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by Lucy McCarraher & Annabel Shaw


International Women's Day; Women's Mental Health

“Women are drawers of water, hewers of wood, labourers, preparers of food, bearers of children, educators, healthcare providers, producers, and decision-makers. Although they are central to caring for families and communities, to production and reproduction, they are accorded unequal status. Throughout the world they are overworked and undervalued. Their subordination makes it more difficult for them to cope with the demands made upon them whether of a physical, social or emotional nature. Woman are more vulnerable than men to sex exploitation and violence, to poverty and malnutrition, to environmental degradation, to chronic diseases which are often exacerbated by pregnancy and lactation, and to the debilitating effects of harmful traditional practices.”

This was the opening of the Preface to the World Health Organisation’s 1993 report into Psychosocial and Mental Health Aspects of Women’s Health. 18 years later, the same still holds, though there is a growing understanding of these issues and more work being done to attempt to right the inequalities.

It is quite clear, though, that "gender 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. Gender differences occur particularly in the rates of common mental disorders - depression, anxiety and somatic complaints. These disorders, in which women predominate, affect approximately 1 in 3 people in the community and constitute a serious public health problem." (World Health Organisation)

MIND’s factsheet on Women and Mental Health gives us the following statistics about women’s mental health in the UK, taken from a variety of sources: 
  • ·     Recorded rates of anxiety and depression are one and a half to two times higher in women than in men.
  • ·     One study showed that 57% of those attending emergency departments for self-harm were women.
  • ·     13 to 15% of new mothers experience postnatal depression.
  • ·     Women in custody have a high level of psychological disturbance – 78%, compared with 15% in women in the general adult female population.
  • ·     Nearly two-thirds of women on remand have a diagnosis of depression. More than 40% have attempted suicide before entering prison. More than twice as many have an eating disorder compared with women in the general population.
  • ·     One in four women will experience intimate partner (domestic) violence (IPV) in their lifetime. Depression affects nearly half of women exposed to IPV, and post-traumatic stress disorder (PTSD) affects almost two-thirds.
  • ·     90% of the 1.6 million people in the UK who have an eating disorder are female.
 Another WHO report demonstrates the international and cross-cultural phenomenon of women’s vulnerability to depression, anxiety, psychological distress, sexual violence, domestic violence and escalating rates of substance use, which affect women to a greater extent than men across different countries and different settings. “Pressures created by their multiple roles, gender discrimination and associated factors of poverty, hunger, malnutrition, overwork, domestic violence and sexual abuse, combine to account for women's poor mental health. There is a positive relationship between the frequency and severity of such 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 predict depression.”

Williams and Miller report that “Gender inequality in society leads to differences in the life experiences of men and women, which affect mental health in different ways. Gender inequality is described as a system that tends to give more advantages to men in terms of employment, status and ownership. Women are much more often expected to look after others in the home or in society, often doing work that is undervalued and unpaid or poorly paid.”
The Geneva report of the WHO agrees that “Some risk factors for mental health problems affect women more often than men. These include gender-based violence, social and economic disadvantage, low income and income inequality, low or subordinate social status and rank, and major responsibility for the care of others.”

For some women, family life may contribute to mental distress. Many women have primary or sole care of children, and women are more likely than men to take on caring responsibilities (e.g. for older family members). Women also tend to work in part-time jobs, and are over-represented in low paid occupations and sectors such as teaching and care work. Williams finds that the low social status traditionally associated with domestic and caring work can damage feelings of self-worth, while the stresses of overwork, extensive responsibilities and feeling undervalued can damage women’s mental health. While the extent of gender-based disadvantages varies according to social class and ethnicity, it has been argued that women bear the brunt of reconciling paid work with family life.

Research also shows that there are three main factors which are highly protective against the development of mental problems, and especially depression. These are:
  • having sufficient autonomy to exercise some control in response to severe events.
  • access to some material resources that allow the possibility of making choices in the face of severe events.
  • psychological support from family, friends, or health providers
Women around the world are less likely than men to have the first two, but hopefully number among their armory against mental health problems the support of family and friends.

And Pilgrim has found that women in the UK receive more services than men for mental health problems at the level of primary care, though this difference is less at the level of secondary care (specialist and hospital treatment). It is difficult to know whether more mental health problems are diagnosed in women at primary care level because they seek help more often than men, or because they actually experience more distress.
Either way, women's place in society the world over - their central role as carers of young and old,  their lower economic status and perceived value compared to men, their difficulties in balancing working and domestic life and their greater vulnerability to violence - negatively affects their mental health outcomes. This is mitigated by supportive relationships with friends and family and a willingness to seek help for problems - but it is not enough. Greater equality for women will bring improved mental health: a number leading charities brought together by Annie Lennox are working towards it under the banner of We Are Equals.

Posted by Lucy

More at:
Williams, J. and Miller J., 2008, ‘Gender inequality and the mental health of women and men’, in T. Stickley and T. Bassett (eds) Learning about mental health practice. Chichester, Wiley: 381–400.
Astbury, J., 2001, Gender disparities in mental health. Mental health. Ministerial Round Tables 2001, 54th World Health Assembly. Geneva, World Health Organisation
Pilgrim, D., 2010, ‘Mind the gender gap: mental health in a post-feminist context’ in: Kohen, D (ed) Oxford textbook of women and mental health. Oxford University Press, Oxford

Perrons, D., 2009, Women and gender equity in employment, Institute for Employment Studies.  

Williams, J., 2005, ‘Women’s mental health’, in: Tew, J (ed), Social perspectives in mental health: developing social models to understand and work with mental distress, Jessica Kingsley Publishers, London
 Department of Health, 2002, Women’s mental health: into the mainstream, DH, London

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