The Winter 2015 edition of the CRG newsletter focused on women’s mental health. This issue is meant to continue the dialogue on that issue, focusing on how females respond to stress and the impact on individual and family functioning when females are experiencing difficult times and situations. While both males and females experience stress and mental health conditions, the presentation and prevalence of conditions is very different. Consider these statistics from the American Psychiatric Association (https://www.psychiatry.org), the National Institute of Mental Health (http://www.nimh.nih.gov/health/topics/women-and-mental-health/index.shtml), the National Institute of Health (www.nih.gov) and the National Center for Post-Traumatic Stress Disorder (www.ptsd.va.gov):
- Depressive disorders account for almost 42% of psychiatric conditions in women while they account for only 29% of psychiatric conditions in men.
- Older women experience depression more often than older men.
- Adolescent females are at increased risk of depression compared to males. In 2014, 11.3% of teenagers reported a major depressive episode. However, the rate of a major depressive in females was even higher – 17.3%.
- Women are 70% more likely to experience depression over the course of their lives than men.
- Lifetime incidence of anxiety disorders is 1.5 to 2 times higher in women than in men. This rate of increase in anxiety is similar in those with Generalized Anxiety Disorder, Agoraphobia, Specific Phobias, Panic Disorder, and PTSD. While women have slightly higher rates of Social Anxiety Disorder, the difference in the two sexes is not as significant as in other disorders.
- There is no significant difference in the age of onset in anxiety between males and females and the median age of onset of symptoms of anxiety is 6 years.
- Despite the fact that women are 1/3 less likely to report having experienced trauma, women are twice as likely to meet criteria for Post-Traumatic Stress Disorder (PTSD) than men and are four times more likely to experience chronic PTSD. This gender difference in PTSD is found across the different causes of PTSD (non-sexual violence, sexual trauma, loss, disaster, accidents, etc.).
- The rate of anxiety in women is relatively consistent across racial categories.
- Autoimmune diseases are strongly linked to stress and adverse childhood events. Current estimates indicate 80% of individuals with autoimmune diseases are female.
- Women with lifetime anxiety disorders are more likely to have diagnoses of other anxiety disorders, Bulimia Nervosa and Major Depressive Disorder while men with lifetime anxiety are more likely to have comorbid diagnoses of ADHD, Intermittent Explosive Disorder, and substance abuse disorders.
- Those with anxiety disorders (both male and female) are more likely to seek both traditional medical intervention and mental health intervention
- Youth with anxiety disorders have been shown to be the most responsive to psychological treatment.
These differences are likely due to a combination of factors including our genetic make-ups, the role of hormones, and cultural expectations and roles.
The statistics reported above reflect a number of issues. First, females are more likely to internalize stress. Second, the age of onset of anxiety disorders are similar for both males and females but the trajectory and chronicity of anxiety for women is greater than for men. Third, females are more likely than males to be impacted by traumatic events and to have long-term physical health and mental health conditions as a result. And finally, those with anxiety (males and females) are more likely to seek medical and mental health treatment.
Despite the increased likelihood that females will experience more stress, anxiety and depression, the quality of the marital relationship is strongly linked to the wife’s ability to down-regulate her negative emotions. We have all heard it said that, “If mama ain’t happy, nobody’s happy.” It has been long thought that emotional regulation plays an important role in satisfactory interpersonal relationships. Recent research has investigated the relationship between emotional regulation and marital satisfaction. A study published online in Emotion (November 4, 2013) focused on the role of downregulation of negative emotion and marital satisfaction. The results revealed that the greater the down-regulation of the wives’ negative emotion and behavior, the greater was the marital satisfaction for both husbands and wives. The use of constructive communication by wives, in the face of negative emotion, appeared to be a mediating factor. While research could not be found to support this claim, it only seems reasonable that the ability to down-regulate emotion has a positive impact on overall family functioning.
Risk factors for both anxiety and depression include family history of these disorders, lifetime experiences including major life changes, trauma, loss, being female and medical health. The good news is that effective treatment is available. Treatment options include psychotherapy (such as cognitive-behavioral therapy), stress management, social supports and group therapy, medication and combinations of these treatments. It is also important to remember the following self-care considerations:
- Stay connected with others
- Keep active and exercise
- Develop a healthy eating and sleeping routine
- Set realistic goals
- Pursue activities that bring you joy and satisfaction
Bloch, L., Haase, C. M., & Levenson, R.W. (2014). Emotion regulation predicts marital satisfaction: More
than a wives’ tale. Emotion, 14(1), 130-144.
Merikangas, K.R. et al. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from
the national comorbidity survey replication-adolescent supplement (NCS-A). Journal of American Academy of Child & Adolescent Psychiatry, 49(10), 980-989.
Weisz, J.R. et al. (2017). What five decades of research tells us about the effects of youth psychological
therapy: A multilevel meta-analysis and implications for science and practice. American Psychologist, 72(2), 79-117.