Empowering Women's Mental Health

A study by the American Psychological Association recruited 49,093 Americans ages 18 and above. The researchers studied participants' lifetime mental history and their mental health over the previous 12 months.

"Women were found to be more likely than men to suffer from depression and anxiety," said Deborah Lee, M.B. Ch.B., a sexual and reproductive health specialist at Dr Fox, an online doctor and pharmacy service in the United Kingdom. "In comparison, men were more likely to engage in substance abuse or be affected by antisocial personality disorder."

The authors noted that women with anxiety tend to internalize emotions and become lonely and withdrawn. On the other hand, men tend to become aggressive, impulsive and display unpleasant behavior.

Seeing there are differences when it comes to men and women and mental health raises questions. Why might women have different triggers? What emotional and physical effects might those triggers have?

Among the various circumstances that can trigger mental health issues for women, the top four are trauma, eating disorders, hormonal changes and the responsibilities of having the role of caregiver.

Trauma

"Women are more likely to experience sexual assault, domestic violence and other forms of trauma than men," said Alisa Ruby Bash, Psy.D., a licensed marriage and family therapist in private practice in Malibu, California.

These traumatic experiences can lead to conditions such as post-traumatic stress disorder (PTSD), depression and anxiety. Lee added that women are three times more likely than men to have PTSD. Women with PTSD are also more likely than men with PTSD to have been physically or sexually assaulted. It's estimated that about 1 in 10 women will develop PTSD at some point in their life.

In addition, mental health problems in women are strongly linked to domestic violence. The Mental Health Foundation said 30 percent to 60 percent of women with mental health problems also experienced domestic violence.

"In London, as many as 70 percent of women have experienced domestic violence during their lifetime, and 27 percent experienced it in the last year," Lee said.

Eating disorders

"Women often face societal pressures to conform to certain standards of beauty and behavior, which can lead to conditions such as body dysmorphic disorder (BDD), eating disorders and depression," Bash said.

Eating disorders have the highest mortality rates among psychiatric disorders. Mortality rates of more than 10,000 were recorded in 2021; that's a death every 52 minutes.

Although eating disorders can happen to anyone, females are three times more likely to have eating disorders than men.

"The reasons for this are not well understood, but young girls are often more sensitive about their bodies and body image," Lee explained. "They are more likely to have body dissatisfaction. Ninety percent of young girls are unhappy with their body image. Many hold themselves back for fear of being criticized about their bodies, and frequently social media is said to play a large part in their anxiety and low self-esteem."

Hormonal changes

Women experience various hormonal changes throughout their lives, such as during the menstrual cycle, pregnancy and menopause. Bash noted these changes can affect mood and cause conditions such as premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), postpartum depression, and perimenopausal and menopausal depression and anxiety.

Lee described a timeline of female reproductive health and mental health in more detail.

"Women—by virtue of their female sex—go through pregnancy, childbirth and motherhood," she said. "After puberty, they start to have monthly ovulatory cycles with the characteristic rise and fall in the levels of their reproductive hormones. During this reproductive phase, some women suffer from PMS or PMDD."

According to the United States Department of Health and Human Services, 3 in 4 women say they have experienced some form of PMS during their reproductive lifetime. The majority of women only suffer from mild symptoms, but 5 percent of women have such severe symptoms they suffer from PMDD. The risk of suicide increases by a factor of seven for women with PMDD.

During and after pregnancy, women experience hormonal changes and remain at risk after delivery of postpartum depression (which affects 1 in 10 women within one year of having a baby). For some women, infertility and/or pregnancy loss from miscarriage and/or ectopic pregnancy can take a toll, Lee added.

Gynecological conditions such as endometriosis and polycystic ovary syndrome (PCOS) can also prove very unpleasant to live with. Endometriosis can severely impact a woman's quality of life, causing excruciatingly painful periods, abdominal and pelvic pain, painful sex and infertility, all of which can cause mental anguish and heartache.

"It can affect their relationships, work-life, leisure time—in fact, every aspect of their whole reproductive life—and beyond," Lee said.

In the perimenopausal period—the transitional time around menopause—a woman's estrogen levels plummet. This is a time when anxiety and depression can become problematic. Two major research studies, the SWAN study and the Penn Ovarian Ageing Study (POAS), found the risk of depression increased two to five times during perimenopause compared to the late premenopausal period. The reasons are thought to be due to a complex interplay of biological, health-related and psychosocial factors.

Traditionally, depression at menopause has been treated with antidepressants but often with disappointing results. More recently, the benefits of treating perimenopausal and postmenopausal depression with hormone replacement therapy (HRT) have been realized.

Estrogen has neuroprotective effects on the brain. Menopause organizations, such as The Menopause Charity, now recommend HRT to treat depression.

After menopause, some women may continue to suffer from low energy, mood disturbance, emotional lability and loss of libido.

"Women are at the mercy of their hormones," Lee explained. "It could be a life event, life stress, a medical illness, a gynecological condition, a pregnancy or a miscarriage—but any of these can throw a woman's hormones into turmoil."

Caregiving responsibilities

"Women are more likely to take on caregiving responsibilities for children, aging parents and other family members," Bash said.

This is due to a combination of social, cultural and historical factors. Traditional gender roles and societal expectations have long dictated women should act as the primary caregivers in a family.

"This can lead to stress, exhaustion and burnout, which can affect mental health," she added.

The disproportionate burden of caregiving can significantly affect women's mental health. Here are ways it can affect their well-being:

• Increased stress. Caregiving can be emotionally and physically demanding. Women who take on caregiving responsibilities may experience heightened stress levels due to the additional workload, juggling multiple responsibilities and the potential lack of support.
• Emotional strain. Witnessing the decline in the health or well-being of a loved one can take an emotional toll. Women in caregiving roles may experience sadness, grief, guilt and other negative emotions associated with their challenges.
• Neglected self-care. When women prioritize caregiving, they may inadvertently neglect their own self-care needs. This can lead to feelings of exhaustion, burnout and a decline in their own mental and physical well-being.
• Limited social support. Women who take on caregiving responsibilities may have limited time for social activities and maintaining their own social networks. This isolation can contribute to feelings of loneliness and exacerbate the impact on mental health.
• Financial implications. Depending on the circumstances, caregiving responsibilities may limit women's ability to participate fully in the workforce. This can result in financial strain and decrease their sense of economic independence, which can impact their mental health and overall well-being.

If a mental health condition goes undiagnosed and untreated, various consequences can impact an individual's well-being and quality of life.

Here are some potential outcomes of not getting a mental health condition diagnosed:

• Impaired functioning and decreased quality of life
• Increased risk of comorbid conditions, as undiagnosed mental health conditions can increase the risk of developing other mental health problems such as substance abuse
• Increased risk of suicide
• Physical health implications such as cardiovascular disease, chronic pain and digestive issues
• Relationship problems
• Self-esteem and self-image issues
• Worsening symptoms

It is important to remember mental health conditions are treatable, and that seeking a diagnosis is the first step toward accessing appropriate care and support. Diagnosis provides individuals with a better understanding of their experiences, facilitates access to treatments and interventions, and enables the development of coping strategies to manage symptoms effectively.

If you suspect you or someone you know may have a mental health condition, contact your healthcare provider or a mental health professional for an accurate diagnosis and to discuss treatment options.

We combined advice from Bash and Lee to provide you with some useful strategies to stay mentally healthy.

Take your own mental health seriously

Ask yourself how you're feeling today. Be aware of your own symptoms. Try keeping a diary so you can spot daily changes; be realistic. Don't push yourself too hard. Be kind to yourself. Take time each day to engage in activities you enjoy, such as reading, listening to music or taking a relaxing bath. If you need help, don't be embarrassed to see your healthcare provider. Every journey starts with a tiny step.

Stay connected

Stay connected with friends and family members who provide support and positivity in your life. Joining a support group or participating in community activities can also help build social connections. Reach out to friends and relatives. Try and join in as much as you can. Human beings need to interact with other human beings.

Practice good sleep hygiene

Sleep is essential for mental health. Practice good sleep hygiene by sticking to a regular sleep schedule, avoiding caffeine and alcohol close to bedtime, and creating a relaxing sleep environment.

Manage stress

There are innumerable ways to do this. Stress is a common trigger for mental health conditions. Identify the sources of stress in your life and develop coping strategies, such as exercise, relaxation techniques, or talking to a friend or therapist. Make a relaxing routine which might include a nature walk, a hot bath and 30 minutes to read a book before bedtime. If stress is getting too much and you're having negative symptoms, notice that and seek professional support.

Look after your physical health

Regular exercise can improve mood and reduce symptoms of anxiety and depression. Aim for at least 30 minutes of moderate physical activity most days of the week. Your mind and body are intricately related, so eating a healthy diet is also important. Eat less processed food as this tends to be high in fat, sugar and salt. Eat fresh foods full of health-giving antioxidants. One excellent option is the Mediterranean diet.

Never feel alone and do your own research so that you'll know what to ask for when you need more advice and support. Here are some great places to start that journey:

• The SeekHer Foundation provides mental health-focused programs and resources built for connection and community to help women thrive in their work and everyday life.
• The Loveland Foundation increases access to mental health resources for women of color. Their resources and initiatives prioritize opportunity, access, validation and healing.
• Postpartum Support International provides a National Maternal Mental Health Hotline (U.S. only) where you can call 800-944-4773 for a 24/7 response. They also provide direct peer support to families, train professionals and many resources.
• WISH is a charitable organization focused on women's mental health, driven by the voices and needs of its users. They are dedicated to creating innovative support services for underserved women while also advocating for social justice through collective action.
• The charity House of Ruth empowers women, children and families to rebuild their lives and heal from trauma, abuse and homelessness.