One in three Americans struggles with a mental illness, but the rate is much higher in women. Research suggests that women are about 40% more likely than men to develop depression. They're twice as likely to develop PTSD, with about 10% of women developing the condition after a traumatic event, compared to just 4% of men. It's easy to write off this epidemic of mental illness among women as the result of hormonal issues and genetic gender differences, or even to argue that women are simply more “emotional” than men. The truth, though, is that psychiatrists aren't really sure why mental illness is more common among women, and teasing out the specific factors that play a role in this challenge isn't easy. So far, doctors have pointed to a number of possibilities.
Discrimination, Trauma, and Stressful Life Experiences
Trauma is common among women, with half of all women experiencing some form of trauma during their lives. One in four women have faced an attempted or completed sexual assault, and one in three report being abused by a domestic partner. Trauma is a risk factor for a host of mental illnesses, most notably post-traumatic stress disorder. Thus the challenges of gender discrimination, gendered violence, and mistreatment of women directly work to undermine women's mental health.
Some women report receiving inadequate or insensitive care in response to trauma, and research suggests this can also play a role in the development of mental illness. For example, some women report being blamed for their own rape or abuse. Others find that street harassment, violence on television, and similar cultural issues compound their pain after a traumatic event.
Sadly, discrimination can increase women's exposure to stress, and stress is a significant predictor of mental illness. Research has consistently shown that women do more than their fair share of housework and childcare, even when they work full-time. Women also report having to work harder to get the same credit as men, and many women worry about an ongoing gender wage gap, as well as workplaces where sexual harassment and discrimination are commonplace. Each of these common challenges are highly stressful, and can conspire to tear down women's coping skills and self-esteem.
It's a common misconception that estrogen is a “female” hormone while testosterone is the “male” hormone. Both men and women have each hormone in their bloodstreams, but in different quantities based on age, health, and an assortment of other factors. Some research suggests that hormonal differences between men and women may play a role in mental illness. Women, for example, tend to produce lower quantities of serotonin than men, possibly due to differences in hormone levels. Serotonin deficiency has been implicated in a host of mental health issues, most notably depression and anxiety.
The physiological changes women face during pregnancy and childbirth truly cannot be overstated. As many as 41% of women suffer from some form of postpartum depression, suggesting that physiological shifts likely play a significant role in mental illness.
The connection isn't just physiological, though. Cultural factors are also at play. Some women are overwhelmed by the demands of parenting, particularly in the early days. Research has shown that women who have unsupportive partners, traumatic births, who live in poverty, or who face high levels of stress are significantly more likely to develop postpartum depression. This suggests that the challenges commonly faced by women may directly contribute to postpartum mental health issues.
Differences in Reporting
Most people are quite certain that women are more emotional than men, even though research into this issue is anything but clear. What we do know is that men are often socialized not to share their emotions, and to view emotional challenges as a form of weakness. It's likely, then, that men are less likely to seek mental health care than women—a decision that makes women more likely to receive a diagnosis. One in four women will seek treatment for depression at some point, compared to only one in 10 men. Though it's certainly possible that this difference is entirely accounted for by innate gender differences, it's much more likely that at least some of the discrepancy can be explained by reporting differences.
Differences in Diagnosis
Research has consistently shown that doctors are more likely to diagnose women with mental illness than they are to apply the same diagnosis to men. Many factors contribute to this challenge. There's some evidence that men's mental health symptoms may not fit standard diagnostic criteria. For some men, anger is the result of depression, even though anger is not listed as a diagnostic criteria for depression. Thus a man complaining about anger might not receive a diagnosis, even when his anger conceals other symptoms that make it clear he has depression.
Because doctors are aware that mental illness is more common among women, they may also be more eager to diagnose mental illness. A man who reports intense sadness might be asked about his lifestyle or told to see how he feels in two weeks. A woman is more likely to be told she's depressed.
There's a more disheartening side to this as well. Implicit bias is a sort of bias of which a person is not aware. Some research suggests that doctors have an implicit bias in favor of labeling women's symptoms as emotional, while taking men's symptoms more seriously. Thus a woman who reports chronic pain to her doctor might be labeled as depressed. A man might be referred to a physical therapist or pain clinic. Of course, doctors aren't deliberately doing this, and are not even necessarily misdiagnosing their patients. In a world where gender discrimination—and notions that women are more emotional and less rational—still figure prominently, though, these notions can play a role.
Research changes on a dime, and we may one day find a “smoking gun” explaining why women have higher rates of reported mental illness. For now, though, it looks like a number of factors interact in complex ways to make women more vulnerable to mental illness.
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