Women and Mental Health

One in three Americans struggles with a mental illness, but the rate is much higher in women. Why is that? Researchers suggest that women are about 40% more likely than men to suffer from depression. They're twice as likely to develop PTSD, with about 10% of women developing the disorder after a traumatic event, compared to only 4% of men. It's easy to shrug off this epidemic of mental illness among women as the result of hormonal issues and genetic gender differences. Some may even argue that women are simply more “emotional” than men. The truth, however, is that psychiatrists aren't really sure why mental illness is more common among women, and figuring out the specific factors that play a role in this challenge isn't so simple. So far, doctors have pointed to a number of possibilities.

Discrimination, trauma, and stressful life experiences

Trauma is common among women, with around half of all women experiencing some form of trauma during their lives. In fact, one in four women have faced an attempted or completed sexual assault, and one in three report being abused by a domestic partner. Trauma is a risk factor for an abundance of mental illnesses, most notably post-traumatic stress disorder. Thus the challenges of gender discrimination, gendered violence, and mistreatment of women directly work to undermine women's mental health.

Some women report receiving inadequate or insensitive care in response to trauma, and research suggests this can also play a role in the development of mental illness. For example, some women report being blamed for their own rape or abuse. Others find that street harassment, violence on television, and similar cultural issues compound their pain after a traumatic event.

Sadly, discrimination can increase women's exposure to stress, and stress is a significant contributor to mental illness. Research has consistently shown that women do more than their fair share of housework and childcare, even when they work full-time. Women also report having to work harder to get the same credit as men, and many women worry about an ongoing gender wage gap, as well as workplaces where sexual harassment and discrimination are present. Each of these challenges are highly stressful, and can conspire to tear down women's coping skills and self-esteem.

Hormonal issues

It's a common misconception that estrogen is a “female” hormone while testosterone is the “male” hormone. Both men and women have each hormone in their bodies, but in different quantities based on age, health, and various other factors. Some research suggests that hormonal differences between men and women may play a role in mental illness. Women, for example, tend to produce lower quantities of serotonin than men, possibly due to differences in hormone levels. Serotonin deficiency has been implicated in a host of mental health issues, most notably depression and anxiety.

Pregnancy, birth, and parenting

The physiological changes women face during pregnancy and childbirth truly cannot be overstated. As many as 41% of women suffer from some form of postpartum depression, suggesting that physiological shifts likely play a tremendous role in mental illness.

The connection isn't just physiological, though. Cultural factors are also at play. Some women are overwhelmed by the demands of parenting, particularly in the beginning. Research has shown that women who have unsupportive partners, traumatic births, who live in poverty, or who face high levels of stress are significantly more likely to develop postpartum depression. This suggests that the challenges commonly faced by women may directly contribute to postpartum mental health issues.

Differences in reporting

Most people are quite certain that women are more emotional than men, even though research into this issue is anything but clear. What we do know is that men are often socialized not to share their emotions, and to view emotional challenges as a form of weakness. It's likely, then, that men are less likely to seek mental health care than women—a decision that makes women more likely to receive a diagnosis. One in four women will seek treatment for depression at some point in their lives, compared to only one in 10 men. Though it's certainly possible that this difference is entirely accounted for by innate gender differences, it's much more likely that at least some of the discrepancy can be explained by reporting differences.

Differences in diagnosis

Research has continuously shown that doctors are more likely to diagnose women with mental illness than they are to apply the same diagnosis to men. Many factors contribute to this discrepancy. There's some evidence that men's mental health symptoms may not fit standard diagnostic criteria. For some men, anger is the result of depression, even though anger is not listed as a diagnostic criteria for depression. Thus, a man complaining about anger might not receive a diagnosis, even when his anger conceals other symptoms that make it clear he has depression.

Because doctors are aware that mental illness is more common among women, they may also be more eager to diagnose mental illness. A man who reports intense sadness might be asked about his lifestyle or told to see how he feels in two weeks. A woman is more likely to be told she's depressed.

There's a more unfortunate side to this as well. Implicit bias is a sort of bias of which a person is not aware. Some research suggests that doctors have an implicit bias in favor of labeling women's symptoms as emotional, while taking men's symptoms more seriously. Thus a woman who reports chronic pain to her doctor might be labeled as depressed or hormonal. A man might be referred to a physical therapist or pain clinic. Of course, doctors aren't deliberately doing this, and are not even necessarily misdiagnosing their patients. In a world where gender discrimination—and notions that women are more emotional and less rational—still figure prominently, though, these notions can play a role.

Research changes on a dime, and we may one day find that distinct reason explaining why women have higher rates of reported mental illness. For now, though, it looks like a number of factors intersect in complex ways to make women more vulnerable to mental health issues than men.

References:

1. Ball, J. (2013, May 22). Women 40% more likely than men to develop mental illness, study finds. Retrieved from http://www.theguardian.com%2Fsociety%2F2013%2Fmay%2F22%2Fwomen-men-menta...
2. Common mental health issues in women. (n.d.). Retrieved from http://www.everydayhealth.com/womens-health/mental-health-issues-in-wome...
3. Diagnosis of mental illness hinges on doctor as much as symptoms. (n.d.). Retrieved from http://behaviorhealth.org/diagnosis_of_mental_illness.htm
4. Gender and women's mental health. (n.d.). Retrieved from http://www.who.int/mental_health/prevention/genderwomen/en/
5. Mental health statistics: Men and women. (n.d.). Retrieved from http://www.mentalhealth.org.uk/help-information/mental-health-statistics...
6. Women, trauma and PTSD. (n.d.). Retrieved from http://www.ptsd.va.gov/public/PTSD-overview/women/women-trauma-and-ptsd.asp