Depression, Disability, and Rehabilitation Services for Women

Rehabilitation of mentally ill women

Women, the fair sex, are principal providers of care and support to families. But, they are considered to be the weaker sex and one of the most powerless and marginalized sections of our society. The provision of Rehabilitation for mentally ill women has been, and still is, one of the major challenges for mental health systems reform in the last decades, for various reasons. The present paper discusses the global and Indian scenario of rehabilitation of mentally ill women and goes on to detail the contribution of the state and voluntary agencies in this regard. It explores the need of recovery, multilayered strategy of Rehabilitation services and the availability of present services. The stigma attached and legal defects which interfere in good quality of life for the mentally ill women are reviewed. Strategies for changes in future are recommended.

Effect of depression onset on adherence to medication among hypertensive patients: a longitudinal modelling study

OBJECTIVES

Although a link between depression and poor adherence to antihypertensive medication (AHM) has been found, it is not known whether depression actually leads to poorer adherence or whether poor adherence only is a marker of depression. In this study we aimed to determine the time order between hypertension, depression and changes in adherence to AHM.

METHODS

The analyses were based on data gathered from a longitudinal cohort of Finnish employees (The Finnish Public Sector Study). A total of 852 chronically hypertensive men and women at baseline with a recorded onset of depression during the 9-year observation window and 2359 hypertensive control participants matched for age, sex, socio-economic status, time of study entry, employer and geographic area were included in the study. Individuals with any sign of depression during 4 years before the beginning of the study were excluded. To describe long-term trajectories (4 years before and 4 years after the recorded depression) of AHM adherence in relation to the onset of depression, annual data on reimbursed AHM prescriptions were gathered from the national Drug Prescription Register. Annual nonadherence rates (i.e. number of 'days-not-treated') were based on filled prescriptions.

RESULTS

Among male cases, the rate of 'days-not-treated' was 1.52 times higher (95% confidence interval 1.08-2.14) in the years after the onset of depression compared to preonset levels. In women and in male controls, no change in adherence to AHM was observed between these time periods.

CONCLUSION

In hypertensive men, the onset of recorded depression increases the risk of nonadherence to AHM.

Sex differences in the disability associated with mental disorders

PURPOSE OF REVIEW

It is well established that women have a higher prevalence of depression and anxiety disorders, but sex differences in the disability associated with depression and anxiety disorders have been less well researched. Earlier studies suggested that women were more disabled by their depression than were men. Studies of schizophrenia, in contrast, have always found that men were more disabled. Recent studies cast new light on this topic and suggest that sex differences in the disability associated with mental disorders may be more consistent than previously thought.

RECENT FINDINGS

Two general population studies found that men (and boys) with depression or anxiety disorders (or symptoms) reported greater impairment in everyday functioning and social relationships than women with depression and anxiety. These findings are consistent with the research on psychotic disorders and with much of the research on sex differences in long-term sickness absence due to psychiatric disorder.

SUMMARY

Men experience more functional and social impairment in association with episodes of depression, anxiety, and psychosis than their female counterparts. The greater social isolation among men with mental disorders may be attributable to male reticence about disclosing emotional distress, limiting their access to support.

Feminist Psychology and Women with Disabilities

This article is an application of the Guidelines for Psychological Practice with Girls and Women to psychological issues faced by Women with Disabilities. It includes culture-specific issues faced by Women with Disabilities, the multiple roles of Women with Disabilities, the importance of informal support systems, and the intersection between feminism and disability. The voices of Women with Disabilities from a variety of cultures are included to demonstrate the breadth of disability as it impacts women. Attention is given to the impact of worldview on understanding disability (medical condition, limitation due to socially constructed barriers, gap between individual resources and demand for ability, or segregation by ability status) and development of theories, services, and laws. Perspectives of health professionals, disability advocates, and family members are provided to identify issues that need to be included in a comprehensive psychology of Women with Disabilities.

Gender and the association between mental disorders and disability

BACKGROUND

Prior data, especially population data, on gender differences in the association between mental disorders and disability are very sparse and therefore earlier conclusions that women with mental disorders are more disabled than men may be premature. The aim of this study was to determine whether gender moderates the associations between 30 day mood, anxiety and substance use disorders and self-reported 30 day disability in five domains of functioning, in a general population sample.

METHODS

Nationally representative face-to-face household survey of New Zealanders (n=7435) aged 16 years and older, with a response rate of 73.3%. Mental disorders were measured with the Composite International Diagnostic Interview (CIDI 3.0). Health-related disability was measured in all participants with a version of the World Health Organisation Disability Assessment Schedule (WHODAS-II).

RESULTS

Men with either mood or anxiety disorders (aggregated into one category) reported significantly more Role, Social and Cognitive disability than did women with those disorders. There were no gender differences in the associations between mental disorders and the Mobility or Self-Care disability domains, nor were there gender differences in the associations between substance use disorders and any disability domain.

LIMITATIONS

The temporal direction of the association between mental disorders and disability is unknown. Disability is measured by self-report only, which is affected by insight.

CONCLUSIONS

Men with emotional disorders experience disproportionately greater role, social and cognitive disability than women with these disorders. More needs to be understood about how to engage and retain men in mental disorder treatment.