We must talk about women’s mental health across the lifespan, as many mental disorders impact women differently across different stages of life.
Mental health is one of today’s most critical and pressing issues; among that, the mental health of girls and women holds particular importance due to unique issues.
We need different approaches to understand the mental health of women. Many mental health related issues occur in all genders, impacting women differently. Also, some problems arise only in women.
Looking across the lifespan is a better approach to understanding women’s mental health.
Mental health is one of today’s most crucial and essential issues. Of which particular emphasis is to be given to the mental health of girls and women. Understanding woman mental health is complicated and needs many fold approach.
Many mental health issues in all genders impact women differently; also, many mental health-related disorders appear only in women at certain stages of life. A better approach to looking for mental health-related issues in women is looking at them across their lifespan.
To understand women’s mental health, we need to answer a few questions-
- The reason why mental health-related issues affect women and men differently
- How mental health conditions change across the life span of women.
- The aetiology, pathology, causes, symptoms and treatment of disorders affecting women only.
Mental health and its association with Sex and Gender
Sex and gender differences significantly affect mental health and mental illness. Though biological differences between men and women may impact mental health, societal differences between men and women can also influence the occurrence and development of mental health-related conditions.
The degree of power an individual enjoys is often determined by gender and is different for males and females. There are many hurdles and obstacles faced by women in terms of cultural, social, and economic determinants of mental health.
The exposure to adversities makes them vulnerable to mental health risks and disorders. Based on various research, significant differences exist between genders regarding the development of common mental health conditions; some diseases are more prevalent in women than men.
Health risks and disorders
Significant differences exist between genders regarding the development of common mental health conditions; some diseases are more prevalent in women than men.
While examining the mental health-related issues in women, it is crucial and of utmost importance to keep the social, cultural and economic differences in mind. It is also essential to detect the issues early, as earlier detection will lead to early intervention and a better prognosis.
Anxiety, Depression, & Eating Disorders
Most mental health-related disorders have their onset during adolescent age. The common Common conditions which appear during the period are anxiety disorders, depression, schizophrenia, OCD, and body image-related disorders like anorexia nervosa, bulimia nervosa, body dysmorphic disorder etc. These disorders either appear alone or coexist with other conditions.
One of the most common mental health-related disorders in women is Depression. The prevalence of depression among women is about 15-20%, and research studies strongly suggest that depression in women is twice more likely than in men.
Due to its high prevalence rate, it is essential to understand the symptoms, signs, diagnosis and treatment of depression in adolescent girls and young adult females.
- Persistent sadness in mood
- Failure to experience and derive pleasure in previously pleasurable activities. • Irritability and anger outbursts
- Rapid mood swings from happiness to despair to anger
- Significant disturbances in biological functions
- Changes in sleeping pattern with excessive or little/no sleep
- Changes in eating habits with excessive or little intake
- Reduced attention and concentration
- Falling academic performance and grades
- Self-injurious and suicidal thoughts and acts
Depression involves many genetic, biological, environmental and social factors. Many factors play a role in the onset and development of depression in adolescent girls, such as the experience of traumatic events, violence, and physical and sexual abuse. Other essential factors include family issues, weight-related issues, academic problems, bullying and shaming problems, problems with friends and peers etc.
Depression is also a significant reason for suicide and suicide attempt. Usually, women attempt suicide more than men; also, the means and modes vary, with men adopting more lethal ways to commit suicide.
It is crucial and essential to diagnose and treat depression as early as possible to prevent the long-term impact of illness on the brain and the growth and development of teens.
Anxiety disorders in Young Women
Anxiety disorders are the constellation of different disorders, with symptoms of anxiety as standard features of all the disorders. The group includes panic disorders, specific phobias, generalized anxiety disorders, and social and performance anxiety disorders. Anxiety disorders are a common mental health-related issue in adolescents and young females.
Anxiety disorders are usually more common in women than men. E.g. panic disorder, generalized and social anxiety disorder, and specific phobias are 2-3 times more likely in women than men.
The experience of anxiety is often overwhelming and has two components:
- The awareness of being frightened or nervous
- The physiological response of bodily sensations like palpitations, sweating, choking, shortness of breath etc.
Anxiety is an intense feeling of tension and worry. It is characterized by episodes of a feeling of restlessness, stress, tension, worries, fears, concerns, apprehensions, repetitive, intrusive thoughts, ruminations of thoughts, nervousness, fatigue, disturbed eating and sleeping patterns, panic-like symptoms and panic attacks.
These symptoms lead to avoidance of situations that may trigger further episodes, which further hamper growth and development.
Anxiety disorders usually have their onset in adolescent and young age groups. Various factors make them vulnerable to anxiety disorders . Some of them are:
Pressure to meet expectations
Excessive pressure to perform and meet the expectations of family members and society generates fear of failure, culminating in fear, apprehension and anxiety. Adolescent and young women criticizing themselves for not being good enough lowers their confidence and develops a sense of insecurity.
Biological and Physiological Changes
Adolescence is a period of many physiological and biological changes. With the onset of menarche (first menstrual cycle/period), many hormonal changes start in the body. Due to hormonal fluctuations and apprehensions about periods, many girls experience anxiety symptoms of varying degrees. As the brain, especially the frontal lobes, are in the development process in adolescence, exposure to stressors and adverse life situations contribute to the onset of anxiety at this age.
Other Comorbid Mental Health Problems
Anxiety disorders seldom occur alone and are often associated and coexist with other mental health conditions like depression, obsessive-compulsive spectrum disorders or substance use disorders.
Common presenting symptoms in adolescents and young girls include
- Vague non-specific physical symptoms like nausea, butterfly sensation in the stomach, gastric discomfort, frequent headaches
- Worries over little things, concerns over things outside their control • Poor eating and sleeping habits
- Avoiding school and other places with the presentation of vague symptoms • Irritability over little trivial things
- Poor attention and concentration and falling grades
- Disruption in their daily routine activities
Anxiety symptoms may vary among boys and girls, while symptoms in girls may be non-specific and vague.
Anxiety disorders need proper evaluation and management as they often go unnoticed and undiagnosed, impacting adolescents and young girls significantly. These disorders hamper their emotional, social, personal and academic growth and development. The proper and timely intervention will prevent disruption and help develop properly.
Eating Disorders – Anorexia Nervosa and Bulimia Nervosa
A pervasive, prevalent and widespread disorder in young girls and women
Eating disorders are severe and devastating mental illnesses commonly affecting teen girls and young women. There are several types of eating disorders with the core feature of a morbid fear of getting obese, apprehensions about gaining weight, and unrealistic expectations regarding body image.
Almost everyone is diagnosed with anorexia nervosa and bulimia nervosa, and two third of individuals with binge eating disorders are women. There can be several reasons for women’s high preponderance of eating disorders.
Apart from genetic and biochemical reasons, many social and cultural factors may also add to the cause.
Unrealistic expectations of beauty standards propagated by mass media, movies, and social media put undue pressure on teenagers to conform to the same standards and lead to dangerous practices to control weight.
Some job and activities like wrestling, ballot dancing etc., requires strict weight management and may increase the probability of eating disorders.
Symptoms of eating disorders have their core features as excessive focus on body weight, shape and food/calorie intake and intense fear of becoming fat. To manage them, patients adopt risky behaviours which may be dangerous.
Associated features include restrictive eating, self-induced vomiting, excessive exercise, use of laxatives and failure to maintain average body weight.
These disordered behaviours significantly impact physical health by nutritional deficiencies, major body organs, bones and teeth, and mental health by affecting attention concentration, coping ability, and associated depression and anxiety disorders.
Most people are diagnosed with anorexia or bulimia, and nearly two-thirds of individuals with binge eating disorders are women. There are many reasons for teenage girls and young women to get affected by eating disorders.
Some of the common symptoms of eating disorders include:
- Sudden changes in mood, irritability,
- Excessive exercise to keep body weight in control.
- Rapid and extreme weight loss in a short time due to unhealthy and dangerous practices to control weight.
- Rigid and much involvement in food rituals from cooking to eating.
- Constant friction and acid exposure cause degradation of teeth, fingernails and knuckles.
- An unhealthy obsession with weight, body image, shape and calorie intake. • the appearance of thin and fragile lanugo hair
- Disturbances in temperature regulation with the feeling of cold in ambient temperature.
Physical/medical complications of eating disorders
- Loss of body fat
- Muscle atrophy and weakness
- Low heart rate
- Low blood pressure
- Swelling/oedema in hands and feet
- Hypoglycemia (low blood sugar)
- Brain atrophy (loss of brain substances)
Management includes in-patient or outpatient treatment depending upon the severity. Severe conditions need long-term in-patient treatment with guided nutritional intake and weight gain. Associated Stress and anxiety-related issues must be treated for complete and sustained recovery.
Reproductive-Related Mental Health Issues in Women
(PMS,PMDD, Postpartum Depression , Postpartum Psychosis)
There are many exclusive mental health-related issues that onset during reproductive years in women. These occur due to an interplay between genetic factors, biochemical factors, and fluctuations in hormonal levels.
Premenstrual Syndrome (PMS)
PMS is a common condition affecting many girls and young women. Due to changes in hormone levels before periods, most women experience symptoms of PMS 1 -2 weeks prior to their periods. Symptoms of PMS usually vary from person to person.
The common symptoms include mild to moderate headache, irritability, fluctuating emotions, gastric upset and bloating sensations. Many signs of PMS and depression and anxiety disorders are overlapping and they impact the severity of each other.
Many times women suffer from comorbid diagnosis of depression or anxiety disorder along with PMS, and in them, the symptoms of PMS are worse. Also, the symptoms of depression and anxiety worsened before and during the menstrual cycle.
Premenstrual Dysphoric Disorder (PMDD)
PMDD is the more severe and extreme form of PMS. The symptoms are somewhat similar but worse than PMS.
PMDD have worse physical symptoms like cramps, bloating tenderness, and significant mental and emotional issues like extreme mood fluctuations, irritability, anger outbursts, tension, worries, severe anxiety and depression. The symptoms are often severe enough to disturb and disrupt daily routine activities, and PMDD impacts personal, academic and professional life.
PMDD often are found to be comorbid with anxiety and depressive disorders. Patients with PMDD often require treatment with medication and therapy. Associated comorbid conditions like depression and anxiety disorders must be adequately addressed and treated.
After giving birth emotional turmoil is a natural phenomenon due to sudden changes in hormonal levels. Milder forms of emotional dysregulation are known as post-partum blues or baby blues, and these are usually present for a short time and gradually improve within two weeks.
If symptoms of post-partum blues are moderate to severe and persist for more than two weeks, it is called post-partum depression. Common symptoms of post-partum depression include sadness, mood swings, loss of energy, reduced activity, anxiety symptoms, apprehensions, crying spells, appetite and sleep disturbances, guilt and hopelessness. It may lead to difficulty in attachment and bonding with the newborn when severe enough.
Post-partum depression should not be ignored and needs to be treated urgently for proper care of the newborn, as maternal mental health adversely affects both the mother and the baby.
Post-partum psychosis is a less common and more severe post-partum condition, usually occurring during the first few weeks of delivery. Onset is typically sudden, and symptoms include disorientation, confusion, suspiciousness, fearfulness, irritability, anger outbursts, tendency to harm self and baby, hallucinations and hallucinatory behaviour, sleep disturbances etc.
Post-partum psychosis is an emergency considering the potential harm to mother and baby, and it should be treated quickly with admission and medications depending upon the severity.
Menopause is another challenging phase of a woman’s life. Due to the reshuffling of hormone levels, women are prone to many physical and mental problems. Towards the climacteric age, women experience hot flushes, apprehensions, restlessness, palpitations, irritability, and disturbances in sleep and appetite. most of these symptoms settle down gradually with the stoppage of periods.
Some symptoms may worsen, leading to depression and anxiety disorders. women already suffering from mental health disorders may worsen during the menopausal phase. Other stressors and challenges of midlife further add ons to the burden and deteriorate mental health conditions.
Old Age Mental Health Issues In Women
(Anxiety, Depression, Loneliness, Suicide, Dementia)
Due to technological advancement and expansive medical care lifespan of older adult women has continuously increased. Currently, in well-developed countries, female life expectancy is around 80-85 years. It has steadily increased from the range of 52- 55 to the current level. That is an increase of over 30 years. This is a very significant increase, and it brings with it a whole lot of issues. We generally focus more on the more obvious physical health and tend to ignore the mental health part. The increased life span brings with it life-altering colossal changes marked by extreme emotions, love, struggles, despair, moments of joy and happiness, along with grief when someone known and important, like the life partner, relative or friend, dies.
Geriatric health and, more specifically, geriatric mental health is the most overlooked and ignored part of a person. The problem becomes more serious when it involves an old woman. In comparison to their younger phase of life, women in old age do not get enough attention to satisfy their various socio-emotional needs.
The most common mental health issues which affect women in old age are Anxiety and depression. Prevalence is more in those with low-income groups and lacking social support.
Anxiety and depression are mostly caused by loneliness compounded by changes in physical health, body condition and life-altering monumental changes in the strenuous journey of life. These colossal changes make the elderly women who lack support and are in isolation more vulnerable to suicide.
In general, older women with family support but in isolation also get lonely as they are not able to mingle and bond with their peers and engage in leisure activities. Sometimes an old woman with family support and not in isolation also may develop depressive symptoms. This can be due to restrictions in activities owing to physical changes which do not allow social interaction with peers.
Besides loneliness, financial insecurity also acts as a stressor and affects the psychological well-being of older women. Full-time caregivers suffer from a loneliness condition which is commonly referred to as Empty Nest Syndrome.
It is a feeling of loss, sadness and gloom when children leave home in adulthood or the life partner of an old person passes away. It primarily affects women and can develop into depression.
While mental health care has grown exponentially, there is still work examining mental health by gender. If taken seriously, the differences in women’s mental health conditions can improve the quality of life of millions of women worldwide.
Apart from anxiety and depression another significant disorder which impacts and affects women in their old age is dementia.
De-stigmatizing women’s mental health starts with us. By looking after ourselves and those we care about and having a voice in conversations about mental health, we can help shape future research, treatment decisions, and societal views on mental health issues.