Lecture 8 Gender Mental Health

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Mental Health & Social Policy: 

Mental Health & Social Policy Lecture 8: Gender & Mental health

Gender & Mental Health: Key differences: Women: 

Gender & Mental Health: Key differences: Women Women more likely to suffer from eating disorders (Gucciardi et al., 2004); Women more likely to attempt suicide (WHO, 2000; Kornstein and Clayton, 2002) Women are also more likely to receive a diagnosis of panic disorder, generalised anxiety disorder obsessive-compulsive disorder somatisation disorder & post-traumatic stress disorder (WHC, 2005) Women are more susceptible to depression, being affected by it at twice the rate of men (Kornstein and Wojcik, 2002; WHO, 2004). Women also more likely to experience two or more mental problems at the same time (WHO, 2001);

Gender & Mental Health: Key differences: Men: 

Gender & Mental Health: Key differences: Men Men are twice as likely to be affected by alcohol or drug abuse Three times more likely to be diagnosed with “antisocial personality disorder”, More likely to commit suicide (Prior, 1999; WHO, 2001). No differences in the rates of severe mental illnesses like schizophrenia and bipolar depression.

Suicide and gender: Male to female ratios : 

Suicide and gender: Male to female ratios

Pathways into care: 

Pathways into care Women are more likely to seek help from and disclose mental health problems to their primary health care physician Men are more likely to seek specialist mental health care and are the principal users of inpatient care. Men are also more likely than women to disclose problems with alcohol use to their health care provider

Gender differences in care : 

Gender differences in care 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. Women more likely to be prescribed mood altering psychotropic drugs. 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).

More difference: 

More difference Gender differences have been reported in age of onset of symptoms, frequency of psychotic symptoms, course of these disorders, social adjustment and long term outcome. The disability associated with mental illness falls most heavily on those who experience three or more comorbid disorders. Again, women predominate.

Schizophrenia & Gender: 

Schizophrenia & Gender Men typically had an earlier onset of symptoms than women and poorer premorbid psychosocial development and functioning (Piccinelli &Homen, 1997). Despite later onset, some studies report that women experience a higher frequency of hallucinations or more positive psychotic symptoms than men (Lindamer et al.1999). When schizophrenia coexists with homelessness, women experience higher rates of sexual and physical victimization, and more comorbid anxiety, depression and medical illness than men (Brunette & Drake, 1998)

Bipolar disorder: 

Bipolar disorder Women are more likely to develop the rapid cycling form of the illness, exhibit more comorbidity (Leibenluft,1997) Women have a greater likelihood of being hospitalized during the manic phase of the disorder (Hendrick, Altschuler, Gitlin et al. 2000).

Gender & Admissions 1965-2004: 

Gender & Admissions 1965-2004

Gender & Admissions Ireland (2002): 

Gender & Admissions Ireland (2002) Males accounted for more than half of all and first admissions (52% and 55% respectively). Male rates for all admissions were higher than the female group in the 20-44 age range and for the 75 and over age groups Females had a higher rate for groups in the 45-75 age range. Males had a higher rate of all admissions than females for most socio-economic groups with the exception of higher professionals, lower professionals, and non-manual workers (Daly and Walsh, 2003).

Diagnosis by Gender 2002: 

Diagnosis by Gender 2002

Gender & Diagnosis 1: 

Gender & Diagnosis 1 The male rate for alcoholic disorders was considerably higher than that for the other disorders from 1972 to the late 1980s, with admission rates reaching a peak in 1978, at 398.9 per 100,000population. The male to female admission ratio for alcoholic disorders decreased from 6:1 in 1968 to 2:1 in 2002.

Gender & Diagnosis 2: 

Gender & Diagnosis 2 Rates of admission for female affective disorders have been consistently higher than those for males. In recent years the male rate has been increasing, from 221.6 in 1997 to 236.3 in 2002. Admission patterns for schizophrenia show males having a consistently higher rate of admission than females for the entire 37-year period.

Gender & Admissions 2004: 

Gender & Admissions 2004

Legal status & gender: 

Legal status & gender

Theories of gender difference in psychiatric illness: 

Theories of gender difference in psychiatric illness ‘Bodies’ ‘Personalities’ ‘Lives’

Bodies: 

Bodies Biological theories usually refer to the concept of hereditability and the role played by physiology in the origins and manifestations of mental illness. Cross-cultural variations found in rates of depression call into question explanations based on a purely biological model.

Personalities: 

Personalities Gender-specific socialisation and coping patterns (Nolen-Hoeksema, 1995; Busfield, 2002). Mental health differences represent a gendered expression of shared underlying emotional difficulties. Differences in the mental health of boys and girls start to appear at the onset of adolescence, when adult social roles are adopted to a greater extent (Kornstein and Wojcik, 2002). More boys are admitted to psychiatric children’s centres up to 13 years of age, but from age 13 to 17 girls predominate. More girls presented with “depressive disorder” (9 admissions for girls vs. 2 for boys), while two-thirds of boys were affected by “conduct disorder” (Daly and Walsh, 2003).

Lives: 

Lives Health linked to status in society (WHO, 1998). Female gender status is still a predictor of lower status, lower participation in decision-making and lower pay. Women are also more likely to be affected by physical and sexual abuse (WHO, 2001), Women are disadvantaged also by the multiple roles they perform in society as carers, partners and workers

Lives: 

Lives Higher work participation rates by women in Ireland without any significant shift in the demands posed by their traditional roles have been reflected in an increased rate of depression in married women, whereas rates for married men have decreased (Connolly 2003). Single parent families have more adverse repercussions on Irish mothers, who tend to have lower levels of psychological well-being than other parents (McKeown, Pratschke and Haase, 2003). The strain caused by multiple roles is even greater for lone mothers, as the absence of a co-parent to share even a part of the workload results in particularly stressful lives (Lasswell, 2002).

Slide22: 

“Women often do not receive appropriate mental health… services whether they are in hospitals, prisons, nursing homes, addiction programmes or community settings. Ineffective treatment is costly in terms of money expended and in the perpetuation of human suffering”. (Lubotsky Levin, Blanch and Jennings, 1998: xi)

Gender balance in provision: 

Gender balance in provision

Gender balance in provision: 

Gender balance in provision

Policy implications : 

Policy implications Insufficient attention in treatment and rehabilitation services has been given to women’s needs (for example: Goldicott, 1996; Mowbray et al., 1998). This situation is also mirrored by Irish studies (Batt and Nic Gabhainn, 2002). Blanch and Lubotsky Levin (1998) attribute the failure of mental health delivery to three factors: The patriarchal structure of mental health delivery systems; Their conceptual inability to integrate psychosocial factors into the medical model; The fragmentation of health and social services, leading to segregated and discontinued healthcare

Women’s Mental Health: an evidence based review Objectives (WHO, 2000): 

Women’s Mental Health: an evidence based review Objectives (WHO, 2000) To assist women to increase control over their lives, and especially to reduce any type of devaluation or discrimination of women’s status in society; To decrease women’s exposure to risk factors through education and legislation that will improve women’s material well being, status and available life choices; To involve women in decision-making, not just in health treatments but also in other aspects of their lives more broadly; To ensure that any treatment towards women’s mental health is obtained on the basis of informed consent and guarantees dignity and confidentiality; To strengthen social networks and communities to enable them to provide practical and emotional support; To preserve and strengthen social capital, as a public good, and reduce income inequalities