Women Hold Up Half the Sky
Mental illnesses affect women and men differently. Some
disorders are more common in women, and some express themselves
with different symptoms. Scientists are only now beginning to
tease apart the contribution of various biological and
psychosocial factors to mental health and mental illness in both
women and men. In addition, researchers are currently studying
the special problems of treatment for serious mental illness
during pregnancy and the postpartum period. Research on women's
health has grown substantially in the last 20 years. Today's
studies are helping to clarify the risk and protective factors
for mental disorders in women and to improve women's mental
health treatment outcome. Depressive Disorders In the U.S.,
nearly twice as many women (12.0 percent) as men (6.6 percent)
are affected by a depressive disorder each year.1 These figures
translate to 12.4 million women and 6.4 million men. Depressive
disorders include major depression, dysthymic disorder (a less
severe but more chronic form of depression), and bipolar
disorder (manic-depressive illness). Major depression is the
leading cause of disease burden among females ages 5 and older
worldwide. Depressive disorders raise the risk for suicide.
Although men are four times more likely than women to die by
suicide, women report attempting suicide about two to three
times as often as men. Self-inflicted injury, including suicide,
ranks 9th out of the 10 leading causes of disease burden for
females ages 5 and older worldwide. Research shows that before
adolescence and late in life, females and males experience
depression at about the same frequency. Because the gender
difference in depression is not seen until after puberty and
decreases after menopause, scientists hypothesize that hormonal
factors are involved in women's greater vulnerability. Stress
due to psychosocial factors, such as multiple roles in the home
and at work and the increased likelihood of women to be poor, at
risk for violence and abuse, and raising children alone, also
plays a role in the development of depression. While many women
report some history of premenstrual mood changes and physical
symptoms, an estimated 3 to 4 percent suffer severe symptoms
that significantly interfere with work and social functioning.
This impairing form of premenstrual syndrome, also called
Premenstrual Dysphoric Disorder (PMDD), appears to be an
abnormal response to normal hormone changes. Researchers are
studying what makes some women susceptible to PMDD, including
differences in hormone sensitivity, history of other mood
disorders, and individual differences in the function of brain
chemical messenger systems. Antidepressant medications known to
work via serotonin circuits are effective in relieving the
premenstrual symptoms. Women with susceptibility to depression
may be more vulnerable to the mood-shifting effects of hormones.
Postpartum depression is a serious disorder where the hormonal
changes following childbirth combined with psychosocial stresses
such as sleep deprivation may disable some women with an
apparent underlying vulnerability. NIMH research is evaluating
the use of antidepressant medication and psychosocial
interventions following delivery to prevent postpartum
depression in women with a history of this disorder. NIMH
researchers recently found that women who suffer depression as
they enter the early stages of menopause (perimenopause) may
find estrogen to be an alternative to traditional
antidepressants. The efficacy of the female hormone was
comparable to that usually reported with antidepressants in the
first controlled study of its direct effects on mood in
perimenopausal women meeting standardized criteria for
depression. Anxiety Disorders Anxiety disorders, which include
panic disorder, obsessive-compulsive disorder (OCD),
post-traumatic stress disorder (PTSD), phobias, and generalized
anxiety disorder, affect an estimated 13.3 percent of Americans
ages 18 to 54 in a given year, or about 19.1 million adults in
this age group. Women outnumber men in each illness category
except for OCD and social phobia, in which both sexes have an
equal likelihood of being affected. Results from an
NIMH-supported survey showed that female risk of developing PTSD
following trauma is twice that of males. PTSD is characterized
by persistent symptoms of fear that occur after experiencing
events such as rape or other criminal assault, war, child abuse,
natural disasters, or serious accidents. Nightmares, flashbacks,
numbing of emotions, depression and feeling angry, irritable, or
distracted and being easily startled are common. Females also
are more likely to develop long-term PTSD than males and have
higher rates of co-occurring medical and psychiatric problems
than males with the disorder. Eating Disorders Females comprise
the vast majority of people with an eating disorder?anorexia
nervosa, bulimia nervosa, or binge-eating disorder. In their
lifetime, an estimated 0.5 to 3.7 percent of females suffer from
anorexia and an estimated 1.1 to 4.2 percent suffer from
bulimia. An estimated 2 to 5 percent experience binge-eating
disorder in a 6-month period. Eating disorders are not due to a
failure of will or behavior; rather, they are real, treatable
illnesses. In addition, eating disorders often co-occur with
depression, substance abuse, and anxiety disorders, and also
cause serious physical health problems. Eating disorders call
for a comprehensive treatment plan involving medical care and
monitoring, psychotherapy, nutritional counseling, and
medication management. Studies are investigating the causes of
eating disorders and effectiveness of treatments. Schizophrenia
Schizophrenia is the most chronic and disabling of the mental
disorders, affecting about 1 percent of women and men worldwide.
In the U.S., an estimated 2.2 million adults ages 18 and older,
about half of them women, have schizophrenia. The illness
typically appears earlier in men, usually in their late teens or
early 20s, than in women, who are generally affected in their
20s or early 30s. In addition, women may have more depressive
symptoms, paranoia, and auditory hallucinations than men and
tend to respond better to typical antipsychotic medications. A
significant proportion of women with schizophrenia experience
increased symptoms during pregnancy and postpartum. Alzheimer's
Disease The main risk factor for developing Alzheimer's disease
(AD), a dementing brain disorder that leads to the loss of
mental and physical functioning and eventually to death, is
increased age. Studies have shown that while the number of new
cases of AD is similar in older adult women and men, the total
number of existing cases is somewhat higher among women.
Possible explanations include that AD may progress more slowly
in women than in men; that women with AD may survive longer than
men with AD; and that men, in general, do not live as long as
women and die of other causes before AD has a chance to develop.
Research is being conducted to find ways to prevent the onset of
AD and to slow its progression. Caregivers of a person with AD
are usually family members. Often wives and daughters. The
chronic stress often associated with the care-giving role can
contribute to mental health problems; indeed, caregivers are
much more likely to suffer from depression than the average
person is. Since women in general are at greater risk for
depression than men are, female caregivers of people with AD may
be particularly vulnerable to depression.