Women Hold Up Half the Sky

Mental health disorders affect women and men differently--some disorders are more common in women, and some express themselves with different symptoms. Scientists are only now beginning to tease apart the contribution of various biological and psychosocial factors to mental health and mental illness in both women and men.

In addition, researchers are currently studying the special problems of treatment for serious mental illness during pregnancy and the postpartum period. Research on women's health has grown substantially in the last 20 years. Today's studies are helping to clarify the risk and protective factors for mental disorders in women and to improve women's mental health treatment outcome.

Depressive Disorders

In the U.S., nearly twice as many women (12.0 percent) as men (6.6 percent) are affected by a depressive disorder each year. These figures translate to 12.4 million women and 6.4 million men. Depressive disorders include major depression, dysthymic disorder (a less severe but more chronic form of depression), and bipolar disorder (manic-depressive illness). Major depression is the leading cause of disease burden among females ages 5 and older worldwide.

Depressive disorders raise the risk for suicide. Although men are 4 times more likely than women to die by suicide, women report attempting suicide about 2 to 3 times as often as men. Self-inflicted injury, including suicide, ranks 9th out of the 10 leading causes of disease burden for females ages 5 and older worldwide.

Research shows that before adolescence and late in life, females and males experience depression at about the same frequency. Because the gender difference in depression is not seen until after puberty and decreases after menopause, scientists hypothesize that hormonal factors are involved in women's greater vulnerability. Stress due to psychosocial factors, such as multiple roles in the home and at work and the increased likelihood of women to be poor, at risk for violence and abuse, and raising children alone, also plays a role in the development of depression.

While many women report some history of premenstrual mood changes and physical symptoms, an estimated 3 to 4 percent suffer severe symptoms that significantly interfere with work and social functioning. This impairing form of premenstrual syndrome, also called Premenstrual Dysphoric Disorder (PMDD), appears to be an abnormal response to normal hormone changes. Researchers are studying what makes some women susceptible to PMDD, including differences in hormone sensitivity, history of other mood disorders, and individual differences in the function of brain chemical messenger systems. Antidepressant medications known to work via serotonin circuits are effective in relieving the premenstrual symptoms. Women with susceptibility to depression may be more vulnerable to the mood-shifting effects of hormones.

Postpartum depression is a serious disorder where the hormonal changes following childbirth combined with psychosocial stresses such as sleep deprivation may disable some women with an apparent underlying vulnerability. National Institute of Mental Health (NIMH) research is evaluating the use of antidepressant medication and psychosocial interventions following delivery to prevent postpartum depression in women with a history of this disorder.

NIMH researchers recently found that women who suffer depression as they enter the early stages of menopause (perimenopause) may find estrogen to be an alternative to traditional antidepressants. The efficacy of the female hormone was comparable to that usually reported with antidepressants in the first controlled study of its direct effects on mood in perimenopausal women meeting standardized criteria for depression.

Anxiety Disorders

Anxiety disorders, which include panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), phobias, and generalized anxiety disorder, affect an estimated 13.3 percent of Americans ages 18 to 54 in a given year, or about 19.1 million adults in this age group. Women outnumber men in each illness category except for OCD and social phobia, in which both sexes have an equal likelihood of being affected.

Results from an NIMH-supported survey showed that female risk of developing PTSD following trauma is twice that of males. PTSD is characterized by persistent symptoms of fear that occur after experiencing events such as rape or other criminal assault, war, child abuse, natural disasters, or serious accidents. Nightmares, flashbacks, numbing of emotions, depression and feeling angry, irritable, or distracted and being easily startled are common. Females also are more likely to develop long-term PTSD than males and have higher rates of co-occurring medical and psychiatric problems than males with the disorder.

Eating Disorders

Females comprise the vast majority of people with an eating disorder—anorexia nervosa, bulimia nervosa, or binge-eating disorder. In their lifetime, an estimated 0.5 to 3.7 percent of females suffer from anorexia and an estimated 1.1 to 4.2 percent suffer from bulimia. An estimated 2 to 5 percent experience binge-eating disorder in a 6-month period. Eating disorders are not due to a failure of will or behavior; rather, they are real, treatable illnesses. In addition, eating disorders often co-occur with depression, substance abuse, and anxiety disorders, and also cause serious physical health problems. Eating disorders call for a comprehensive treatment plan involving medical care and monitoring, psychotherapy, nutritional counseling, and medication management. Studies are investigating the causes of eating disorders and effectiveness of treatments.

Schizophrenia

Schizophrenia is the most chronic and disabling of the mental disorders, affecting about 1 percent of women and men worldwide. In the U.S., an estimated 2.2 million adults ages 18 and older, about half of them women, have schizophrenia. The illness typically appears earlier in men, usually in their late teens or early 20s, than in women, who are generally affected in their 20’s or early 30’s. In addition, women may have more depressive symptoms, paranoia, and auditory hallucinations than men and tend to respond better to typical antipsychotic medications. A significant proportion of women with schizophrenia experience increased symptoms during pregnancy and postpartum.

Alzheimer’s Disease

The main risk factor for developing Alzheimer's disease (AD), a brain disorder that leads to the loss of mental and physical functioning and eventually to death, is increased age. Studies have shown that while the number of new cases of AD is similar in older adult women and men, the total number of existing cases is somewhat higher among women. Possible explanations include the possibility that AD may progress more slowly in women than in men; that women with AD may survive longer than men with AD; and that men, in general, do not live as long as women and die of other causes before AD has a chance to develop. Research is being conducted to find ways to prevent the onset of AD and to slow its progression.

Caregivers of a person with AD are usually family members—often wives and daughters. The chronic stress often associated with the caregiving role can contribute to mental health problems; indeed, caregivers are much more likely to suffer from depression than the average person. Since women in general are at greater risk for depression than men, female caregivers of people with AD may be particularly vulnerable to depression.

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