Women and Mental Health

The world is becoming more and more conscious of mental health issues. Yet women’s mental health is still underserved owing to the gender disparity. The psychological well-being of women is influenced by a variety of biological and social variables. Women have varied psychological needs from childhood to puberty to childbearing to menopause, however,  the necessary support is always lacking, which has increased the rates of mental distress among women. Women throughout their lifetime are predisposed to many stressors related to their social roles and biology. They bear the responsibility of childbirth along with being the primary caregiver of the whole family. In recent years, women’s primary roles have extended  beyond  taking care of their families to the professional workplace. Nonetheless, it is clear that these working women are disproportionately more prone to stress because as compared to their male counterparts as they juggle their personal and professional lives. Many of these disparities are the product of embedded inequalities affecting women’s socio-economic determinants of health. Gender-specific risk factors like gender-based violence, socio-economic disadvantage, low income and income inequality, low or subordinate social status, and rank and unremitting accountability for others’ care predisposes women to common mental disorders (WHO).

Women are more prone to internalising types of mental disorders like anxiety, depression and somatic disorders while on  the other hand men tend to have more externalising symptoms characterized by impulsivity, disruptive conduct and other addictive symptoms. In particular, gender differences occur in the rates of common mental disorders where females predominate (Shah & Ruchita, 2015). The unique and more complex biology of women have to be specially catered through medical sciences like gynaecology and obstetrics, whereas there is no special medical discipline for men. A woman’s body undergoes so many changes throughout her entire life like the onset of menarche, puberty, menstrual cycle, pregnancy, puerperium and menopause.  Many of these changes are linked to various hormones that cause biological stress, and if women don’t have strong enough social support, their vulnerability to mental health issues increases.(Chadda & Sood, 2010).  

According to WHO “Gender differences occur particularly in the rates of common mental disorders – depression, anxiety and somatic complaints. These disorders, in which women predominate, affect approximately 1 in 3 people in the community and constitute a serious public health problem.” According to many researches depression is more prevalent among women than in men with an estimation of unipolar depression sharing the second largest burden of global disability among women in the year 2020. Its effect permeates into one’s  social life, relationships with family, career, and the sense of self-worth and one’s purpose. 

Depression among women can be classified among women according to different reproductive stages during their lifetime:

Menstrual Cycle

Menstruation is still a taboo in many parts of the world. A lot of shame is attached to this biological process. Women in many countries find it difficult to manage during their periods and due to lack of safe and hygienic facilities adds to the burden. Hormones  influence the mood of a woman during her lifetime.Moods often define the quality of their life. Once a young woman begins to menstruate, she may start to experience mood-swings during the time of her period along with many emotional changes. Around seventy-five percent of women experience unpleasant physical or psychological problems before and during their periods. Many women experience symptoms like anger, depression, irritability, anxiety, sensitivity to rejection, sense of feeling overwhelmed, social withdrawal. Many women also suffer from Premenstrual Dysphoric Disorder which is akin to PMS, however women with  PMDD have more  symptoms, particularly psychiatric, lead to major distress that is sufficient to interfere with day-to-day activities and disrupt interpersonal relationships (Reid, 2017). About 5-8% of women thus suffer from severe premenstrual syndrome (PMS); most of these women also meet criteria for premenstrual dysphoric disorder (PMDD) (Yonkers et al, 2008). 

Pregnancy and Postpartum Period

Pregnancy is often associated with joy and expectations in the family, however, it is a major stressor among many women owing to different biological and social factors Pregnancy is the most crucial time of a woman’s life as in that period women become more vulnerable to anxiety and stress as women undergo both physiological and psychological during this period. About 20% of the women suffer from depression during the antenatal period but also increase the risk of postpartum depression (Bowen & Angela, 2006). According to a study done by Biaggi Et al. (2016). The prevalence of depression during the period of pregnancy ranges from 4-20%. Problems like forced sterilization, or not having consent to invasive procedures and examinations, denial of privacy during gynaecological examinations, lack of access to proper information about health related information or access to safe and affordable services add to their woos are some of the factors that are often ignored while considering their well-being and predispose women to depression. 

Also the prevalence of antenatal depression is quite high among women all over the world. “The most relevant factors associated with antenatal depression or anxiety were: lack of partner or of social support; history of abuse or of domestic violence; personal history of mental illness; unplanned or unwanted pregnancy; adverse events in life and high perceived stress; present/ past pregnancy complications; and pregnancy loss.” A study by Edwards et al (2006) highlighted that there was  a higher incidence of antenatal and postpartum depressive symptoms associated with young maternal age, primarily attributed to the prevalence of financial distress, unwanted pregnancy, and lack of a partner. A study by Bussel et al (2006) showed that depression and anxiety are common during pregnancy and postpartum and chances increase if there is a miscarriage. 

Use of Contraception and Mental Health

According to  clinical studies of depression and anxiety, deficiencies in mood-impacting neurotransmitters like serotonin, norepinephrine, dopamine, GABA, and peptides have been involved along with  genetic predisposition and psychosocial stressors tend to be important determinants of neurotransmitter deficiencies (National Institute of Mental Health). A study by Moller (1981) highlighted that use of oral pills contraceptives containing high dosage of synthetic estrogens and progesterone may interact with these mood related neurotransmitters. Women’s fears of certain conditions or events: fear of unintended pregnancy, for example, or not getting pregnant at all; fear of potentially debilitating side effects of contraception; trauma of abortion also play a crucial role in determining their mental health. 

Mental Health of Women in India

Being a woman and playing the diverse roles that modern society has to offer, has been a challenge that women globally have taken up well. A great deal of emphasis has been put on empowering women to play an equally important social, economic, political, cultural and individual role. In India, while many of the changes have been implemented in ink and made law, more needs to be done; there are few examples where lacunae remain: skewed sex ratio, abuse and sexual harassment of women, inequality at social and family level, in jobs, education and old age. Adjustment is expected out of women in many situations and these problems can act as stressors leading to poor mental health; alternatively, the preexisting mental health problems can be greatly magnified in women . Compared to males, the challenges faced by the female sex along with their psychological features have led to an increased occurrence of depression, anxiety disorders, and completed suicides (females > males, in India) in females. (Rao & Tandon, 2015). A case study  by Patel et al (2006) aimed at assessing gender disadvantage and reproductive health as major determinants of women’s mental health, found that anxiety disorder was as high as 64.8% among women and the factors that were indicative of the common mental disorder that got highlighted were gender disadvantage with domestic violence by husbands, being widowed or separated, reproductive health factors and financial difficulties. The psychosomatic symptoms are found to be more common in women especially Asian women. 

Due to numerous factors, such as urbanization, industrialization, increased level of education, knowledge of rights, and media power, the role of women in society has changed rapidly. More and more women tend to be working in some kind of job, so that they can contribute to their families financially. However, the attitude towards women, especially married women, and their position in the family has remained the same, as it is still considered their primary duty to take care of the family and children today. A married working woman is therefore overstrained by carrying out duties and obligations both at home and at work, leading to numerous psychological problems such as position conflict, job pressure, mental exhaustion, tension, anxiety, resentment, depression, anger, phobias, and other social and emotional distress. All of these issues may have an interactive effect on the emotional well-being of working people (Dhutra & Jogsan, 2002). A study by Panigrahi et al (2014) showed that about 32% of the working women in India were suffering from poor mental health conditions and only 10 % of women sought help. The study also highlighted social stigma around mental health issues in general. 

Both men and women have different psychological needs so different infrastructure to cater to them. Very few people receive medical attention for mental illness. In most of the cases, mental disorders among women go undetected and untreated. 

The treatment of mental illness is comparatively more complex for women.They require a different approach and have to be carefully prescribed medicines, especially to pregnant women. However, there are only a few initiatives that have been taken up by the government to promote mental health especially for the women. The first initiative was commenced by the National Health Programme and District Mental health Program in 1982 to increase the mental health  coverage and maintain minimum standard of mental health care. During the 1970s and 1980’s many NGOs catering to mental health services especially in the area of substance abuse came up.  This was done through integrating the services with the primary health care system. Following this was a survey conducted by National Institute of Mental Health and Neurosciences, Bengaluru which gathered data on mental health. At the local level there is Mahila Mangal Dal which also works in the field of mental health of women.

References

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