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Social factors that affect women’s mental health;
Far more women than men use primary care services for mental health problems, and one reason suggested is that women are more likely to report symptoms of common mental health problems. Rates of undiagnosed depression could be equally high in men, but evidence suggests that men are less likely to talk about their problems or consult a doctor about their mental health. By contrast, women are more likely to acknowledge their mental distress and to seek help.
Some mental disorders, such as depression, are more common among those living in poverty. Women are more likely to be poor because their jobs are likely to be lower paid, they are more likely to work part-time, to take time out of the labour market to bring up children, to be lone parents, and, because of their different working history, likely to receive a lower pension. This goes a long way to explain why rates of depression are higher in women.
Trauma, violence and abuse in childhood or adulthood
Up to 13 per cent of children experience sexual abuse, physical abuse, neglect, or disruption such as being in care, with slightly higher figures for girls than boys. One in four adult women experience IPV (domestic violence). IPV is defined as any incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults who are (or who have been) intimate partners or family members, regardless of gender or sexuality. This includes so-called ‘honour killings’ that are of concern in black and minority ethnic (BME) communities.
Women are much more likely than men to experience repeated and severe forms of IPV, although this is not always evident in statistical summaries such as Home Office studies, which may focus on single incidents rather than on repeated abuse. Women are also more likely to experience sexual abuse and violence, and their experience is more likely to have a long-lasting psychological/emotional impact or result in injury or death. In some cases, mental illness, such as schizophrenia, can increase the risk of IPV.
Experience of IPV can lead to feelings of guilt and shame, anxiety, depression, low self-esteem, lack of confidence, vulnerability to abusive relationships, inability to trust people, anger, sexual difficulties and self-hate. Women can also experience physical symptoms related to abuse, such as abdominal pain, insomnia and headaches. Further, these problems can lead to the diagnosis of a wide range of mental disorders, including PTSD, BPD, self-harm, suicide (or suicide attempts), multiple personality disorder, mania, bulimia, eating disorders and substance abuse.
Family and social roles
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. 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.
Women who are mothers, or who want to have children, can experience particular barriers to the use of mental health services. They may avoid disclosing their problems for fear of losing custody of their children, leave hospital sooner than they otherwise would, in order to look after children, or find themselves unable to use services because of childcare commitments.
Childhood and adolescent mental health difficulties are strongly correlated with mental health problems in adulthood. Problems that are more likely to be diagnosed in women than men, such as eating disorders, BPD and self-harm, often start in teenage years or early adulthood.
Teenage girls and young women are at high risk for traumatic experiences such as sexual abuse, rape and domestic violence. As discussed above (‘Trauma, violence and abuse in childhood or adulthood’), girls who experience sexual or physical abuse are more likely to develop mental health problems later in life.
Issues around old age are particularly relevant to women’s mental health.
- Because of their longer life expectancy, women make up the larger part of this demographic group. Among all older people, women are more likely than men to be diagnosed with a mental health problem.
- Higher rates of mental ill-health have been associated with the greater social and personal pressures that women often face in later life: isolation and poverty are more common in older women than in older men.
- Older women are less likely to have a company or personal pension, and are more likely to be reliant on state pensions.
- Older women are less likely to be drivers or to have access to a car.
- Bereavement, chronic physical illness and institutional care are also likely to impact upon older women’s mental health.
However, the higher rates of diagnosed mental health problems in older women may partly reflect the fact that women are, in general, more likely than men to acknowledge their distress and seek appropriate help.
Women in prison and secure psychiatric services
Women in prison often have complex problems. A high proportion have had adverse childhood experiences, problems at school and poor employment records. Rates of mental disorder and substance abuse are high, and being in prison can increase women’s problems, as they may be separated from their children and social networks, and they may be victimised. Women in prison experience higher rates of mental disorder than women in the community or men in prison, and rates are higher still for remand prisoners. Rates of self-harm and suicide are high among women in prison.
Women in secure psychiatric hospitals are in a minority, but women are proportionately more likely than men to be sent to such hospitals for criminal behaviour, or transferred from another hospital because of a behavioural disorder. They have had similar adverse experiences growing up to women in prison generally, though fewer are mothers. Self-harm and substance abuse are common among this group.
Women refugees and asylum seekers
Being a refugee or asylum seeker can be traumatic for both men and women, but particular experiences such as rape are more common among women. Women who are refugees or asylum seekers may arrive from traumatic situations to find themselves detained, which has been described as ‘retraumatisation’. They are physically examined, but are rarely asked if they are victims of torture; even if they are asked and the response is ‘yes’, often nothing is done.
Women in detention centres are almost inevitably depressed, having fled from their home countries, and having often been persecuted, tortured or raped, and are in fear of being deported back to the countries they have fled.
Race, ethnicity and mental health
Women from BME groups in the UK may experience the dual impact of gender inequality within their family or community setting, and alienation from mental health services. The high levels of suicide and self-harm among young south Asian women are indications of this.
Specific groups of BME women are heavily represented in psychiatric diagnoses and service use; Pakistani and Bangladeshi women have higher rates of depression than both their male counterparts and White British women. Higher rates of psychosis (including bipolar disorder and schizophrenia) are diagnosed among Black Caribbean women than among women from other groups. It is argued that this may be partly because racism within society is reflected by racial stereotyping within mental health services. Many mental health service users from BME groups are also living in poverty, which is an important social factor in mental distress.
Lesbian and bisexual women tend to have higher rates of suicide, attempted suicide and suicidal thoughts, depression, anxiety and substance use disorders than heterosexual women. Such mental health issue may of course be unconnected with their sexuality, but there is evidence that social hostility, stigma and discrimination are contributing factors.
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