The received view among professionals, summarised by the World Health Organisation, is that: “Overall rates of psychiatric disorder are almost identical for men and women.” But is this true? Is the risk of developing a mental illness truly equal for both sexes?
It seems that it isn’t. For our book The Stressed Sex, we analysed the best evidence currently available: twelve large-scale, national epidemiological surveys from the UK, US, Europe, Australia and New Zealand, South Africa and Chile. A remarkably consistent picture emerged: in any given year, women appear to experience higher overall rates of psychological disorder than men. In fact, the difference is typically as much as 20-40%.
Women tend to have higher rates of depression, panic disorder, phobias, insomnia, post-traumatic stress disorder, and eating disorders and men have higher rates of alcohol, drug, and anger problems, but these statistics don’t balance out. In the current environment, women are bearing the brunt of mental health problems.
But let’s be clear: even for problems that are more common in women – such as anxiety and depression – very significant numbers of men are also affected. Categorising mental health troubles as essentially a female problem is wide of the mark. Rates of mental health problems are too high in both genders.
So what do we know about the factors causing this imbalance? Why are women more susceptible to mental illness than men?
Well, it’s an under-researched area. In the case of certain disorders – depression, most notably – some useful work has been done on gender. For most conditions, however, we have little evidence for why men and women are affected differently.
Some would argue that the statistics simply reflect the fact that men aren’t willing to come clean about their psychological problems. There’s doubtless some truth in this. We know that men are less likely to visit a doctor for a physical ailment, for example. But virtually no research has been done on the issue. Not that it’s an easy phenomenon to study: how do you measure what men – or indeed women – are not telling you?
In the absence of reliable data, it’s just not possible to know how big a role male under-reporting plays. But there are plenty of other factors that may help explain the imbalance, meaning that under-reporting probably explains only a small proportion of the difference in the overall rates of psychological problem between men and women.
There are, for instance, some indications that biological and genetic influences may be involved. But – for now at least – the bulk of the evidence points toward the contribution of life events and social roles. Indeed the conditions to which women seem especially vulnerable (such as anxiety and depression) are those for which we know genetic factors are much less significant than environmental influences. Conditions with relatively high heritability – such as schizophrenia and bipolar disorder – tend to occur equally in men and women.
It’s certainly plausible that women experience higher levels of stress because of the demands of their social role – with that stress helping to trigger problems like anxiety, depression, eating disorders, and insomnia. Increasingly, women are expected to function as carer, homemaker, and breadwinner – all while being perfectly shaped and impeccably dressed. Given that domestic work is undervalued, and considering that women tend to be paid less, find it harder to advance in a career, have to juggle multiple roles, and are bombarded with images of apparent female “perfection”, it would be surprising if there weren’t some emotional cost.
These are the kind of pressures that can leave women feeling as if they’ve somehow failed; as if they don’t have what it takes to be successful; as if they’ve been left behind. Women may also be vulnerable because of the importance they learn to attach to social relationships. Such relationships can be a source of strength, of course. But to some extent we’re relying on other people for our happiness: a risky business.
Why does any of this matter? If mental illness is so prevalent among men and women alike, is it useful to highlight the issue of gender? Although much more research is needed, it does appear that what sex you happen to be can have a significant bearing on your mental health. And if that’s true, then by ignoring the influence of gender we deprive ourselves of the opportunity to change the situation for the better – and for both sexes.
The Stressed Sex: Uncovering the Truth about Men, Women, and Mental Health was published last month by Oxford University Press