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 tear 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. 2 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. 3
Depressive disorders raise the risk for suicide. Although men are 4
times
more likely than women to die by suicide, 4 women report attempting
suicide
about 2 to 3 times as often as men. 5 Self-inflicted injury, including
suicide, ranks 9th out of the 10 leading causes of disease burden for
females ages 5 and older worldwide. 3
Research shows that before adolescence and late in life, females and
males
experience depression at about the same frequency. 6,7 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. 8
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.9,10 This
impairing
form of premenstrual syndrome, also called Premenstrual Dysphoric
Disorder
(PMDD), appears to be an abnormal response to normal hormone changes.11
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.12,13
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. 14
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. 15 Women outnumber men in each illness category except for OCD
and
social phobia, in which both sexes have an equal likelihood of being
affected. 16,17
Results from an NIMH-supported survey showed that female risk of
developing
PTSD following trauma is twice that of males. 18 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. 19
Eating Disorders
Females comprise the vast majority of people with an eating
disorder-anorexia nervosa, bulimia nervosa, or binge-eating disorder.20
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.20 An
estimated 2 to 5 percent experience binge-eating disorder in a 6-month
period.21,22 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. 20 Eating disorders call
for a
comprehensive treatment plan involving medical care and monitoring,
psychotherapy, nutritional counseling, and medication management.20
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. 23 In the U.S., an
estimated 2.2 million adults ages 18 and older, about half of them
women,
have schizophrenia. 2 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. 13 In addition, women may have more
depressive
symptoms, paranoia, and auditory hallucinations than men and tend to
respond
better to typical antipsychotic medications. 24 A significant proportion
of
women with schizophrenia experience increased symptoms during pregnancy
and
postpartum. 25
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. 26 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. 26,27 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. 27 The chronic stress often associated with the caregiving
role
can contribute to mental health problems; indeed, caregivers are much
more
likely to suffer from depression than the average person. 28 Since women
in
general are at greater risk for depression than men, female caregivers
of
people with AD may be particularly vulnerable to depression.
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3 Murray CJL, Lopez AD, eds. The global burden of disease and injury
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