Men, women and mental health Flashcards
What is gender according to the World Health Organisation (2017)?
A sociocultural construct
How is gender linked to mental health?
Gender can affect:
- Development and manifestation of mental illness
- Detection and measurement of mental illness
- Wether somebody receives adequate care
What is the consequence of the effects of gender on the measurement of mental illness?
Affects our understanding of the epidemiology of a condition
AND cross-country variation in the prevalence of mental disorders
What is the implication of the effect of gender on wether somebody receives adequate care?
Need to design equitable, acceptable and effective services
Which mental disorders have an equal male/female prevalence?
- OCD
- Schizophrenia
- Bipolar disorder
Which mental disorders are more prevalent in men than women?
Alcohol dependence (3-4 : 1)
Which mental disorders are more prevalent in women than men?
- Depression
- Panic disorder
What are DALYs?
Disability Adjusted Life Years:
= years of life lost + years lived with the disease
-> characterises disease burden
What did Whiteford and colleagues (2013) show on the effect of age and sex on DALYs for all mental and substance use disorders in 2010?
At nearly all age points, women have a higher burden of mental ill-health than men
- except in boys under age 10, largely due to child behavioural disorders
What is the association between country income status and the prevalence of depression in men and women (Rai et al., 2013)?
- Prevalence of depression in men stays roughly constant across low, middle and high-income countries
- Prevalence of depression in women is much higher in high-income countries
(female to male ratio for depression = 1.5 : 1 up to 2.3 : 1 in high-income countries)
Why does the idea that “women are too busy” not explain why fewer women are depressed in low-income countries?
- Little evidence for this
- Depression is constantly more common in less affluent populations
Why is the stress of the modern urban world unlikely to explain why fewer women are depressed in low-income countries?
Rural people have high suicide rates
-> people in low-income countries tend to have much higher exposure to stressors triggering depression, particularly in women
What would explain why fewer women are depressed in low-income countries?
- Possible protective role of culture (evidence of cultural risk factors needed)
- Probably due to measurement
What are the psychological explanations to why women get depressed more than men?
> Response style theory
> Western men are more likely to seek distraction from problems
> Negative cognitive schemas (Beck, 1979)
- higher in average in women
What are the social explanations to why women get depressed more than men?
> Stressors
- e.g. 3 children under five, lack of confidence, lack of paid employment
> Roles
> Expectations
- “grown men don’t cry” vs. women expected to cry
> Labelling
What are the four established risk factors for depression and other mental health problems women in LMICs are more likely to be exposed to?
- Poverty
- Low education
- Intimate partner violence
- Health risks related to reproduction
What is the problem of standard measures of postnatal depression?
They lack validity in rural women who have a low educational level
- there’s no difference between depressed vs. non-depressed women
-> misclassification
What did the meta-analysis of Fisher and colleagues (2012) show on the symptoms and risk factors of depression in LMICs?
> Levels of significant depressive symptoms in LMICs are higher than in high-income countries
> Risk factors: poverty, intimate partner violence, low education, unplanned pregnancy, poor social support, obstetric complications, previous stillbirth, gender preference
What is the evidence for culture’s role in the prevalence of postnatal depression in LMICs (Patel et al., 2012)?
Birth of girl baby is an effect modifier for other risk factors for postnatal depression
What would explain the culture’s role in the prevalence of postnatal depression in LMICs?
In India and many other cultures: strong societal preference for a women to give birth to boy baby, especially if woman does not already have a male child
What is the basis of the idea of ‘culture-bound’ depression in LMICs?
Childbirth rituals remain intact in traditional societies and can protect women during childbirth by facilitating her transition into role of mother
- traditional perinatal practices
What is the evidence of ‘culture-bound’ depression in LMICs (Hanlon et al., 2010b)?
> Stronger endorsement of traidiotnal perinatal practices was protective against persistence of depression from pregnancy into postnatal period
> Women who did not carry out practices that they endorsed had an increased risk of postnatal depression
-> may reflect high levels of traditional practices being protective in the community
How could perinatal depression affect child’s health?
Perinatal depression
-> difficulty with maintaining hygiene, following health advice, seeking help on time
-> child illness and undernutrition
What is the impact of perinatal depression on a child?
- Undernutrition
- Birth weight
- Cognitive development
- Mortality
- Child emotional and behavioural problems
- Accidents
- Illness episodes
What is the implication of the adverse effects of perinatal depression on children’s health for interventions?
Interventions for perinatal mental health problems also need to mitigate these adverse effects on the child
What is the gender basis of differing mental health service needs?
> Depressed men are more lily to be irritable than depressed
> Men have less contact with health facilities, but more contact with the criminal justice system
> Men are less likely to frame mental health difficulties as a health problem
- depressed men are less likely to seek help
> Substance use is more of a factor
How can we increase coverage for mental healthcare in men?
> Engage with other agencies
- go to where men are: police, emergency departments, prisons, community structures for arbitration
> Combine mental health interventions with livelihood interventions
- more likely to motivate men
> Take family approach
> Tackle causes as well as consequences
> Raise awareness and increase acceptability of treatments
-> provide role models
Why should interventions for women in LMICs be carried out during the antenatal period?
- Antenatal period is when women are most likely to be in contact with health service
- Postnatal period is a challenge due to confinement after childbirth
What are the limiting factors of interventions for women in LMICs?
> Low autonomy undermines help-seeking
> Medications have low acceptability in perinatal (postnatal) period
> Psychosocial interventions often not available
> Essential drug list recommendations are problematic: teratogenicity in breast milk
What is teratogenicity?
Any significant change in the formation or form of a child after prenatal treatment
What was the ‘Thinking Healthy’ programme (Rahman et al., 2008)?
CBT-based intervention for depressed perinatal women in Pakistan
- mother and child-focused approach (mother focus only not accepted)
- CBT delivered by community health workers, who visited the women at their home
- Analysis after 6 months
- Analysis after 1 year
What did the ‘Thinking Healthy’ programme (Rahman et al., 2008) result in?
- Reduced perinatal depression
- Reduced child illness and increased vaccination coverage
