Men, women and mental health

Question 1

What is gender according to the World Health Organisation (2017)?

Answer 1

A sociocultural construct

Question 2

How is gender linked to mental health?

Answer 2

Gender can affect:

1. Development and manifestation of mental illness
2. Detection and measurement of mental illness
3. Wether somebody receives adequate care

Question 3

What is the consequence of the effects of gender on the measurement of mental illness?

Answer 3

Affects our understanding of the epidemiology of a condition

AND cross-country variation in the prevalence of mental disorders

Question 4

What is the implication of the effect of gender on wether somebody receives adequate care?

Answer 4

Need to design equitable, acceptable and effective services

Question 5

Which mental disorders have an equal male/female prevalence?

Answer 5

• OCD
• Schizophrenia
• Bipolar disorder

Question 6

Which mental disorders are more prevalent in men than women?

Answer 6

Alcohol dependence (3-4 : 1)

Question 7

Which mental disorders are more prevalent in women than men?

Answer 7

• Depression

- Panic disorder

Question 8

What are DALYs?

Answer 8

Disability Adjusted Life Years:
= years of life lost + years lived with the disease

-> characterises disease burden

Question 9

What did Whiteford and colleagues (2013) show on the effect of age and sex on DALYs for all mental and substance use disorders in 2010?

Answer 9

At nearly all age points, women have a higher burden of mental ill-health than men
- except in boys under age 10, largely due to child behavioural disorders

Question 10

What is the association between country income status and the prevalence of depression in men and women (Rai et al., 2013)?

Answer 10

• Prevalence of depression in men stays roughly constant across low, middle and high-income countries
• Prevalence of depression in women is much higher in high-income countries
  (female to male ratio for depression = 1.5 : 1 up to 2.3 : 1 in high-income countries)

Question 11

Why does the idea that “women are too busy” not explain why fewer women are depressed in low-income countries?

Answer 11

• Little evidence for this

- Depression is constantly more common in less affluent populations

Question 12

Why is the stress of the modern urban world unlikely to explain why fewer women are depressed in low-income countries?

Answer 12

Rural people have high suicide rates

-> people in low-income countries tend to have much higher exposure to stressors triggering depression, particularly in women

Question 13

What would explain why fewer women are depressed in low-income countries?

Answer 13

• Possible protective role of culture (evidence of cultural risk factors needed)
• Probably due to measurement

Question 14

What are the psychological explanations to why women get depressed more than men?

Answer 14

> Response style theory

> Western men are more likely to seek distraction from problems

> Negative cognitive schemas (Beck, 1979)
- higher in average in women

Question 15

What are the social explanations to why women get depressed more than men?

Answer 15

> Stressors
- e.g. 3 children under five, lack of confidence, lack of paid employment

> Roles

> Expectations
- “grown men don’t cry” vs. women expected to cry

> Labelling

Question 16

What are the four established risk factors for depression and other mental health problems women in LMICs are more likely to be exposed to?

Answer 16

1. Poverty
2. Low education
3. Intimate partner violence
4. Health risks related to reproduction

Question 17

What is the problem of standard measures of postnatal depression?

Answer 17

They lack validity in rural women who have a low educational level
- there’s no difference between depressed vs. non-depressed women

-> misclassification

Question 18

What did the meta-analysis of Fisher and colleagues (2012) show on the symptoms and risk factors of depression in LMICs?

Answer 18

> Levels of significant depressive symptoms in LMICs are higher than in high-income countries

> Risk factors: poverty, intimate partner violence, low education, unplanned pregnancy, poor social support, obstetric complications, previous stillbirth, gender preference

Question 19

What is the evidence for culture’s role in the prevalence of postnatal depression in LMICs (Patel et al., 2012)?

Answer 19

Birth of girl baby is an effect modifier for other risk factors for postnatal depression

Question 20

What would explain the culture’s role in the prevalence of postnatal depression in LMICs?

Answer 20

In India and many other cultures: strong societal preference for a women to give birth to boy baby, especially if woman does not already have a male child

Question 21

What is the basis of the idea of ‘culture-bound’ depression in LMICs?

Answer 21

Childbirth rituals remain intact in traditional societies and can protect women during childbirth by facilitating her transition into role of mother
- traditional perinatal practices

Question 22

What is the evidence of ‘culture-bound’ depression in LMICs (Hanlon et al., 2010b)?

Answer 22

> Stronger endorsement of traidiotnal perinatal practices was protective against persistence of depression from pregnancy into postnatal period

> Women who did not carry out practices that they endorsed had an increased risk of postnatal depression

-> may reflect high levels of traditional practices being protective in the community

Question 23

How could perinatal depression affect child’s health?

Answer 23

Perinatal depression
-> difficulty with maintaining hygiene, following health advice, seeking help on time

-> child illness and undernutrition

Question 24

What is the impact of perinatal depression on a child?

Answer 24

• Undernutrition
• Birth weight
• Cognitive development
• Mortality
• Child emotional and behavioural problems
• Accidents
• Illness episodes

Question 25

What is the implication of the adverse effects of perinatal depression on children’s health for interventions?

Answer 25

Interventions for perinatal mental health problems also need to mitigate these adverse effects on the child

Question 26

What is the gender basis of differing mental health service needs?

Answer 26

> Depressed men are more lily to be irritable than depressed

> Men have less contact with health facilities, but more contact with the criminal justice system

> Men are less likely to frame mental health difficulties as a health problem
- depressed men are less likely to seek help

> Substance use is more of a factor

Question 27

How can we increase coverage for mental healthcare in men?

Answer 27

> Engage with other agencies
- go to where men are: police, emergency departments, prisons, community structures for arbitration

> Combine mental health interventions with livelihood interventions
- more likely to motivate men

> Take family approach

> Tackle causes as well as consequences

> Raise awareness and increase acceptability of treatments
-> provide role models

Question 28

Why should interventions for women in LMICs be carried out during the antenatal period?

Answer 28

• Antenatal period is when women are most likely to be in contact with health service
• Postnatal period is a challenge due to confinement after childbirth

Question 29

What are the limiting factors of interventions for women in LMICs?

Answer 29

> Low autonomy undermines help-seeking

> Medications have low acceptability in perinatal (postnatal) period

> Psychosocial interventions often not available

> Essential drug list recommendations are problematic: teratogenicity in breast milk

Question 30

What is teratogenicity?

Answer 30

Any significant change in the formation or form of a child after prenatal treatment

Question 31

What was the ‘Thinking Healthy’ programme (Rahman et al., 2008)?

Answer 31

CBT-based intervention for depressed perinatal women in Pakistan
- mother and child-focused approach (mother focus only not accepted)

• CBT delivered by community health workers, who visited the women at their home
• Analysis after 6 months
• Analysis after 1 year

Question 32

What did the ‘Thinking Healthy’ programme (Rahman et al., 2008) result in?

Answer 32

• Reduced perinatal depression

- Reduced child illness and increased vaccination coverage