An introduction to women, gender and mental health

by the Canadian Women’s Health Network, adapted from a presentation by Marina Morrow at the Women, Gender and Mental Health Workshop at Carleton University, October 15th, 2007.

Sex and gender matter when discussing mental health, mental illness and addiction.
Conditions can be more prevalent or less prevalent among women or men; for example, in Canada, women are almost twice as likely as men to either experience or be diagnosed with depression and anxiety while men are more likely to have problems with addictions to alcohol. Women are also more likely than men to be diagnosed with seasonal affective disorder, eating disorders, panic disorders and phobias. Men, especially elderly men, are more likely to commit suicide, while women are more likely to attempt suicide and engage in self-harming behaviours without intent to die (used as a coping mechanism when faced with overwhelming emotion).

Sometimes conditions appear to be gender neutral but in reality have different signs and symptoms requiring different treatments and services. An example of this is schizophrenia; men typically develop schizophrenia younger than women, therefore requiring different forms of treatment and services. With addictions, the forms of substance use among men and women differ as well, in their seriousness, prevalence and health impact.

There are also pharmacological differences; sex differences such as variations in lean body mass, hormonal concentrations and gastric absorption have been shown to affect the absorption, distribution, metabolism and elimination of drugs and the biochemical and physiologic effects of drugs. Women are more frequently prescribed anti-depressant and anti-anxiety (psychotropic) drugs, and are far more likely to consume these medications than men. These medications are potentially addictive and are associated with other problems such as falls.

Women access the mental health system more frequently and have higher rates of hospitalization for psychiatric problems than men do. When discussing mental health services, women cope with stress and life events in different ways and vary from men in how they signal their distress.

Gendered roles in society also influence mental health. Women bear the burden of responsibility associated with being wives, mothers and caregivers of others. Over 80% of caregivers are women. Unpaid caregivers have very high rates of stress—which affects both emotional and physical health. Female caregivers are often part of the “sandwich generation” caring for young families as well as elderly parents. Caregivers of those with serious persistent mental illness often take on the role of nurse, counsellor, advocate, crisis worker, homecare worker and income provider all in one.

Unpaid caregiving responsibilities also have an impact on women’s relationships with paid employment; women leave paid work, more frequently work part-time positions and have less access to benefits. This employment picture contributes to the higher rates of poverty in women across their lifespan and why access to new social programs such as daycare, home care or mental health care is a “women’s issue.”  Women, especially elderly women, Aboriginal women and single mothers, are disproportionately poorer than men.

But women and men are not homogenous groups. Socioeconomic status, race, ethnicity, age, ability, sexual orientation and gender intersect and influence mental health, mental illness and addiction in many ways. The process of resettlement and pre-immigration experiences affect mental health, sometimes resulting in increased anxiety and depression. Language barriers, weather induced depression, reduced family ties, unemployment, lack of social integration and racial discrimination are some of the post-migration stressors experienced by those who have immigrated to Canada. This may be more so for women, as immigrant and refugee women have fewer opportunities than immigrant and refugee men to learn English and French during the post-migration period, and immigrant and refugee women experience far more unemployment than Canadian-born women (and if employed, are often more likely to be underpaid).

In Aboriginal communities, the legacies of colonization and residential schooling have resulted in cultural discontinuity that has been tied to high rates of depression, alcoholism and suicide. It is estimated that the suicide rate of Aboriginal women is more than three times the rate for Non-Aboriginal Canadian women. Also, lesbians, gays and bisexuals have higher rates of suicide than the general population. In British Columbia, young women who identified as lesbian were nearly five times more likely to attempt suicide than young women who did not.

There are strong connections between experiences of violence/abuse and mental illness and addictions. Women are at greater risk of interpersonal victimization, including childhood sexual abuse, sexual abuse and intimate partner violence. Substance use and mental health problems frequently co-occur among women who are survivors of violence, trauma and abuse, often in complex, indirect, mutually reinforcing ways.

Thus a sex- and gender-based analysis of mental health, mental illness and addiction in Canada means more valid and reliable evidence that leads to better recommendations, interventions and outcomes for individuals and communities.