Various pressures created by the multiple roles women need to fulfil; including gender discrimination, cultural norms and values, income inequality, low or subordinate social status, and associated factors of poverty, hunger, malnutrition, domestic violence, sexual abuse as well as substance abuse, collectively combine to account for women’s poor mental health globally, affecting them disproportionately.
There is also a positive relationship between the frequency and severity of the above-mentioned 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, for example, predict depression.
This is according to Dr Eileen Thomas, a psychiatrist affiliated with Akeso clinics and Panorama Healthcare.
She has a special interest in women’s mental health and is currently also a PhD student at University of Stellenbosch where she is examining biomarkers that predict risk of post-traumatic stress disorder and metabolic disease onset among female rape survivors in a South African cohort).
Extant literature furthermore points to the increase in common mental disorders among women globally, Dr Thomas adds.
“This may be due to many varying and confluent factors, inter alia, a greater awareness of mental disorders, increased accessibility of mental health care services that screen and diagnose these disorders, and the increasing prevalence of precipitating and perpetuating stressors such as violence, poverty, disparity in health services and stigma.”
Gender
“Gender is a critical determinant of mental health and mental illness. It 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,“ Dr Thomas explains.
This said, “the morbidity associated with mental illness has however received substantially more attention than the gender specific determinants and mechanisms that promote and protect mental health and foster resilience to stress and adversity,” she adds.
Differences
According to her the “overall rates of psychiatric disorder are almost identical for men and women, however striking gender differences are found in the patterns of mental illness. Gender differences occur particularly in the rates of common mental disorders such as depression, anxiety and somatic complaints.
“These disorders are more common in women. There are also certain types of depression that are unique to women. Some women may experience symptoms of mental disorders at times of hormone change, such as perinatal depression, premenstrual dysphoric disorder, and perimenopause-related depression.
Women with severe mental illness, including mood and psychotic disorders, appear to have elevated risks of being both victims and perpetrators of Intimate Partner Violence (IPV), with an estimated IPV rate of 10-30% in South Africa.
Current data suggest that South African rates of postpartum depression are also much higher than global estimates. A recent rural study in the Witzenberg area showed rates as high as 50% of participants suffering from postnatal depression, whilst studies in peri-urban areas indicate a prevalence of 30 – 40% she adds.
“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, but more research explaining the underlying is needed.
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.
“Gender differences also 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,” Dr Thomas points out.
Signs, symptoms
While mental disorders can affect women and men differently, in general the presentation (symptoms and signs) indicative of a mental health problems do not differ from those in males, she advises.
“Although each mental health problem may present with its own set of specific features, example excessive fear or worry, disrupted sleep, low mood, fatigue, changes in appetite or weight, irritability and thoughts of suicide- the key feature that defines whether someone is suffering from a mental health problem or not, is their ability to function in their usual social; and occupational roles,” Dr Thomas stresses.
Examples would be employed women who previously were very social, but then start to struggle at work due to lack of concentration or not meeting work-targets, or females who become withdrawn, not socialising with friends or family anymore.
Treatment
Occurring in different degrees of severity, milder forms of certain mental health problems can be managed and treated by a general practitioner, but ideally treatment should be sought from a mental health professional (a clinical psychologist or psychiatrist) who is well versed in treating the specific disorder, Dr Thomas points out.
“Treatment approaches are individualised and take into account the individual’s preferences, available medical funding, comorbid disorders and may include pharmacotherapy and/or psychotherapy. Other important components of treatment include exercise, support groups and general self-care (scheduling pleasurable activities, ensuring good nutrition and adequate rest),” she explains.
Recurring
Indeed, any mental disorder confers a vulnerability for future recurrent episodes of that specific or another mental health problem, Dr Thomas confirms.
“Specific to females, conditions such as post-partum depression are likely to recur in subsequent pregnancies and females who suffer from premenstrual dysphoric disorder are more likely to later experience other hormonally-related disorders such as peri-menopausal depression.
“This highlights the importance of early identification and adequate treatment of these conditions to ensure future mental health. Additionally, past personal or family mental health problems are important information to provide to your health care provider when experiencing changes in mood in key transitional periods, for example, the onset of menses, pregnancy and peri-menopausal period,” Dr Thomas concludes.
Tips for women to keep mentally fit and healthy throughout their life:
• Live your best life – you have only have one life to live, life it to the fullest;
• Be kind to yourself
• Ensure self-care: adequate rest, nutrition, and physical wellness (for example, adhere to chronic illness medication).
• Schedule pleasurable activities. All human beings need something to look forward to, meet a friend for coffee, phone your sibling, treat yourself to a movie.
• Exercise, and partake in physical activity that you enjoy, whether its Zumba dancing or playing with your kids in the park.
• Create a social support network, this may include friends, colleagues, family, church-members or join online support groups.
• Don’t keep secrets! Secrets make us ill.
And never feel ashamed to admit if you are not coping. If you are not okay, speak to someone – you are more likely to be experiencing something that many others have gone through already.
• Know your personal and family history of mental illness, as well as your general health history.
This informs health care providers of possible risk, vulnerability, and best treatment options.
