Mental health issues are not only significant to the individual, they also present a huge challenge to society, contributing significantly to the global burden of diseases and illnesses. They affect women and men differently. For example, women are known to put others before themselves, yet when it comes to their mental health, they tend to be able to seek out support.
There are some symptoms of mental conditions that are more common in women, such as anxiety and eating disorders, and the gender of the individual can determine the course of the illness. Yet, gender-based risks to mental health have often been overlooked, even neglected in areas such as education, research, clinical training, intervention, and health promotion.
Gender matters in mental health
The words “gender” and “sex” have often been used interchangeably. However, they are quite different – sex denotes characteristics which are biologically determined, while gender refers to how a particular culture perceives women and men and what is expected of them in the society.
Mental issues are a challenge for both women and men, but statistically speaking, women tend to develop psychological disorders at a higher rate than men. It is uncommon that biological background alone can result in how women are affected by and experience mental health issues differently from men. Rather, these problems are multifactorially determined by biological, psychological and social risk and protective factors.
As gender differences exist in every society, a gender approach to mental health can explore interactions, and differentiate biological factors from other factors in order to turn out appropriate responses and treatment from mental health services and improve mental health policies and decision-making processes by the government.
Overlooking gender-based differences or gender bias, however, can have consequences for all aspects of health. For example, women tend to have higher rates of depression, panic disorder, phobias and eating disorders despite showing similar symptoms or similar scores on measures as men. Men, on the other hand, have a higher rate of alcoholism, drug and anger issues. Yet in the current environment, women are bearing the brunt of mental health problems. These biases can reinforce social stigma and impede help-seeking behaviours resulting in delayed treatment.
With women having over 60 percent presence in the workforce participation rate in Singapore and at the same time as caregivers, their mental health is often closely intertwined with that of their children and parents. Their mental health therefore, has a significant impact not only on productivity, but also on society.
Determinants of mental disorders among women
Some research found that sex differences in the rates of common mental disorders such as depression and anxiety are biologically determined. Hormones, especially those associated with puberty, the menstrual cycle, pregnancy, and menopause, are thought to be responsible for rendering women innately more susceptible to poor mental health. It has also been argued that sex differences in the prevalence of depression and anxiety cannot be attributed to over-simplistic explanations using just biology. Further research has consistently shown that while certain individuals may be more sensitive to hormonal changes, depression and anxiety in women are not related to sex hormones alone.
Rather, gender is more relevant in determining the course of mental disorders, through interactions with family members, health services and healthcare professionals. Women are likely to experience greater symptom reduction for their disorders if their family members are also involved in the treatment and are more accepting of their mental health conditions.
In terms of psychological functioning, women tend to internalise problems of anxiety and depression. They more likely turn problematic feelings inwards with maladaptive strategies such as negative thinking, catastrophising, and excessive worrying. Men, on the other hand, are likely to develop alternative disorders in response to stress, such as exhibiting externalised problems such as substance abuse and antisocial behaviour, including aggression and violence.
Women are also more likely to deploy emotion-focused strategies such as expressing their feelings and seeking social support rather than problem-focused ones such as trying to control stressful situations, something that men do.
Such differences can be attributed to the way women and men are socialised and shaped within cultures, leading to stereotypes about what is normal in women and men. Men are more likely to express anger or other forms of acting out, whereas women have dysphoria in response to stress. Women’s propensity to worry is also likely to stem from the culture where girls and women are confined to passive roles, where there are significantly less developmental and educational opportunities for them to gain autonomy and mastery. This can be attributed to the rise of industrial capitalism in the 1800s when the workplace became separated from the home as middle-class men left home for work, and women stayed to care for the children.
Increasingly, women are expected to be carer, homemaker and sometimes even breadwinner, all the while looking beautiful, perfectly shaped and well-dressed. Given that domestic work is under-valued, it has been argued that many aspects of the lives of women make them particularly vulnerable to mental health.
According to the World Health Organization (WHO), gender norms restrict the rights, opportunities, and full development of all capacities among girls and women. It also found that discrimination, subordination and exploitation of girls and women result in their experiencing social suffering. More specifically, the lack of several factors including education, housing, family relationships, financial resources, access to healthcare, working conditions, recreation activities and community resources are important causes of the woman’s health issues. Women tend to hold lower socioeconomic positions and are therefore more likely to experience both absolute and relative poverty.
Exposure to violence is also significant. One of the most common violations of girls is sexual abuse, and research have found the detrimental impact of childhood sexual abuse on adult mental health, which is also fuelled by other risk factors including neglect, emotional and physical abuse. Such violence, perpetuated especially by an intimate partner, occurs in all societies, but issues such as gender stereotypes, role restrictions and the lack of women’s rights often exacerbate the problem. Research has found that women are more likely to suffer from psychological and sexual abuse in intimate relationships and this results in depression, anxiety, substance use and suicidal tendencies.
Women as caregivers often go unnoticed and unappreciated. They are more likely to have to care for people who are sick, frail, or disabled, which often requires round the clock care and this exerts a huge toll on their mental health as they face issues such as increased social isolation and reduced energy and confidence.
Improving women’s mental health
It is now agreed that reducing mental health issues among women cannot be focused solely on pharmacological and psychological therapies alone. Attention needs to be paid to understanding the social determinants as women continue to face numerous challenges such as unequal and limited life opportunities and inadequate resources. Thus, effective strategies need to be gender-specific in the area of mental health, and population-based prevention and early intervention. Women’s autonomy and mental health need to be protected and promoted through education, research and policies not just at the government level, but also at the organisational and community levels. They need to play a bigger role in advocating for fairer rights and opportunities. In today’s digitally connected world, the role of social media in raising awareness, reducing stigma and promoting mental health in relation to women’s mental health is crucial.
Chad Yip is a registered clinical psychologist who provides psychological assessment and treatment for children, adolescents and adults. He is the Head of Psychology at Neurowyzr Pte Ltd, a neuroscience company specialising in brain health. He is involved in clinical work, product development and research. He is committed to serve the ever-changing needs of the individual and society.