One of the greatest challenges facing the health care industry is the fight against mental illness. To begin with, serious conditions such as schizophrenia, bipolar disorder, depression, and anxiety are often difficult to diagnose. But perhaps the most daunting obstacle to treatment of mental health disorders is the societal stigma attached to the diseases. The reluctance of patients to seek treatment for mental health disorders disproportionately affects women, in large part because women are more susceptible than men to many common mental health conditions.
- In 2017, 46.6 million adults in the U.S. were treated for a mental illness, representing nearly 20% of the adult population, yet the percentage of women being treated for mental illness was almost 50% higher than the percentage of men (22.3% vs. 15.1%, according to the National Institute of Mental Health).
- A study conducted by the U.S. Armed Forces Health Surveillance Branch found that women service members were diagnosed with anxiety at a rate that was 1.4 times that of their male counterparts, and women in the survey were 1.9 times more likely than men to be diagnosed with depression. (Psychological Health Center of Excellence)
While all segments of the world’s population are impacted by mental illness, health professionals are discovering that treating women requires a different approach than is used to treat men with the same illnesses. For example, while the incidence of schizophrenia and bipolar disorder is the same for men and women, the symptoms women experience often differ from those present in men, according to the National Institute of Mental Health (NIMH).
In addition to feeling too ashamed to seek help for a mental disorder, many women simply aren’t aware that their symptoms constitute an illness that can be treated. A big step toward improving the diagnosis and treatment of mental health conditions in women rests in education: providing information about the prevalence of mental illness, the negative effects it has on women and their families, and the many resources available to help them receive the treatment they need to return to health.
The information presented in this guide is intended as a starting point for health care professionals as well as for women and their families as they seek resources that can set them on the path to wellness.
Women’s Mental Health: Facts and Figures
Under-diagnosing mental illness continues to be a problem in the health care industry. The World Health Organization (WHO) reports that more than half of patients who meet the criteria for a psychological illness are not identified as such by doctors. It’s understandable that family and friends can fail to spot the signs of some mental illness, especially when trained doctors are unable to do the same.
Below is a snapshot of the progress made—and yet to be made—in diagnosing and treating women’s mental health issues.
Women’s mental health in the U.S.
- Women are twice as likely as men to be impacted by Generalized Anxiety Disorder (GAD).
The Anxiety and Depression Association of America (ADAA) reports that 6.8 million people in the U.S. are affected by GAD, although only 43% of them are being treated for the disorder. Women are also twice as likely as men to be diagnosed with panic disorder (PD), which affects 6 million U.S. adults, and with specific phobias, which impact 19 million adults in the U.S.
- The prevalence of serious mental illness is almost 70% greater in women than in men.
Figures compiled by the NIMH indicate that serious mental illness (SMI) affects more than 11 million adults in the U.S. each year, which is 4.5% of the adult population. Yet SMI was diagnosed in 5.7% of adult women and 3.3% of men.
- Exposure to violence makes a woman three to four times more likely to be affected by depression.
Researchers at WHO state that women who were exposed to sexual abuse as children, or to a violent partner as an adult, are diagnosed with depression at a much higher rate. The research also found that the severity and duration of the initial sexual or violent exposure impacts the severity of the resulting mental illness.
Differences between the mental health of men and women
- Women are twice as likely as men to be affected by unipolar depression, which is forecast to be the second most common source of “global disability burden” by 2020.
Figures compiled by WHO indicate that treating women with depression would “contribute significantly” to easing the worldwide impact of disabilities caused by psychological disorders. Women are also more likely to suffer from three or more “comorbid” mental illnesses (two or more disorders affecting one person). This condition increases the burden of the disability, and may also make the disorders more persistent in women.
- Women are more likely to experience post-traumatic stress disorder (PTSD), and they wait much longer than men after symptoms arise to seek diagnosis and treatment.
The Office of Women’s Health at the U.S. Department of Health and Human Services reports that women wait an average of four years after the onset of PTSD symptoms before asking for help. Men, on the other hand, seek assistance an average of one year after PTSD symptoms arise. Sexual violence is the primary source of PTSD worldwide. Recovery Across Mental Health states that women have a higher rate of developing PTSD after a traumatic event: 20.4% for women, compared to 8.1% for men. According to the ADAA, 65% of male rape victims and 45.9% of women who are victims of rape will develop PTSD as a result.
- Women are almost 10 times more likely than men to be affected by an eating disorder.
According to Recovery Across Mental Health, 1.9% of women will experience anorexia (excessive weight loss) each year, compared to 0.2% of men. Young women are particularly susceptible to eating disorders: between 0.5% and 1% of young women are impacted by bulimia (binge eating and purging) in the course of a year.
Stigma and issues surrounding women’s mental health
- Women may be less likely than men to seek treatment after experiencing symptoms of mental illness. This is due to “internalized or self-stigma” that results from their self-image being formed by how others perceive them.
The Women’s Health Research Institute at Northwestern University points out that women are more prone than men to feel stigmatized for seeking assistance with a mental health issue. Women tend to rely on the opinions of the outside world for their self-esteem much more than men do. As a result, they often avoid having their mental illness treated because they want to prevent others from thinking less of them, which would cause them to think less of themselves.
- The stigma of seeking treatment for a mental illness is greater among women of color.
Johns Hopkins Medicine reports that while women are twice as likely as men to experience serious depression, African-American women are half as likely as Caucasian women to ask for help from a mental health professional. Latina women are similarly hesitant to seek treatment when experiencing symptoms of mental illness.
Researchers posit that the culture of minority communities may be a hindrance, because it often presents women as “strong and stoic,” placing the needs of their loved ones above their own. Inroads are being made to combat such stigma by convincing women that seeking treatment for their mental illness will improve their ability to take care of their families.
Women’s Mental Health Conditions and Symptoms
Every patient—whether male or female, old or young, rich or poor—experiences mental illness in their own unique way. Even though there are similarities in the symptoms and impacts of specific mental health conditions, women often face different challenges than men in how they perceive and experience symptoms, and also in how strategies are devised to treat the disorder.
Here is a quick look at how women are affected differently than men by common mental health issues.
In addition to being more likely than men to experience the disease, some forms of depression are unique to women, as explained by the NIMH. Among the mental disorders tied to changes in women’s hormone levels are perinatal depression (depression occurring before and after giving birth, the latter known as postpartum depression), premenstrual dysphoric disorder, and depression related to perimenopause.
The Office of Women’s Health lists the symptoms of depression, emphasizing the differences in number, frequency, and duration of symptoms a given person will experience in the course of their illness. Common depressive symptoms include:
- Feelings of sadness, hopelessness, uselessness, or emptiness
- Crying frequently
- No longer enjoying favorite activities
- Loss of energy
- Inability to focus, remember, or decide
- Inability to sleep, sleeping too much, or struggling to get out of bed
- Loss of appetite, weight loss, or overeating in an attempt to “feel better”
- Thoughts of self-harm, death, or suicide
- Persistent headaches, nausea, or other physical pain that doesn’t improve with treatment
- Becoming easily annoyed or angered
Research funded by the NIMH discovered genetic differences in men and women who are affected by depression. The hope is that by determining the different causes of the disease in men and women, researchers will be able to create improved diagnostic tests and treatments based on gender.
The NIMH defines General Anxiety Disorder (GAD) as experiencing “excessive anxiety or worry” for most days over a period of six months. Other anxiety disorders include panic disorder, obsessive-compulsive disorder, social anxiety disorder (or social phobia), separation anxiety disorder, and phobia-related disorders (such as fear of flying, fear of heights, or fear of specific objects). While 19% of all adults in the U.S. report having experienced anxiety disorder in the past year, the percentage is much higher for women than for men (23.4% vs. 14.3%).
Symptoms of anxiety disorder include the following:
- Chronic irritability or nervousness
- Feelings of impending doom or disaster
- Racing heartbeat, hyperventilating, sweating, or trembling
- Weakness or tiredness
- Inability to concentrate
- Stomach aches or other digestive problems
WHO estimates that worldwide, 10% of pregnant women and 13% of women who have just given birth experience a mental disorder, primarily depression. Perinatal depression, which encompasses both categories of women, impairs a woman’s ability to function and also hinders the development of the child. While pregnant women everywhere are susceptible to perinatal depression and other mental illnesses, the problem is greatest in developing countries, where WHO estimates that 20% of mothers experience postpartum depression.
Perinatal depression is exacerbated by poverty, migration, stress, and exposure to violence, according to research compiled by WHO. The organization emphasizes the need to integrate maternal mental health with general health guidelines, along with educating women about children’s health and reproductive health.
Twice as many women in the U.S. are affected by eating disorders as men: 20 million vs. 10 million, according to figures compiled by the National Eating Disorder Association. The causes of the illnesses remain a mystery for the most part, but researchers believe biology, psychology, and culture are all involved.
Among the risk factors for developing an eating disorder are the following:
- Being closely related to someone who has an eating disorder or other mental illness
- Chronic dieting
- Burning more calories than are ingested (negative energy balance)
- Being diagnosed with Type-1 (insulin-dependent) diabetes, including a pattern of missing insulin injections (diabulimia), which can cause death
- Poor body image
- Being diagnosed with an anxiety disorder
- Being the victim of bullying or body-shaming due to weight
- Having a tendency toward perfectionism or behavioral inflexibility
This subset of perinatal depression affects some women within one year of giving birth. It is characterized by feelings of extreme sadness, anxiety, and tiredness that impact the woman’s ability to care for herself and her baby. The NIMH emphasizes that the condition does not originate with any action on the mother’s part, but rather occurs as a result of a combination of physical and emotional factors that include: hormonal changes during pregnancy and after delivering, a lack of sleep in the weeks and months after the baby’s arrival, and the physical exhaustion and pain related to pregnancy and giving birth.
Diagnosing postpartum depression is challenging because the symptoms vary from woman to woman, and many of the symptoms are easy to attribute to some other cause. In particular, postpartum depression may be interpreted as the “baby blues,” which many new mothers feel as a result of the worry, exhaustion, or sadness that commonly accompany a baby’s birth. NIMH recommends that women consult with their health care provider right away if they experience any of the symptoms listed under “Depression” above.
Body dysmorphic disorder
The Cleveland Clinic defines this condition as a person’s extreme anxiety about some perceived physical defect. People with body dysmorphic disorder (BDD) constantly seek reassurances about their appearance and may consider themselves “ugly” to the point where they seek a remedy. This remedy may include plastic surgery to remove whatever is considered a physical imperfection.
While the disorder occurs with equal frequency in men and women, societal pressures about physical beauty may make the condition more difficult for women to overcome. The obsession with their appearance can impair the ability of people with BDD to function at work, at home, and in their social lives. The most common physical attributes of concern to sufferers of BDD involve blemishes and other skin problems, hair anywhere on the body (or the lack of it), and the shape and size of specific facial features.
This condition, which was previously referred to as “manic-depressive illness,” is characterized by wide mood swings that are much more extreme than the ups and downs people normally experience in their day-to-day lives. The drastic changes in mood and energy level can seriously hinder the person’s ability to function, particularly for people affected by “bipolar I” (pronounced “bipolar one”), in which the mood swings are more severe than in “bipolar II.”
Bipolar I occurs less frequently and impacts men and women equally, according to the HHS Office of Women’s Health. In bipolar II, which is diagnosed in women much more frequently than in men, the mood “highs,” or manic episodes, and the “lows,” or depressive episodes, are less severe (referred to as “hypomania”). However, women with bipolar II tend to experience more depressive episodes than manic episodes. Bipolar II is usually treatable without requiring hospitalization.
Borderline personality disorder
NIMH describes borderline personality disorder (BPD) as a mental illness characterized by changeable moods, continually varying self-image, and inconsistent behavior over an extended period of time. According to the Office of Women’s Health at HHS, BPD is a “serious mental illness” that causes instability in a person’s mood, behavior, relationships, and self-image on a daily basis. While 2% of adults are affected by the disorder, it strikes young women more than any other demographic.
Along with erratic changes in mood, behavior, and values, symptoms of BPD include: quickly entering into and ending physical and emotional relationships; extreme swings in feelings toward people and activities; an unrealistic, skewed sense of oneself; and acting in impulsive and dangerous ways. Factors that increase a person’s risk of BPD are a family history of the disorder, childhood traumatic events, and brain trauma.
The National Institute on Drug Abuse reports that 15.4% of adult women in the U.S. have taken an illegal drug in the past year. Research shows that women can become addicted to a drug faster than men, even though women generally take smaller amounts of drugs and use them over a shorter period of time. In addition, sex hormones may cause women to be more susceptible to the effects of drugs, and they may experience more cravings once addicted, which can lead to more frequent relapses.
When a woman abuses drugs while pregnant or nursing a baby, both the woman and her child are at greater risk. Opioids, stimulants, and other drugs can damage the baby’s health and cause pregnant women to miscarry. Pregnant women who smoke tobacco or cannabis, ingest prescription pain medication, or use illegal drugs increase their risk of a stillbirth by a factor of two to three.
Recovering from a substance abuse disorder is also different for women than for men. For example, treatment programs for women that incorporate child care, parenting classes, job training, and similar services have a higher success rate than recovery programs that do not offer such support.
Women’s Mental Health Treatment and Resources
Despite the complexity of the mental health challenges women face, treatment options and resources are available to help these women lead healthy lives. Sometimes, the simplest advice is the most effective, and may begin with something as basic as not being afraid to ask for help. Mental health professionals are ready to help women affected by mental illness. They are there to ensure afflicted women receive the treatment and attention they need to start on the road to recovery, and return to health should they ever stray.
Health practitioners, centers, and clinics
There are many different kinds of mental health care providers, although most share basic characteristics: professionals who diagnose and treat mental health disorders hold a master’s degree and often an advanced degree, as well as specific training and state licensing credentials. The Mayo Clinic describes the most common types of mental health practitioners and providers:
- Psychiatrists are medical doctors (MDs) or doctors of osteopathy (DOs) with a specialty in mental health. In addition to diagnosing and treating mental illnesses, psychiatrists can write prescriptions and offer counseling via psychotherapy.
- Psychologists typically hold a doctoral degree—Ph.D., Psy.D., or Ed.D. They provide psychological counseling in groups and one-on-one sessions, and while most cannot write prescriptions, many are licensed to do so or work with providers who can prescribe medication.
- Psychiatric mental-health nurses are registered nurses with training in mental health. Many are advanced-practice RNs holding advanced degrees (doctorate of nursing practice) or certifications (certified nurse practitioner), and in some states they are able to prescribe medication.
- Licensed clinical social workers generally have master’s degrees or doctorates in social work, while licensed professional counselors hold master’s degrees and have relevant clinical training. Both provide counseling and other services, though they cannot prescribe medication.
Women who are looking for a nearby mental health provider are instructed to ask for a referral from their primary care provider or request a list of covered mental health providers from their health insurance company. Many employee assistance programs cover some or all of the cost of mental healthcare.
- The National Alliance for Mental Health (NAMH) provides a help line that is staffed 24/7 by people who can answer questions about mental health symptoms and treatments, help with family members, and provide contact information for local mental health resources.
- The Office of Women’s Health’s mental health resources include links to federal agencies that offer information about specific disorders, and to organizations that offer assistance to families and individuals impacted by mental health issues.
People coping with mental health challenges—their own and those of loved ones—cannot be reminded too often that they don’t face those struggles alone. At all hours, an encouraging voice or online chat is just a call or click away.
Listed below are some sources for more information about support groups for everyone and anyone affected by mental health disorders.
- The National Alliance for Mental Health offers a Find Support page that lists the National Suicide Prevention Hotline (800-273-8255), and provides links to state organizations representing the 950-plus NAMH affiliates in the U.S.
- The Depression and Bipolar Support Alliance offers a Find a Support Group web page. It lets you search for a group by ZIP code or by state, and includes contact names, phone numbers, email addresses, and websites of various alliance chapters.
- WebMD’s depression support guide discusses how to create a support group by recruiting family members and friends. It has a link to WebMD’s online depression support group but also emphasizes the importance of receiving psychotherapy and psychological counseling from trained professionals.
One of the most comprehensive collections of useful resources for women’s mental health patients and providers is available through the Massachusetts General Hospital Women’s Mental Health Center. Links to sources for information and help lines are categorized by disorder and include: illnesses that occur during and after pregnancy, breastfeeding while taking psychiatric medication, the impact of infertility on mental health, mood disorders, and menopause.
The website of the U.S. Food & Drug Administration (FDA) features a guide to Women’s Health Topics that includes sections on pregnancy, menopause, and safe use of pain medicine and other medications. The FDA’s Take Time to Care program seeks to disseminate free health education information to women through health care organizations and professionals, community nonprofits, schools, and local government agencies. Organizations wishing to participate can learn more about the program on the FDA’s Invitation to Collaborate page.
The HHS website at MentalHealth.gov features an extensive list of local organizations that provide mental health support services, several of which are particularly geared to meet the mental health needs of women. For example, many local branches of the YWCA USA offer women expert advice on mental health issues and how to receive professional help.
Tips for women’s mental health
Much of maintaining good mental health entails developing the skills to cope with the ups and downs of everyday life. The Office of Women’s Health’s Good Mental Health web page features tips and suggestions that teach women of all ages the important coping skills that can prevent small problems from becoming big ones. These are among the helpful tips offered by the service:
- Improve your mood by exercising regularly. Aerobic exercise releases endorphins, which are chemicals that help alleviate stress and promote calmness. Regular physical exercise also helps improve sleep habits and quality, and may also reduce the symptoms of anxiety and depression.
- Eat a balanced diet. Consuming healthy foods has been found to improve people’s mood in addition to improving their physical health. In particular, avoid sugary foods, which can lead to tiredness and irritability when blood sugar levels drop. Researchers recommend that alcohol and coffee be consumed in moderation. Also, certain vitamins and minerals—such as selenium, omega-3 fatty acids, folate, vitamin B12, calcium, iron, and zinc—appear to alleviate the symptoms of depression.
- Find a job you enjoy. Often, a woman’s mental health issues can be exacerbated by her employment. A change of job can give such women a renewed sense of purpose and alleviate some of the effects of their illness. However, it can be difficult for women who suffer from mental illness to rejoin the workforce or switch jobs. Many states and mental health services offer vocational rehabilitation services, employment support, and free employment and job counseling services.
The HelpGuide from HelpGuide.org International, offers six strategies intended to promote mental health by boosting contentment and happiness. The first is to invest in face-to-face relationships with people you trust in a friendly, engaging, and nonjudgmental manner. Other tips include staying physically active; identifying and avoiding (when possible) the stressors in your life; eating foods that are good for your brain (low in sugar, high in “healthy” fats); sleeping well; and finding a purpose in life.
Women’s Mental Health: Knowledge Is Power
Often, the first and most important step on the road to mental health is acknowledging the need to take action. For women, taking that first step can be particularly challenging due to the societal pressures women feel to be the strong, nurturing caregiver for their families, friends, and communities. The health care industry is continuing to discover the unique needs of women affected by mental illness in terms of treatment options and support services.
Armed with accurate, up-to-date information on the most effective strategies for overcoming mental health challenges, women can be more empowered to reclaim the fulfilling, enjoyable, and purposeful lives they so richly deserve.
American Psychiatric Association, “Mental Health Disparities: Women’s Mental Health”
American Psychiatric Association, Women’s Mental Health
Cambridge University Press, “A Handbook for the Study of Mental Health: Gender and Mental Health: Do Men and Women Have Different Types and Amounts of Problems?”
The Conversation, “Biology Is Partly to Blame for Higher Rates of Mental Illness in Women — the Rest Is Social”
Everyday Health, “State of Women’s Wellness 2017” Forbes, “These Female Founders Are Addressing a Majorly Neglected Area of Women’s Mental Health with This App” International Association for Women’s Mental Health JAMA Network, “Women’s Mental Health and Well-being 5 Years After Receiving or Being Denied an Abortion: A Prospective, Longitudinal Cohort Study”
Joan Lunden, “Differences in Men and Women’s Mental Health”
Journal of Psychiatry and Neuroscience, “Why Is Depression More Prevalent in Women?”
The Lancet Psychiatry, Women’s Mental Health
Mental Health America, “Depression in Women”
Prevention, “4 Mental Health Issues that Are More Common in Women”
Psychology Today, “Women and Mental Illness: Why Are Mental Health Issues More Common Among Women?”
Stigma-Free Society, Women’s Peer Support Group
Theravive, “What Is Mental Health Stigma?”
Thrive Global, “A Women’s Mental Health Support Group: Going Beyond and Changing Society”
University of California San Diego Health, “Postpartum Depression, Postpartum Anxiety, and Other Women’s Reproductive Mental Health Issues”