Sex differences in mental illness: a community study of the influence of physical health and sociodemographic factors

Mixed methods exploration of Ghanaian women's domestic work, childcare and effects on their mental health

This research paper aims to understand the effects of time spent in domestic work, including childcare, on women’s mental health in Ghana. The paper adopted a triangulation convergence mixed methods approach. The quantitative information was sourced from two waves (2009/ 2014) of the Ghana Socioeconomic Panel Survey (GSEPS) while qualitative information was obtained from in-depth interviews with couples and key informants from five (5) regions, representing diverse ethnic backgrounds, in Ghana. Employing fixed effects regressions and a multinomial logistic regression model with fixed effects, we find that domestic work contributes to poorer mental health outcomes among women. These results are consistent, even when we correct for potential self-selectivity of women into domestic work. We also examine whether the relationship is differentiated between women of higher and lower socioeconomic status. We find that women from wealthier households who spend increasing time in domestic work have higher odds of mental distress. These results are supported by the qualitative data- women indicate increasing stress levels from domestic work and while some husbands acknowledge the situation of their overburdened wives and make attempts, however minor, to help, others cite social norms and cultural expectations that act as a deterrent to men’s assistance with domestic work. Efforts should be made to lessen the effects of social and cultural norms which continue to encourage gendered distributions of domestic work. This may be done through increased education, sensitization and general re-socialization of both men and women about the need for more egalitarian divisions of household work.

Risk factors of mental illness among adult survivors after the Wenchuan earthquake

PURPOSE

This study was to analyze the mental health status of the adults from the areas struck by the Wenchuan earthquake, to understand the factors that may have impact on their mental health after they were exposed to the earthquake, to obtain information specifically relevant to further research and future preventive measures.

METHODS

We used multistage stratified random sampling methods in three areas that were severely damaged in the Wenchuan earthquake, Sichuan Province, China. For this study, 14,798 individuals were identified with simple random selection methods at the sampling sites, 14,207 were screened with the 12-item General Health Questionnaire (GHQ-12), and 3,692 individuals were administered a Chinese version of the Structured Clinical Interview for Diagnostic and Statistical Manual (DSM)-IV axis I disorders by 180 investigators.

RESULTS

The risk factors for post-traumatic stress disorder included old age, female gender, low school education and witness someone die in the earthquake (P < 0.05, 95 % CI). The risk factors for anxiety disorder included old age, female gender, low school education, living alone and witness someone die in the earthquake (P < 0.05, 95 % CI). The risk factors for depression included old age, female gender, low school education and living alone (P < 0.05, 95 % CI).

CONCLUSIONS

Given inadequate knowledge and practices concerning the mental health of disaster victims in China, the information provided by this study is useful for directing, strengthening, and evaluating disaster-related mental health needs and interventions after the earthquake.

[Depressive symptoms in elderly women. The influence of gender]

OBJECTIVE

To examine gender differences in depressive symptoms in people over 75 years of age in the community.

METHODS

This is a descriptive cross-sectional study. The data was obtained from the study of frailty in Lleida (FRALLE survey). Depressive symptoms were measured using the Centre for Epidemiologic Studies Depression Scale (CES-D). Logistic regression were used to analyse the relationship of gender with depressive symptoms.

RESULTS

The prevalence of depressive symptoms was 33.1%; 22.8% for men and 40.3% for women. In the total population, gender was statistically significant in all three models constructed. Thus, women have nearly double the prevalence rates for depression compared to men, even after adjusting for social and demographic factors and the health status.

CONCLUSIONS

The results suggest that women have a higher risk of depressive symptoms than men, and the protective factors of depressive symptoms are higher education in women, and the presence of a partner in men.

Gender differences in insomnia and the role of paid work and family responsibilities

PURPOSE

A higher prevalence of insomnia in females has been consistently demonstrated across countries and cultures. The aim of this study was to clarify whether gender differences in insomnia could be explained by gender differences in paid work and family responsibilities.

METHODS

Participants were employees at two local governments in Hokkaido, Japan, who underwent annual health checkups from April 2003 to March 2004. All data were obtained via self-administered questionnaires. Insomnia was evaluated by the Athens Insomnia Scale. For work and family characteristics, occupation, working hours, days off, shift work, visual display terminal (VDT) work, occupational stress, marital status, hours spent on household tasks, childcare, and caregiving were chosen. Data from 7,451 participants (5,951 men and 1,500 women) were analyzed. Logistic regression analysis examined how much paid work and family responsibilities explained gender differences in insomnia.

RESULTS

The prevalence of insomnia in female subjects (31.0%) was significantly larger than in males (23.2%), but the gender difference disappeared after adjustment for paid work and family responsibilities. The results of stratified analyses revealed that significant gender differences were found only among workers with comparatively favorable work and family conditions, such as non-shift work, less than 6 h/day of VDT work, exposure to low levels of occupational stress, household tasks for less than 1 h/day, and not living with persons who needed care and support.

CONCLUSIONS

These results suggest that gender differences in insomnia are explained, in the main, by gender differences in work and family characteristics.

Household roles, poverty and psychological distress in internally displaced persons affected by violent conflicts in Indonesia

BACKGROUND

Some of the possible reasons for deteriorating mental health among forced migrants have been identified as poverty, traumatic experiences before migration and postmigration negative life events. Previous studies suggest that the prevalence of psychological distress of forced migrants is higher among women than men. However, there is a lack of studies of internally displaced persons (IDP) that assess the relationship between psychological distress and selected variables in low income countries.

OBJECTIVES

This study aims to assess the association between poverty, household roles and psychological distress among IDP in Ambon, Indonesia, and to identify different risk factors of psychological distress across household roles.

METHODS

In a cross-sectional study carried out in Ambon from July to September 2005, 460 adults were recruited from 200 households in 10 camp locations on Ambon Island. The Hopkins Symptom Check List-25 was used as a dichotomous variable ("case" score >/= 1.75) to measure psychological distress, and questionnaires were used to measure socioeconomic level, trauma experiences related to conflict and current health conditions. Data were collected through face-to-face structured interviews.

RESULTS

The overall prevalence of psychological distress was 47%. Prevalence was highest among women, regardless of their household roles (55%), and lowest among men (37%). Different risk factors for psychological distress were identified for each household role. Poverty-related risk factors were only significant among "mothers". An important risk factor for "fathers" was long-term illness (lasting more than three months), and for "mothers" was witnessed murder.

CONCLUSION

Different risk factors were identified for each household role of IDP, indicating that their mental health care requirements may be different.

Anxiolytic effects of steroid hormones during the estrous cycle. Interactions with ethanol

Behavioral differences in anxiety have been observed between both males and females and across the ovarian cycle in females. However, the data are not entirely consistent and the mechanisms of this potential interaction are largely unexplored. It appears that the GABA/BZ receptor complex is a site of action for steroids as well as for many anxiolytic drugs. Both natural steroids, such as progesterone and its metabolites, and synthetic steroids, such as alphaxalone, reduce anxiety-like behavior in rats. Alphaxolone also reverses the behavioral effects of potent anxiogenic agents in the conflict test of anxiety. Studies reported here found that ethanol administered to rats in different phases of the estrous cycle was more effective as an anxiolytic when hormone levels were high. The anticonflict response to chlordiazepoxide also was examined in ovariectomized and steroid-replaced female rats. Insight into the mechanisms and sites of action for these steroids can be gained from such an approach.

Gender differences of depressive symptoms in depressed and nondepressed elderly persons

OBJECTIVES

Women suffer more frequently from major depression and depressive symptoms than men. The somatic and the atypical subtype of depression seem to be more prevalent in women. However, few studies investigated gender differences of depressive symptoms in the elderly. These gender differences in the elderly will be investigated in the present study.

METHODS

In the course of a family study 236 subjects with a lifetime diagnosis of major depression aged > 50 years and 357 control subjects from the general population matched for age and gender were questioned using the Composite International Diagnostic Interview (CIDI). Chi-square tests were used to compare the individual depressive symptoms between men and women and logistic regression analyses were performed to account for the subjects' age, cognitive performance, family and employment status.

RESULTS

Women in the general population suffered from more depressive symptoms than men and had more appetite disturbance and joylessness. These gender differences could be entirely explained by gender differences in the family and the employment status. Men and women with a major depressive disorder presented with a distinct profile of symptoms that could not be explained by psychosocial factors: elderly depressed women presented with more appetite disturbances and elderly depressed men with more agitation.

CONCLUSION

Major depression in the elderly presents with partially different symptoms in men and women. The results suggest that the gender differences in the symptoms of major depression in the elderly reflect gender differences in the perception and the expression of depressive syndromes.

Mental disorders and medical conditions. A community study in a small island in Spain

OBJECTIVES

This study focuses on the comorbidity between medical and psychiatric illnesses in a sample taken from the general population.

METHODS

We design a two-stage epidemiological community study in the island of Formentera (Spain), using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). In the first stage, the sample (N=697) was screened using the General Health Questionnaire (GHQ-28). In the second stage, the SCAN, subjects' clinical histories and General Practitioners' diagnosis were used to evaluate psychiatric disorders and medical illnesses. The final sample comprised 242 subjects.

RESULTS

Subjects with diagnosed ICD-10 mental disorders presented higher comorbidity with medical pathologies than the group of respondents without psychiatric diagnosis, although the differences were not statistically significant. Of the psychiatric conditions, mood disorders (in which differences were significant) and neurotic disorders were the ones that most frequently presented comorbidity, followed by sleep disorders. Mean scores on the GHQ-28 used at the screening stage, and mean scores on neurotic, depressive and somatic symptoms on the SCAN, were significantly higher in the comorbid group. Comorbidity was more frequent in females.

CONCLUSION

More studies on comorbidity in general population are required, with diagnostic instruments that cover the whole of the psychiatric spectrum and correct assessment systems for medical diagnosis.

Gender and minor psychiatric morbidity: results of a case-control study in a developing country

OBJECTIVE

Women suffer from minor psychiatric disorders (MPM) more frequently than men. Most of the studies were conducted in England and in the United States and some reported the higher occurrence of MPM among women to be modified by marital status and others by sociodemographic variables. The present study intends to address this question in a developing country.

METHOD

A population based case-control study was conducted in three important urban centers in Brazil. Two hundred seventy-six individuals diagnosed as new cases of MPM and 261 controls were selected to investigate the role of a set of sociodemographic variables in the association between gender and MPM using logistic regression models.

RESULTS

Univariate analysis showed that women were more likely than men to suffer from MPM (OR = 3.34; 2.27-4.91). After controlling for other sociodemographic variables, female gender was still positively associated with MPM, but not in a homogeneous way. A multiplicative interaction of gender with age group was found (LRT = 6.01; 2 df; p = 0.05) suggesting an increment in the magnitude of the association among those older than thirty years. Odds-ratios were 2.33 (1.19-4.55), 6.85 (2.86-16.41), and 7.47 (2.90-19.22) for age groups of fourteen to twenty-nine; thirty to forty-four; forty-five or more, respectively. There was no evidence of interaction of gender with marital status or other sociodemographic variables.

CONCLUSIONS

The findings are consistent with the modification of the association between gender and MPM being mediated by social factors.

Psychological distress and its correlates in secondary school students in Pavia, Italy

Adolescence is a time of social as well as biological transition; nevertheless, there are very few epidemiological studies in this field in Italy. Therefore, we felt it would be useful to conduct a cross-sectional study on a sample of 1346 adolescents aged 14-19 years attending high schools in the Health Authority Area of Pavia (northern Italy) through a multi-dimensional approach, taking into consideration physical and psychological health, life habits, family environment and social life of teen-agers. We used a structured self-administered questionnaire consisting of 264 question items to achieve the study aim, which was to find the variables (among personal data, scholastic, family, relational characteristics and habits) correlated with psychological distress. The results showed that in this sample psychological distress (evaluated by GHQ-30) was significatively (p < 0.005) associated with female sex, problems with school friends and teachers, having at least one immigrant parent (from a region different from that of residence), little love for parents and poor parental psycho-physical health status, staying at home on the weekend, smoking and using psychoactive medicines.

[Health status of adolescents: what relations with family image? Adolescents Work Group]

INTRODUCTION

Many studies have been carried out recently to investigate the relationship between health conditions and family and self characteristics.

OBJECTIVES

To identify family characteristics (such as type of family, socio-economic status, parent immigration, affection for parents, parents' psychological and physical health) and self characteristics (age, drug use, satisfaction for several life circumstances, psychosomatic symptomatology) that are differently distributed by sex and levels of psychological and physical distress among teen-agers.

METHODS

We carried out a cross-sectional study on a sample of teen-agers attending high school in Pavia (Italy), using a self-administered questionnaire. The students were divided in four groups having different levels of psychological and physical distress, based on GHQ-30 (psychological distress indicator), on the number of hospital admissions and consultations to a physician in the last year (the last two are physical distress indicator). Data were analysed applying the multivariate analysis of Canonical Variate.

RESULTS

1346 students were sampled, but only 1189 questionnaire were analysed: 36.8% regarding males and 63.2% females. The Canonical Variate analysis indicated that psychosomatic symptomatology, satisfaction for several life circumstances and affection for parents are important for describing the four distress groups.

CONCLUSIONS

Only affection for parents has an important role on psychological and physical distress of adolescents, while family characteristics traditionally considered associated with psychological and physical distress in teen-agers (such as living with one or without parents, low socio-economic status) are not associated.

The contribution of epidemiology to psychosomatic medicine

OBJECTIVE

To discuss the contribution of epidemiology and epidemiological methods to psychosomatic medicine.

METHOD

Critical review of the literature, including both philosophical concepts and empirical data.

RESULTS

The adjective "psychosomatic" has been used in two different ways: in the so called "psychosomatic" or holistic approach to medicine; and in a narrower approach, referring to particular disorders in which psychological factors were considered to have a fundamental aetiological role. While the ideal of the holistic, "humanistic" or "anthropological" approach should probably be never abandoned, the practical limitations of encompassing models, including Engel's bio-psycho-social model are also obvious: they may be heuristically sterile. On the other side, in relation to the narrow psychosomatic approach, psychogenetic views in the so called "psychosomatic illnesses" have been strongly criticized on empirical grounds. The potential of epidemiological methods to study these illnesses, but also "somatopsychic" disorders is shown in a number of papers in the empirical literature. We have grouped such contributions, including our own experience, in the five categories suggested by M. Shephered for epidemiological methods in general: 1) the completion of the spectrum of disease; 2) the establishment of outcome; 3) the actuarial assessment of morbid risk; 4) the evaluation of the efficacy of treatment; and 5) the conceptual construction of diagnosis and classification.

CONCLUSIONS

The contribution of epidemiological data to areas of interest in psychosomatic medicine has been relevant in recent years. The potential of epidemiological methods in this area is very important both to increase knowledge and to improve the quality of clinical practice.

Physical and psychiatric comorbidity in general practice

BACKGROUND

The aim of this study was to determine the association between physical and psychiatric morbidity among general practice patients and to explore the influence of possible intervening variables.

METHOD

Physical and psychiatric morbidity in 1620 consecutive patients attending their general practitioner (GP) was assessed using a two-stage design. Ninety-four per cent of the patients (n = 1523) were successfully screened using the General Health Questionnaire (GHQ-12); 428 of the 602 patients (71%) eligible for the second stage were interviewed using the Composite International Diagnostic Instrument adapted for use in primary health care (CIDI-PHC), the Brief Disability Questionnaire (BDQ) and the Groningen Social Disability Schedule (GSDS) to assess psychiatric, physical and social status. Assessments of physical and psychiatric morbidity were also obtained from the patients' GPs.

RESULTS

There was a significant association between physical and psychiatric morbidity, although patients with four symptoms or less of physical illness were no more likely to be psychiatric cases than those with none. The association was accounted for by patients at the severe end of the physical continuum with five or more medically explained somatic symptoms: these were twice as likely to be psychiatric cases as those with no such symptoms. Female gender, social disability and physical disability were all significantly more likely to be associated with psychiatric disorder, whether measured by GP or research interview; and these relationships remained after the data were corrected for age differences.

CONCLUSIONS

Patients in general practice with moderate to severe physical morbidity are at increased risk of developing psychiatric illness, and when medical illness is present, psychiatric symptoms are more severe. As physical and psychiatric comorbidity is relatively common in general practice, the specific needs of these patients should receive greater attention.

Alcohol consumption in a rural area of Cantabria

A two-stage cross-sectional survey was performed in a representative rural sample of the autonomous community of Cantabria, to investigate the social, medical and psychopathological factors associated with alcohol consumption. Alcohol consumption was investigated by means of a specific questionnaire. Mental and physical health was evaluated in the first-stage sample using: (1) the General Health Questionnaire, (2) the Cornell Medical Index. In the second stage all members of the sample were interviewed at home using the 140-item version of the Present State Examination (PSE-9). We found that 25.4% of males and 0.6% of females were consuming more than 63 alcohol units per week. Alcohol consumption was significantly associated with different social variables. Although it was possible to detect an increase in weekend drinking, especially in the heavy alcohol users, daily alcohol consumption, mainly around meals, was the predominant drinking pattern. We also found a significant inverse association between excessive alcohol consumption and the presence of physical or mental illness. Excessive alcohol use tended to be associated in males with depression and in females, with anxiety.

Sex differences in morbidity: a case of discrimination in general practice

Several factors influence sex differences in morbidity and general practice utilization rates. These factors are of a biological, social and behavioural nature and have differential effects on varying morbidity types. Secondary analysis of data from the Australian Morbidity and Treatment Survey 1990-91, was conducted using multiple logistic regression to discriminate female from male patient encounters in general practice. This approach considered possible confounding influences of GP and patient characteristics. The results showed there was a tendency for larger differences in the types of problems managed than in the types of reasons for encounter presented. Morbidity related to the reproductive, genitourinary and neurological systems, the blood, and of a psychological and social nature were significant contributors to female poor health and service utilization. Females were also more likely to present with digestive, cardiovascular and respiratory problems, while males were more likely to have digestive and cardiovascular problems managed. Furthermore, males were more likely to present skin complaints and have them managed. The potentially higher rates for males in cardiovascular, digestive, skin and respiratory morbidity not only reflect biological differences, but suggest differences in health reporting, utilisation and illness preventive attitudes.

Pathways to psychiatric care in Cantabria

This article delineates the pathways taken in different health areas of Cantabria (Spain) by a series of newly referred patients to the mental health services and explores the influence of sociodemographic, medical and service-related factors on the delays in referral. The work forms part of an ongoing World Health Organization multicentre research programme aimed at exploring and optimizing the quality of mental health care in different centres of the world. We found that, in a rural health area, the majority of newly referred patients establish the first contact with the general practitioner and to a lesser extent with the hospital doctor and from there directly progress to the psychiatric services; in the urban health area there is a greater tendency to contact specialized medical and psychiatric services. Delays in these health areas are remarkably short and are comparable to the ones in other European centres. Our data also show that somatic symptoms are the main presenting problem both at the primary care and at the mental health level; and that, in general, psychotropic drug prescriptions are high both in hospital and in general medical settings, and that women were more often prescribed psychotropic medication than men.

Risk factors for the onset of depression in middle age and later life

Using prospectively gathered data to study first-time occurrence of major depression rather than its persistence, this inquiry tested whether the risk of major depression might be elevated among middle-aged and older adults who were not currently working for pay and among those with less than 12 years of schooling. Diagnostic interviews were administered 1 year apart to identify incident cases of major depression among 7,737 continuing participants of the Epidemiologic Catchment Area Program aged 40 years and older. After all subjects were sorted into risk sets by age and residence census tract, and after persons with a prior history of major depression were excluded, in 162 risk sets, there were 180 incident cases as well as 960 subjects at risk for future occurrence of major depression. The estimated risk for persons not currently working for pay was not reliably greater than the level of risk for those currently working for pay [estimated relative risk (RR) = 1.48; 95% confidence interval (CI), 0.85-2.56]. Compared with adults who had 12 or more years of schooling, those who had less schooling were at increased risk (RR = 2.22; 95% CI, 1.42-3.46). Compared to men with more than 12 years of schooling, women with less schooling were at especially increased risk for major depression over the course of the 1-year follow-up interval (RR = 3.26; 95% CI, 1.78-5.95).

The effects of physical illness on psychiatric disorder

Somatic symptoms of both organic and non-organic causes are associated with an increase in psychiatric morbidity irrespective of setting; patients with chronic medical conditions are approximately twice as likely to report psychiatric disorder as controls. This increase cannot be entirely explained in terms of help-seeking behaviour, recognition rates by treating doctors or treatment outcome. The detection and treatment of coincident psychiatric disorder in this group of patients needs further clarification.