Women Hold Up Half the Sky

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

tease 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. 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. Depressive disorders raise the risk for suicide.

Although men are four times more likely than women to die by

suicide, women report attempting suicide about two to three

times as often as men. Self-inflicted injury, including suicide,

ranks 9th out of the 10 leading causes of disease burden for

females ages 5 and older worldwide. Research shows that before

adolescence and late in life, females and males experience

depression at about the same frequency.



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. 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.



This impairing form of premenstrual syndrome, also called

Premenstrual Dysphoric Disorder (PMDD), appears to be an

abnormal response to normal hormone changes. 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.



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. 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. Women outnumber men in each illness category

except for OCD and social phobia, in which both sexes have an

equal likelihood of being affected. Results from an

NIMH-supported survey showed that female risk of developing PTSD

following trauma is twice that of males. 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. Eating Disorders Females comprise

the vast majority of people with an eating disorder?anorexia

nervosa, bulimia nervosa, or binge-eating disorder. 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. An estimated 2 to 5 percent experience binge-eating

disorder in a 6-month period. 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. Eating disorders call

for a comprehensive treatment plan involving medical care and

monitoring, psychotherapy, nutritional counseling, and

medication management.



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.

In the U.S., an estimated 2.2 million adults ages 18 and older,

about half of them women, have schizophrenia. 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. In addition, women may have more depressive

symptoms, paranoia, and auditory hallucinations than men and

tend to respond better to typical antipsychotic medications.



A

significant proportion of women with schizophrenia experience

increased symptoms during pregnancy and postpartum. 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. 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.

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. The

chronic stress often associated with the care-giving role can

contribute to mental health problems; indeed, caregivers are

much more likely to suffer from depression than the average

person is. Since women in general are at greater risk for

depression than men are, female caregivers of people with AD may

be particularly vulnerable to depression.