The battle with mental illness has been ongoing in the United States but has become more prevalent in recent years. Much of this is due to the increased number of people suffering from a mental illness and the lack of funding and programs available to provide treatment. Nearly 1 in 5 (19%) of people in the United States have a mental illness with 1 in 24 (4.1%) suffering a severe mental illness (APA, 2019). There are many factors that contribute to the development of mental illness with our focus on the female gender and the different affects it has on women. Gender, according to the DSM-5, can influence illness in several ways including the risk of developing a disorder along with the prevalence and incidence rates for certain disorders. This paper will discuss the battle of mental illness in females and how we can and should provide adequate screening and treatments to turn mental illness into mental health.
Background of Mental Illness
Mental Illness is an umbrella term that encompasses a broad range of medical conditions marked by enough disorganization or personality, mine or emotions leading to impairment of normal psychological functioning (Merriam-Webster, 2019). Mental illness is typically associated with the disruption of normal thinking, feeling, mood, behavior, interpersonal interactions and daily functioning (Merriam-Webster, 2019). In Indiana alone based on the 2013 BRFSS, one-fifth of adults have been diagnosed by a healthcare professional with a depressive disorder with female reporting higher rates of mental illness (21.8%) compared to men (14.1%). (Fairbanks, 2016). Nationwide every year 1 in 5 women are diagnosed with a mental illness such as: depression, PTSD and anxiety (APA, 2017). Women have a higher rate of mental disabilities compared to men with the following examples:
- Anxiety Disorders- Women 36%, men 25%
- Panic disorders – women 6%, men 3%
- PTSD- Women 10%, men 4%
- Major Depression (The most common mental health problem in women)- Women 20%, men 13% (APA, 2017).
Unipolar depression is predicted to the second leading cause of global disability and twice as common in women by 2020 (World Health Organization, 2019). Depressive disorders causing disability from neuropsychiatric disorders account for 41.9% in women (World Health Organization, 2019).
Economic aspects of Women with Mental Illness
Financial turmoil, in general, has a negative effect on mental health associated with increased levels of anxiety, depression and psychological stress contributing to a higher mortality rate (Ruiz-Perez, Bermudez-Tamayo and Rodriguez-Barranco, 2017). Some economic barriers associated with mental health care for women include lack of insurance or cost (including premiums and copays) (APA, 2017). This barrier is the result of the gender biases offering women low income and income inequality as opposed to men (World Health Organization, 2019). Studies have shown that women earn less than men after adjustment for factors such as age, race, marital status, years of experience, specialty, reported work hours, research productivity, and faculty rank (Jena, Olenski and Blumenthal, 2016). According to a study by the APA (2017) women working full time earn approximately one-fourth less than their male counterparts each year. Another economic barrier includes the elevated poverty rate of women. For women aged 18-64, the poverty rate is 14.2% compared to men at 10.5% and for women greater than 65 years the poverty rate is 10.3% (APA,2017). With this poverty, low-economic status it’s hard to eat right. Studies have shown the role nutrient’s play in mental disorders (Senicato, Soares de Azevedo and Berti de Azevedo Barros, 2018). There has been a link between women malnourished with deficiency in zinc, magnesium and folic acid and depression/dysthymia as well as changes in memory and cognition (Senicato, Soares de Azevedo and Berti de Azevedo Barros, 2018).
Social Injustices and Health Disparities
Some health disparities that affect women to a greater extent include gender discrimination, poverty, hunger, malnutrition, overwork, domestic and sexual abuse (World Health Organization, 2019). Gender usually determines the “power and control” men and women have over socioeconomic determinants and their mental health, social position, status and treatment in society and exposure to specific mental health risk factors (World Health Organization, 2019). Gender discrimination and gender stereotyping places women at a “proneness to emotional problems” (World Health Organization, 2019). This stigma along with the lack of appropriate intervention strategies provided by the healthcare provider leads to a mass number of patients underdiagnosed (APA, 2017). Other gender inequalities that have led to the consequence of mental illness such as depression/anxiety and psychosocial conditions include the overload of domestic work (Senicato, Soares de Azevedo and Berti de Azevedo Barros, 2018).
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Sexual violence is a big social injustice and a health disparity for women leading to several mental illnesses. Women subject to sexual violence render the largest single group of people suffering from PTSD (World Health Organization, 2019). Physical/mental/emotional acts of violence against women are also a big factor for mental illness leading to depression (the main cause per the World Health Organization) and suicide 2.28 times higher compared to women who were not exposed to violence (Secato, Soares de Azevedo and Berti de Azevedo Barros, 2018). 1 in 3 women have been victims of some sort of sexual, physical violence or stalking by a partner (APA, 2017).
Again, gender is a big key with not only the symptoms a patient may come to a healthcare provider with but with the way a healthcare provider may perceive the patient. Gender bias is an issue with healthcare providers and occurs in the treatment of psychological disorders. Women are more likely to be diagnosed with depression compared to men even when their PHQ-9 scores are similar (World Health Organization, 2019). Studies have shown that the female gender alone is a significant predictor of being prescribed mood altering psychotropic drugs as primary treatment (World Health Organization, 2019).
Plan of treatment
As an Advance practice advocate for these patients it is important to learn and understand mental health and mental illness. It is also very important to be observant of each individual woman recognizing signs of possible domestic violence, sexual abuse and acute/chronic stress (APA, 2017). Also, promoting health policies that address women’s needs and concerns is a great steppingstone. There are 3 factors which can help protect against the development of mental problems such as:
- Allowing the patient to have enough autonomy to exercise control in response to critical or severe life events.
- Providing access to resources allowing the patient to make choices during a critical or high-tension situation.
- Assisting with the creation or a psychological support team be it family, friends or solely the healthcare provider (World Health Organization, 2019).
The best way to measure the progression of treatment is by assessment and tracking with the PHQ-9 questionnaire. There is no laboratory test that will state if the patient is improving. The best way to assess this is by the patient. By keeping a supportive and open relationship with the patient she will feel more comfortable opening and discussing how she has been feeling, is she in a safe relationship and how she has been managing her illness.
The gap between people suffering from mental illness and facilities available to provide needed help is astronomically inadequate for all people, however women are at a higher prevalence of mental illness due to a multitude of factors. Gender discrimination not only plays a big part in the creation of mental illness for many women due to wage inequality, work overload and lower societal acceptance but it plays a disadvantaged role in appropriately screening, diagnosing and treatment women with mental illness. Much of this has to do with the lack of knowledge and comfort on the part of the healthcare provider as well. Mental illness is underdiagnosed by physicians less than half of the time even for those who meet diagnostic criteria (World Health Organization, 2019). It’s important to keep an open ear and open mind when speaking with a female patient who may have symptoms of a mental illness. With some act of violence being the largest reason for depression in women it’s important to be an advocate and provide support and reassurance and strength to that patient. All forms of treatment should be offered to women to help assist with their mental illness. While medications can be helpful, they should not always be the “go to” treatment based on gender. Providing holistic care and support is what is needed for a successful outcome.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. (5th ed). Washington D.C. retrieved from. https://www.google.com/books/edition/Diagnostic_and_Statistical_Manual_of_Men/-JivBAAAQBAJ?hl=en&gbpv=1&printsec=frontcover
- American Psychiatric Association. (Dec. 19, 2017). Mental Health Disparities: Women’s Mental Health. Retrieved from: www.psychiatry.org
- American Psychiatric Association. (2019). What is Mental Illness? Retrieved from https://www.psychiatry.org/patients-families/what-is-mental-illness
- Fairbanks, R.M. (Feb. 2016). Behavioral Health Disparities in Indiana. Center for Health Policy. Retrieved from https://fsph.iupui.edu/doc/research-centers/Behavioral%20Health%20Disparities%20in%20Indiana%202016.pdf
- Jena, A.B., Olenski, A.R., Blumenthal, D.M. (Sept. 2016). Sex differences in physician salary in US public medical schools. 176 (9), 1294-1304. Doi:10.1001/jamainternmed.2016.3284
- Merriam Webster (2019). Mental Illness. Retrieved from: https://www.merriam-webster.com/dictionary/mental%20illness
- Ruiz-Perez, I., Bermudez-Tamayo, C., Rodriguez-Barranco, M. (March 2017). Socio-economic factors linked with mental health during the recession: a multilevel analysis. International Journal for Equity in Health. 16, 45. Doi:10.1186/s12939-017-0518-x
- Senicato, C., Soares de Azevedo, R.C., Berti de Azevedo Barros, M., (2018). Common mental disorders in adult women: Identifying the most vulnerable segments. Doi: 10.1590/1413-81232018238.13652016
- World Health Organization. (2019). Mental health: gender and women’s mental health. Retrieved from: www.who.int/mental_health/prevention/genderwomen/en/
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