
psychotropic medication after statistically controlling for demographics, health
status, economic status and diagnosis (Simoni-Wastila, 2000).
• Gender differences exist in patterns of help seeking for psychological disorder.
Funding, organization and insurance
• To reduce gender disparities in health care in relation to the disorders in which
women predominate, requires that barriers to accessing care are lowered and patient
preferences are heeded.
• Women's overrepresentation amongst those living in poverty, means that cost will be
a significant barrier to mental health care.
• 'user pays' system
• medical insurance status can significantly predict access to speciality care.
• One US study reported that those with insurance were six times more likely to have
access to care than those without (McAlpine & Mechanic, 2000).
Violence and severe mental illness
• Violence-related mental health problems are poorly identified, victimization histories are
not routinely taken and women are reluctant to disclose a history of violent victimization
unless physicians ask about it directly (Mazza & Dennerstein, 1996).
GENDER AND RISK
‘no society treats its women as well as its men’. Women constitute more than 70% of the world’s
poor (UNDP 1995) and carry the triple burden of productive, reproductive and caring work.
Even in developed countries, lone mothers with children are the largest group of people living in
poverty (Belle 1990)
GENDER ROLES
• Gender socialization, which stresses passivity, submission and lower rank, are not
only reinforced for women by their structural position in paid employment but by
their much larger contribution to unpaid domestic and caring work in the home.
• Not surprisingly, gender differences in rates of depression are strongly age related .
❑ Three to four fold increases in rates of depression and anxiety in large community
samples amongst those exposed to violence compared with those not exposed (Mullen
et al. 1998; Saunders et al. 1993).
❑ Severity and duration of violence predicts severity and number of adverse
psychological outcomes, even when other potentially significant factors have been
statistically controlled in data analysis. This has been found in studies on the mental
health impact of domestic violence (Campbell & Lewandowski, 1997; Roberts et al.
1998) and childhood sexual abuse (Mullen et al., 1993).
❑Marked reductions in the level of depression and anxiety once women stop
experiencing violence and feel safe (Campbell et al., 1996) compared with increases
in depression and anxiety when violence continues (Sutherland et al., 1998).
CONCLUSION
To address gender disparities in mental health requires action at many levels. In
particular, national mental health policies must be developed that are based on an
explicit analysis of gender disparities in risk and outcome.
rights framework needs to be adopted to improve the ethical and interpretative
dimensions of research, mental health care practice and policy.
References
• “GENDER DISPARITIES IN MENTAL HEALTH “ WORLD HEALTH
ORGANIZATION
• Pomerants, A. M. (2008) Clinical Psycholgy: Science, practice and culture,
New Delhi: Sage publications
