A Brief History of Women’s Mental Health

The first mention of a ‘sex-selective disorder’ dates back to ancient Egypt. The Egyptians believed that a moving or wandering uterus would migrate around the body, placing great amounts of pressure on different organs, which would result in serious health problems for women. They called it hysteria. Today, the condition is characterized by an expression of violence or extreme emotion that is out of the person’s control. In this article we will briefly explore mental health care in the United States, symptoms of mental health conditions among women and different gender responsive approaches to mental health issues. 

The late 1800’s brought advocacy for better living environments for those deemed mentally ill. Coupled with the psychoanalytical breakthroughs of Jung and Freud, it was a time of transformation in the recognition and treatment of mental health issues. In the U.S., this meant greater availability of opioid medications to the general public. Advertising campaigns frequently targeted women, branding drugs containing opioids as a ‘women’s friend’ or ‘mothers’ helpers’, they were also used to medicate irritable children and wailing babies. By the early 1900’s there were over 50,000 patent medicines that had opioids as an active ingredient. The availability of cheap opioid-based medications, lack of opportunities for women, and lack of information during the 50’s and 60’s culminated in a generation of American women addicted to opium derivatives.

Before we analyze the most serious mental health issues affecting women today, we must first define mental health. The World Health Organization in 2019 define it as ‘a state of well-being where an individual realizes his or her own abilities, can cope with the common stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.[1]’

Common Mental Health Issues as They Relate to Women

PTSD is an anxiety disorder caused by significant stressful or frightening events, known as trauma. Symptoms of the condition include insomnia, feelings of isolation, irritability and guilt. Women are twice as likely to experience PTSD compared to men, around 10-12% of women suffer from a lifetime prevalence to PTSD in comparison with only 5-6% in men[2]. PTSD currently affects over 4 million women in the U.S. According to a study carried out by the University of Amsterdam, women are far more susceptible to PTSD as a result of greater exposure to trauma, severity of trauma and exposure to trauma at a younger age[3].

Often intrinsically linked with PTSD is depression; greater exposure to trauma equals greater chance of developing depression. Compared to men, women experience more specific forms of depression-related illness including postmenopausal depression and premenstrual dysphoric depression. Both are heavily linked to changes in ovarian hormones. Such data highlights not only a greater probability of women experiencing depression but also calls attention to the biological catalysts. A global study in 2010 found rates of depression in women to be around 1.7% higher than in men, further evidencing this hypothesis[4].

Changes that women’s bodies go through as a result of puberty, natural growth and sexual maturity greatly influence the likelihood of substance abuse among women. Increased levels of testosterone found in young women have shown a greater propensity for them to commit high-risk behaviors. Such behaviors have been attributed to the physiological and emotional changes that young women’s bodies go through during puberty and subsequent natural growth. These biological changes are one factor that may cause women to engage in such high-risk behaviors, and as a result suffer to a far greater extent then their male counterparts. In a study conducted by the University of British Colombia, researchers found that women using intravenous drugs were 22 times likely to die from use of these drugs than males[5].

It would appear that, in general, women are more prone to experiencing mental health issues than men. Nowhere is this more evident than in rates of eating disorders among women. In the U.S. alone, 30 million people suffer from a form of eating disorder with 20 million of them being women. Anorexia Nervosa has been noted as the most common eating disorder affecting women, with 0.9% of women in the U.S. suffering from the condition in their lifetime. Recent research has suggested that the condition may be hereditary. Another sobering statistic is that 1 in every 5 deaths from Anorexia is suicide.

In a study carried out by Dr. Catherine Preston at the University of York, she discusses how eating disorders such as Anorexia have historically been thought to have a social origin, explaining that ‘social pressures differ for men and women, particularly in terms of the importance of physical appearance.[6]’ However, her study looks to further examine how women with eating disorders, particularly anorexia nervosa, have a negative, distorted conception of their own body, often experiencing them as larger than they actually are. ‘In today’s Western society, concerns regarding body size and negative feelings towards one’s body are all too common[7]’. Such feeling are only further compounded by societal pressures in a time where social media makes it impossible to escape societal conceptions of beauty. As a result of this women tend to pursue more self-destructive behaviors that either lead to, or exacerbate, eating disorders.

Similar to PTSD, anxiety disorders affect women twice as frequently as men. Over the years, there have been many studies looking at the different groups of people affected by anxiety disorders and trying to analyze which demographic is most affected and why. In 2016, researchers the University of Cambridge’s Institute of Public Health funded by the National Institute for Health Research (NIHR), decided to analyze all of the reviews on anxiety in order to synthesize the results. ‘Out of over 1,200 reviews, the researchers identified 48 reviews that matched their criteria for inclusion.[8]’ From these reviews, they found that 4 in every 100 people suffer from anxiety around the world. They also found that this number increased to 8 in every 100 in North America. Nausea, raised blood pressure and disrupted sleep were all noted in the study as common symptoms of anxiety. The study listed hormonal fluctuations and exposure to stress as the two most common causes of anxiety disorders. The study also stated that anxiety is noted as a common symptom in PTSD and depression.

According to the first author of the study, Olivia Remes from the Department of Public Health and Primary Care at the University of Cambridge: “Anxiety disorders can make life extremely difficult for some people and it is important for our health services to understand how common they are and which groups of people are at greatest risk. By collecting all these data together, we see that these disorders are common across all groups, but women and young people are disproportionately affected. Also, people who have a chronic health condition are at a particular risk, adding a double burden on their lives.”

In spite of the evidence demonstrating that women are more affected than men by many mental health disorders, the rate of suicide among women is actually lower than it is among men.  In the U.S., men are over three times more likely to die from suicide than women. 6 out of every 10 gun-owners in the US are men and half of all suicides are carried out by firearms. Women, on the other hand, had higher rates of depression, signalling a greater awareness of mental health issues compared with men, and that they are more akin to seeking help[9].

However, although suicide rates are lower amongst women, and we have more mental health diagnoses reported for women, we need to remember that women still experience higher levels of abuse, earn less money and, in 65% of cases, are also a primary caregiver to a child. It is due to these myriad factors that women are less likely to disclose any history of violent victimization and therefore, in some ways, are harder to reach and help. Of those who have come forward, we can be sure that there are many other women who can’t, or don’t dare.

Treatment

In order to effectively help both women and men suffering from mental health issues, effective gender-responsive screening is vital. A paper from the Women’s Health Research Centre stated that women are more likely to experience trauma at the hands of an intimate partner, known as IPV, whereas men are more likely to suffer trauma at the hands of a stranger from a stranger[10]. 1 out of every 3 women have experienced sexual, or physical violence at the hands of an intimate partner.

Because of these statistics, it is essential that mental health professionals who workwith women with mental health disorders are trauma-informed.

A trauma-informed approach to women, especially those suffering from substance abuse or mental health issues, is vital. Between 55%-99% of women suffer from co-occurring mental health or substance abuse issues have also suffered trauma at some point in their lives. Greater focus on individual treatment is vital in identifying high risk areas. There is an importance in contextualizing it to the environment that the specific individual lives in, such as reoccurring substance abuse or being placed back into a high risk environment. By breaking down all aspects of the individual’s life, future treatments will be able to understand the fundamentals of intervention which will in turn lead to more positive outcomes post-treatment. Recognizing that women come from different socio-economic backgrounds and the specific issues these bring with it provide a more effective support-based framework for recovery.

Individual Placement and Support schemes aim to assist those suffering from mental health issues to re-enter employment and begin to create stability in their lives. This empowerment of the individual is one of the five cornerstones of trauma informed intervention along with trust, safety, choice and collaboration. Gender-Responsive Recovery guidelines provide clear frameworks through which healthcare professionals can work. While recovering, it is essential that those receiving treatment feel empowered. This action aids in celebrating the strength and resiliency of these women while building further on these positive attributes. Differentiating between the two genders and the specific traumas they face is essential in facilitating recovery, while also endorsing a developmental perspective. As we have seen, the importance of effective treatment is vital in reducing instances of mental health issues among women.

Sources:

1. World Health Organisation. (2019) Mental Health. World Health Organisation. https://www.who.int/mental_health/management/en/ (Accessed on 10 November 2019)

2. Olff, Miranda. “Sex and gender differences in post-traumatic stress disorder: an update.” European Journal of Psychotraumatology vol. 8,sup4 1351204. 29 Sep. 2017, doi:10.1080/20008198.2017.1351204

3. ibid.

4. Albert, P. (2015). Why is depression more prevalent in women? Journal of Psychiatry and Nueroscience 40 (4) p.219-221

5. Spittal, P.M. et al. (2008) Drastic Elevations in mortality among female injection users in a Canadian Setting 18 (2) p.101-8

6. Catherine Preston, H. Henrik Ehrsson, Illusory Obesity Triggers Body Dissatisfaction Responses in the Insula and Anterior Cingulate Cortex, Cerebral Cortex, Volume 26, Issue 12, 1 December 2016, Pages 4450–4460, https://doi.org/10.1093/cercor/bhw313

7. Whiteman, H. (2016) Why are women more vulnerable to eating disorders? Brain study sheds light. Medical News Today https://www.medicalnewstoday.com/articles/313466.php#1 (Accessed on 12 November 2019.)

8. Remes, Olivia et al. “A systematic review of reviews on the prevalence of anxiety disorders in adult populations.” Brain and behavior vol. 6,7 e00497. 5 Jun. 2016, doi:10.1002/brb3.497

9. https://www.bbc.com/future/article/20190313-why-more-men-kill-themselves-than-women accessed 13/11/2019

10. Women’s Health Research Institute. (ANON). The Importance of Gender-Responsive Trauma-Informed care  https://www.womenshealth.northwestern.edu/blog/importance-gender-responsive-trauma-informed-care (Accessed on 13 November 2019)