Introduction
Gender and other social factors influence popular conceptions of mental health.
Overall, the prevalence rates of most mental health disorders are almost identical
for men and women; however, gender differences occur in the rates of the most
common mental disorders, particularly depression, anxiety, and somatic complaints,
which are more prevalent in women. Socially constructed differences between men
and women regarding role responsibilities, status, and power interact with
biological differences, creating variations in mental health problems,
help-seeking behavior, and the response of the mental health community.
The Double Standard
In 1970, Inge Broverman and her colleagues used an adjective checklist to
demonstrate that clinicians defined characteristics of mental health differently
based on the sex of the person being described. Mental health professionals were
asked to describe the characteristics of a healthy, mature, and socially competent
man, woman, or "adult person." A normal, healthy adult of unspecified gender was
described with similar adjectives as a healthy man, with adjectives such as
independent, adventurous, objective, and decisive. By contrast, a normal, healthy
woman was described as noncompetitive, passive, emotional, and
dependent—adjectives that the mental health professionals more readily ascribed to
"unhealthy" individuals.
These descriptions of mature, competent men and women revealed a double
standard concerning mental health. Stereotypical male behavior was shown to serve
as the norm to identify good mental health overall; however, many of the
characteristics viewed as positive in terms of mental health in general were seen
by these professionals as being negative in women. Consequently, if women
demonstrated the characteristics that these mental health professionals attributed
to healthy and socially competent women, they would be labeled abnormal (having
masculine traits). This study demonstrated that the behaviors and characteristics
judged by clinicians to reflect an ideal standard of mental health resembled the
characteristics and behaviors deemed to be healthy for men but not for women.
Broverman and her colleagues pioneered the study of sex role stereotypes and their
impact on mental health services for both men and women.
Diagnoses and Distribution Patterns
Research shows that some of the most common mental health disorders (such as
depression, anxiety, and anorexia
nervosa) are more prevalent in women. On the other hand,
mental health problems such as alcohol addiction, substance
abuse, and antisocial personality disorder are
more common in men. Other disorders that affect less than 2 percent of the world's
population (such as schizophrenia and borderline personality
disorder) are equally prevalent in both genders. Multiple
diagnoses, especially the presence of three or more conditions, are more common in
women than in men.
The rates of depression in surveys of both clinical patients and the general
population are higher in women than in men. More than twice as many women as men
report a major depressive
episode in any given year. The gender disparity in rates of depression
is one of the strongest findings in epidemiological psychiatry. Depression
persists longer in women, and women are more likely to relapse than men.
Depression rates vary by country. According to the World Health Organization,
depression is the leading cause of disease burden for women worldwide. Depressive
disorders account for approximately 41 percent of the disability from
neuropsychiatric disorders among women compared to 29 percent among men.
Furthermore, postpartum depression affects 10 to 15 percent of mothers
worldwide, presenting a significant public health problem for women and their
families. However, clinicians are more likely to diagnose women with depression
than men, even when men have similar scores on standardized measures of depression
or present identical symptoms, indicating an ongoing gender bias in the assessment
of mental health disorders.
Anxiety diagnoses, including panic disorder, posttraumatic stress
disorder, generalized anxiety disorder, and
phobias, are nearly twice as common among women than men.
The National Comorbidity Survey Replication surveyed the general population of the
United States and found that 23 percent of women reported suffering from an
anxiety disorder in the last twelve months compared to 14 percent of men. Social
anxiety disorder and obsessive-compulsive disorder, by
contrast, are equally prevalent in men and women. Generalized anxiety disorder
affects about 6.6 percent of women and 3.6 percent of men during their lives.
Anxiety disorders are also associated with a greater illness burden in women than
in men, indicating that anxiety disorders are not only more prevalent in women but
also tend to have a more severe impact. The lifetime prevalence rate of violence
against women ranges from 16 to 50 percent worldwide, and at least one in five
women suffer sexual assault or rape in their lifetimes; the psychological impact
of experiencing physical and sexual violence is thought to contribute to the
higher rates of anxiety disorders among women. Furthermore, women are more
frequently diagnosed with somatic symptom disorder, in which mental factors such
as stress cause debilitating physical symptoms.
Eating disorders, including anorexia and bulimia, are more
prevalent in women than in men. Women are more likely to evaluate their self-worth
in terms of appearance, largely due to sociocultural expectations that highly
value women's attractiveness. Furthermore, women report higher rates of
discrimination related to being overweight or obese than men.
Men are more likely than women to drink in public, to drink alone, and to
engage in episodic binge drinking. Men are more likely to
use alcohol to manage stress and are more likely than women to become dependent on
it. Twelve-month prevalence rates of alcohol abuse are nearly three times higher
among men than women. One in five men as compared with one in twelve women develop
an alcohol problem over the course of their lives.
Furthermore, men are more likely than women to abuse drugs other than alcohol;
however, rates of prescription drug abuse are nearly identical across genders.
About twice as many men as women report illicit drug use. Additionally, men and
women continue to use drugs for different reasons: men for thrill seeking and
pleasure, and women for self-medication of abuse or trauma.
Men are more likely than women to be diagnosed with neurodevelopmental
disorders such as autism spectrum disorder, intellectual
disability, and attention-deficit hyperactivity
disorder. About four times more men than women receive
diagnoses of autism spectrum disorder. However, women with autism tend to have
more severe symptoms and greater cognitive impairment than men with autism.
Although schizophrenia affects men and women equally, clinicians identify the
onset of symptoms in men with schizophrenia earlier (late teens or early twenties)
than in women with schizophrenia (late twenties or early thirties). In contrast to
autism, schizophrenia is typically more disabling in men, and symptoms more
commonly found in men are harder to treat.
Four times as many men as women die by suicide, even
though women attempt suicide at two to three times the rate at which men do. Most
successful suicides among both men and women are related to a diagnosed mental
disorder, typically depression or substance abuse.
Treatment Disparities
Overall, women are more likely than men to seek out and make use of mental
health services. Women are more likely to disclose mental health issues to general
practitioners, while men are more likely to ignore mental problems in their early
stages and prefer to deal with mental health specialists. Women are also more
likely than men to seek psychological help, particularly regarding anxiety and
depression. After admitting mental health problems, men and women are equally
likely to accept help, but women are overrepresented in mental health
statistics.
The problem lies in men’s reluctance to admit to mental health disorders and
professionals’ frequent failure to diagnose them in men. Professionals are less
likely to perceive men’s problems as psychological. Cultural patterns of male
stoicism and a reluctance to ask for help may cause lower diagnosis and treatment
rates in men.
More women than men use outpatient care; however, men are more likely than
women to be involuntarily committed. Apparently, many men wait to seek help until
a later stage of disease, when the symptoms are more severe and hospitalization
more necessary. However, women are almost twice as likely to be prescribed
psychotropic drugs, regardless of social class, physical health status, and type
of diagnosis, and most are prescribed by a general practitioner, internist,
obstetrician, or gynecologist.
Men’s mental health symptoms tend to be more severe and difficult to treat.
Onset of many mental disorders in women occurs at older ages than in men, and
consequently women may have a better established base of social skills and
cognitive functioning, allowing them to better cope with symptoms of the disorder
than younger men with the same diagnosis.
Explanations for Variations
Gender differences in patterns of diagnosis and treatment of mental illnesses
have been studied since at least the 1970s. Explanations for these differences
have been both biological and social.
Many scientists suggest that biology and reproductive functions may account for
gender differences in mental health. Different levels of hormones between men and
women are related to some diagnoses. Scientists know that estrogen reacts with
serotonin, a neurotransmitter associated with mood, and some studies suggest
estrogen may protect against schizophrenia. Biological reactions to stress in
general, and specifically biological changes associated with motherhood, help
explain higher levels of depression and anxiety in women. Though biological
factors, especially hormones, play a role in mental health, social class, cultural
values, and family relationships also significantly affect mental health.
Psychosocial theorists point to the fact that girls experience greater levels
of violence than boys do and that their responses to this violence lead to higher
rates of mental disorders in adult women. Child abuse creates long-term changes in
brain circuitry and thus increases the likelihood of anxiety disorders. Rates of
depression in adult women are three to four times higher for women exposed to
childhood violence than for those without this exposure. A particularly strong
connection between sexual abuse and posttraumatic stress disorder (PTSD) has been
established. The severity of and length of exposure to violence is positively
correlated with being diagnosed with a mental illness.
Sociocultural explanations focus on the dominance of a masculine model of
mental health. Definitions of normality are often based on culturally determined
gender roles. A social constructionist explanation of mental health differences by
gender focuses on how conceptions of proper male and female behavior and
characteristics are embedded into diagnostic categories of mental disorders.
Gender Stereotyping
Early socialization of children into gender-appropriate behavior may teach
girls to internalize distress and boys to act out. Consequently, when subjected to
stressors, women tend to experience depression and anxiety as internal responses,
whereas men tend to take more external action by abusing substances, engaging in
antisocial behavior, and committing suicide.
Worldwide, women’s social roles and positions in society may make them more
vulnerable than men to mental health disorders. Traditional gender roles for women
offer fewer personal choices and lower life satisfaction. Positive psychological
health is linked to a greater number and increased diversity of social roles. A
variety of roles gives an individual a stronger sense of identity, leading to
fewer mental health problems.
Furthermore, gender affects control of socioeconomic determinants of mental
health. Women’s greater exposure to poverty, combined with low social standing,
job insecurity, and housing uncertainties, leads to more chronic stressors and
increases the severity of mental health problems. Depression, anxiety, and somatic
symptoms are highly related to social status and responsibility for the care of
others.
The relationship between mental health and gender is complicated by issues of
class, age, race, and ethnicity. Gender differences in mental health have been
examined more in industrialized countries than in less developed countries, and
adult women and men have been studied more than children and adolescents. Although
the rates of most mental disorder diagnoses are similar for men and women, there
are definite patterns regarding the types of problems men and women experience.
Future research needs to consider gender discrepancies in more detail, and
professionals need to consider gender disparities in planning, implementing, and
evaluating mental health programs. Mental health professionals must be aware of
gender stereotypes in the diagnosis and treatment of mental disorders, as these
stereotypes can present a significant barrier to the accurate identification and
treatment of psychological disorders in both men and women.
Bibliography
Fine, Cordelia. Delusions of
Gender: How Our Minds, Society, and Neurosexism Create
Difference. New York: Norton, 2010. Print.
Freeman, Daniel, and Jason Freeman.
The Stressed Sex: Uncovering the Truth about Men, Women, and
Mental Health. Oxford: Oxford UP, 2013. Print.
Maclean, Alice, Kate Hunt, and Helen
Sweeting. “Symptoms of Mental Health Problems: Children’s and Adolescents’
Understandings and Implications for Gender Differences in Help Seeking.”
Children and Society 27.3 (2013): 161–73. Print.
McGeown, Sarah. Psychology of
Gender Differences. New York: Nova Science, 2012.
Print.
Narrow, William D.,
et al., eds. Age and Gender Considerations in Psychiatric
Diagnosis. Arlington: American Psychiatric Association, 2007.
Print.
National Institute
of Mental Health. “The Numbers Count: Mental Disorders in America.”
Washington: Author, 2007. Print.
Nydegger, Rudy.
“Gender and Mental Health: Incidence and Treatment Issues.” The
Psychology of Gender. Ed. Michele A. Paludi. Westport: Praeger,
2004. Print.
Prior, Pauline M.
Gender and Mental Health. New York: New York UP, 1999.
Print.
Sachs-Ericsson,
Natalie. “Gender, Social Roles, and Mental Health: An Epidemiological
Perspective.” Sex Roles: A Journal of Research 43.9/10
(2000): 605–28. Print.
No comments:
Post a Comment