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When it comes to mental health and suffering in silence, women continue to face challenges and it is imperative to end this culture because gender is increasingly becoming a critical determinant of mental health and mental illness. Unfortunately, this response has been perpetuated by centuries of sexism and a disregard for womankind. A gendered approach to health means distinguishing biological and social factors while exploring their interactions and being sensitive to how gender inequality affects health outcomes.
The legacy of harmful attitudes towards women’s mental health — from the stigmas and falsehoods that surrounded it in the past to the challenges that still keep many women from speaking out today — continues to impact how mental health conditions present depending on gender. NIMHANS Director Dr Pratima Murthy shares some insights on the gender gap in mental health.
Mental health disorders affect people of all genders, but are there similarities and differences in how each gender struggles with anxiety and depression?
Gender definitely is one of the critical elements of mental health as well as mental illness both from a biological and physiological perspective. “Unlike in other parts of the world, it is young women in India who are at greatest risk of suicide and that’s why it also brings in not just the biological element but the social milieu and the fact that women perhaps in terms of their roles, responsibilities, and gender inequity, face a lot of stress.
They also have to bear the burden of distress, domestic violence, child-rearing or balancing work outside and inside the house which posts huge amounts of interpersonal conflicts and stress upon women. There also tends to be a greater victimisation of women and they are very patriarchal and therefore construed as being responsible for most situations gone awry (a typical example being rape) which renders a gendered perspective to mental health.
Is there more stigma of mental health illness in women?
While seeking help, women tend to hesitate due to the stigma and even if they do approach a specialist, they are not accompanied by their male family members but the same is not the case when a man suffers from a mental health issue. This influences both the presentation to services, getting the treatment, as well as overcoming the situation.
Even a lack of equal opportunities add to an imbalance in mental health. During the pandemic, a study was conducted to check how adolescents were faring and we realised that when all classes went online, a lot of girls in families which had limited gadgets were less likely to have access to those gadgets and could not attend online classes which became a source of distress. Even though we have a lot of pro-enabling educational policies, we find that girls tend to drop out of school earlier than boys.
Are internalising disorders more common in males or females?
Young girls have two kinds of disadvantages — that of being adolescents and having problems related to adolescence which is irrespective of gender but there is also the gendered element which creates a problem and young people end up using substances to handle their stress as a way of establishing some degree of equality. There is a greater preoccupation with body image among younger women that adds to stress levels in this age group. We do see cases where self-harm and suicidality have been a concern among young people.
With young women, responsibilities of family and children, as well as work, can be hugely burdensome and very often, not having confiding relationships and stressful marital relations can add another layer of causing problems and that’s why we find that anxiety and depression are indeed more common among young women. Further, biological strains in the reproductive age group can cause problems due to hormonal changes and emotional difficulties.
It’s not just the presence of stress but the absence of support that determines whether a person is able to adeptly manage their situations. One must not look at only the negative aspects as, in a more equitable world, women are having many more opportunities and when they are nurtured and confident, one can see that they are able to do very well.
In older adult women who were traditionally in the roles of homemakers, managing interpersonal stress and nurturing the family are sources of a gendered kind of stress. Women who are at home do not have enough recreational avenues apart from the TV which in some cases can get them stuck watching regressive content that reflects all the stresses of society. Older women also face lifestyle-related issues like obesity and hypertension due to lack of exercise and sometimes also because of the recreational use of alcohol or sleeping pills that contributes to their mental health getting affected. For the elderly, loneliness is another factor that plays a key role in their overall health. The traditional understanding is that women tend to have more internalising problems and men tend to have more externalising problems. The externalising problems may be in terms of impulsivity or the immediate gratification of desire speeding the use of substances, and violence. Women are also more anxious, feel more lonely and withdrawn and even deliberate self-harm. Due to such gender imbalances in society, in some parts of the world, girls initiate substance use earlier than boys and even violence among women is on the rise. This kind of very clear difference between internalising and externalising disorders is starting to blur. We’re also starting to see that women are more likely to present with atypical reverse vegetative symptoms such as increased appetite, and weight gain, to some conditions like anorexia nervosa which is more common among women because again, women traditionally are more concerned about their body image.
How can we make mental health a priority?
Everyone needs to make it a priority and it’s particularly important to women because of the social constructs that make them more vulnerable at different times. There’s something called a cohort effect that some of these problems with successive generations start to occur earlier and earlier so it’s possibly also to do with how soon you become independent, how soon you kind of individuate in terms of your family, how soon you’re exposed to various kinds of things that you have to deal with that makes younger people become more vulnerable to all these influences. It’s very important to deal with stigma and improve what we call mental illiteracy.
There’s also a need to sensitise all healthcare professionals to recognise mental health problems as it is not inseparable from physical diseases. While we’ve come a long way from the unacceptable mental health approaches of the past, it’s important to recognise the legacy of harmful attitudes towards women’s mental health — from the stigmas and falsehoods that surrounded it in the past to the challenges that still keep many women from speaking out today.