Gender Differences in Mental Health and Stress

Amity Institute of Psychology and Allied Sciences
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AIPS
Gender and Mental Health
Health & Fitness,
Stress & Coping
Treatment for Mental Disorders
BA (Hons) 5 Semester

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•Mental health is a term used to describe either a level of cognitive or emotional well-being
or an absence of a mental disorder.
• From perspectives of the discipline of positive psychology or holism, mental health may
include an individual’s ability to enjoy life and procure a balance between life activities and
efforts to achieve psychological resilience.
•On the other hand, a mental disorder or mental illness is an involuntary psychological or
behavioral pattern that occurs in an individual and is thought to cause distress or disability
that is not expected as part of normal development or culture.
•Gender is a critical determinant of mental health and mental illness. The morbidity
associated with mental illness has received substantially more attention than the gender
specific determinants and mechanisms that promote and protect mental health and foster
resilience to stress and adversity.

INTRODUCTION
• Mental health problems are among the most important contributors to the global
burden of disease and disability.
• Mental and neurological conditions account for 12.3% of disability adjusted life
years (DALYs) lost globally and 31% of all years lived with disability at all ages and
in both sexes, according to 2000 estimates. These conditions are a concern in
industrialized as well as in developing countries, where the mental health situation
has shown limited improvement, and may have deteriorated significantly in many
communities.
• Although there do not appear to be sex differences in the overall prevalence of
mental and behavioral disorders, there are significant differences in the patterns and
symptoms of the disorders. These differences vary across age groups.
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GENDER DIFFERENCES THROUGH THE YEARS
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UNDERLYING FACTORS OF GENDER DIFFERENCES IN MENTAL DISORDERS
• Gender difference
• A large number of studies provide strong evidence that gender-
based differences contribute significantly to the higher prevalence of
depression and anxiety disorders in girls and women when
compared to boys and men.
• The feeling of a lack of autonomy and control over one’s life is
known to be associated with depression.
• Socially determined gender norms, roles and responsibilities place
women, far more frequently than men, in situations where they have
little control over important decisions concerning their lives. 6

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THEORIES OF DEPRESSION
•Sex differences in depression can be understood by distinguishing between two sets of factors:
•susceptibility factors and precipitating factors (Radloff & Rae, 1979).
•Susceptibility factors are innate, usually biological, factors that place women at greater risk for depression than men.
•Hormones or genes unique to women would be susceptibility factors.
•Gender-role socialization, however also could be a susceptibility factor. If we learn women are socialized in different
ways than men that make them more at risk for depression, their learning history would be a susceptibility factor.
•Precipitating factors are environmental events that trigger depression. If certain environmental factors induce
depression—and women face them more than men—such as poverty or high relationship strain, depression might be
triggered more in women than in men.
•One fact that any theory of sex differences in depression must take into consideration is that sex differences in
depression do not appear until adolescence. Before age 13 or 14, boys and girls are equally depressed or boys are more
likely than girls to be depressed (Twenge & Nolen-Hoeksema, 2002).
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This fact suggests that any theory of sex differences in depression must take one of three forms (Nolen-Hoeksema &
Girgus, 1994):
(1) same cause but cause activated in females during adolescence,
(2) different causes but female cause activated in adolescence, or (3) interactive theory, in which females have more of the
cause than males and the cause is activated in adolescence.
The same cause theory suggests that the same factor causes depression in both females and males, but that factor must
increase during adolescence for females only.
For example, imagine that a poor body image was equally associated with depression in girls and boys, but a poor body
image increased among girls but not boys during adolescence.
The different cause theory says there are different causes of girls’ and boys’ depression, and only the cause of girls’
depression increases during adolescence.
For example, imagine a poor body image is associated with depression among girls and being a poor athlete is associated
with depression among boys.
This theory could explain the emergence of sex differences in depression during adolescence if it were true that a negative
body image (i.e., women’s risk factor for depression) becomes more prevalent during adolescence, but poor athletic
ability (i.e., men’s risk factor for depression) does not change over time.

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The interactive theory suggests being female always poses a risk for depression, but the events
of adolescence activate that risk factor. For example, imagine females are more concerned than
males with their relationships—before and after adolescence— and that unsatisfying
relationships are more strongly related to girls’ than boys’ distress.
Concern with relationships would be the “female risk factor.” This concern could interact with
events likely to occur during adolescence such as interpersonal conflict. Because females are
more relationship focused than males, girls will be more likely than boys to react to
interpersonal conflict with depression.
In sum, these theories suggest either that the cause of depression is the same for men and
women, that there are different causes for male and female depression, or that environmental
factors interact with predisposing factors to predict depression. Each of the theories that follow
supports one of these perspectives.

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Gender and Stress
Men and women* report different reactions to stress, both physically and
mentally. They attempt to manage stress in very different ways and also perceive
their ability to do so — and the things that stand in their way — in markedly
different ways.
Findings suggest that while women are more likely to report physical symptoms
associated with stress, they are doing a better job connecting with others in their
lives and, at times, these connections are important to their stress management
strategies.

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Stress on the Rise for Women
Though they report similar average stress levels, women are more likely than men to report
that their stress levels are on the rise. They are also much more likely than men to report
physical and emotional symptoms of stress. When comparing women with each other, there
also appears to be differences in the ways that married and single women experience stress.
Women are more likely than men (28 percent vs. 20 percent) to report having a great deal of
stress.Almost half of all women (49 percent) surveyed said their stress has increased over the
past five years, compared to four in 10 (39 percent) men.
Women are more likely to report that money (79 percent compared with 73 percent of men)
and the economy (68 percent compared with 61 percent of men) are sources of stress while
men are far more likely to cite that work is a source of stress (76 percent compared with 65
percent of women).

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Women are more likely to report physical and emotional symptoms of stress than men, such as
having had a headache (41 percent vs. 30 percent), having felt as though they could cry (44
percent vs. 15 percent), or having had an upset stomach or indigestion (32 percent vs. 21 percent)
in the past month.
Married women report higher levels of stress than single women, with one-third (33 percent)
reporting that they have experienced a great deal of stress in the past month (8, 9 or 10 on a 10-
point scale) compared with one in five (22 percent) of single women.
Similarly, significantly more married women report that their stress has increased over the
past five years (56 percent vs. 41 percent of single women).
Single women are also more likely than married women to say they feel they are doing enough to
manage their stress (63 percent vs. 51 percent).
Married women are more likely than single women to report they have experienced the following
due to stress in the past month: feeling as though they could cry (54 percent vs. 33 percent),
feeling irritable or angry (52 percent vs. 38 percent), having headaches (48 percent vs. 33 percent)
and experiencing fatigue (47 percent vs. 35 percent).

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Men and women report wide gaps between determining what is important and how successful they are
at achieving those behaviors.
Women are much more likely than men to say that having a good relationship with their families is
important to them (84 percent vs. 74 percent). While fewer women say they are doing a good job at
succeeding in this area, they outpace men (67 percent vs. 53 percent).
Women are also more likely than men to say that having a good relationship with their friends is
important to them (69 percent vs. 62 percent), even though friendship is cited less often than family for
both men and women.
Even though nearly half of all women (49 percent) say they have lain awake at night in the past month
because of stress, three-quarters of women rate getting enough sleep as extremely or very important (75
percent compared with 58 percent of men).
Across the board, men’s and women’s perceptions of their ability to succeed in areas that are important
to their well-being are far out of line with the importance they place on these behaviors. Even more so
than women, men report less likelihood of success in these areas.

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Only 33 percent of women report being successful in their efforts to get enough sleep
(compared with 75 percent who believe this is important); only 35 percent report success in
their efforts to manage stress (compared with 69 percent who believe this is important); 36
percent report success in their efforts to eat healthy (compared with 64 percent who believe
this is important); and only 29 percent are successful in their efforts to be physically active
(compared with 54 percent who believe this is important).
Only 25 percent of men report being successful in their efforts to get enough sleep
(compared with 58 percent who believe this is important); only 30 percent report success in
their efforts to manage stress (compared with 59 percent who believe this is important);
only 25 percent report success in their efforts to eat healthy (compared with 52 percent who
believe this is important); and only 26 percent are successful in their efforts to be
physically active (compared with 54 percent who believe this is important).

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Strategies for Managing Stress
Regardless of their sources of stress and the physical and emotional symptoms of stress that men and women
report, both groups say they manage their stress in very different ways.
In general, though, both men and women tend to choose sedentary activities like reading, listening to music and
watching television to manage their stress over healthier behaviors like seeing a mental health professional or
exercising.
Women are far more likely than men to say they read to manage stress (57 percent vs. 34 percent for men) and
overall, tend to report more stress management activities that connect them with other people, like spending
time with friends or family (54 percent vs. 39 percent) and going to church or religious services (27 percent vs.
18 percent).Men are more likely than women to say they play sports (16 percent vs. 4 percent) and listen to
music (52 percent vs. 47 percent) as a way of managing stress.
They are also more likely than women to say they do nothing to manage their stress (9 percent vs. 4
percent).Women are more likely than men to report that they eat as a way of managing stress (31 percent vs. 21
percent). Similarly, women also report having eaten too much or eaten unhealthy foods because of stress in the
past month far more often than men (49 percent of women vs. 30 percent of men).

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•Significantly more women (35 percent) than men (24 percent) exercise only once a week or less. When asked
why they don’t exercise more often, they are more likely than men to say they are just too tired (39 percent vs.
26 percent).
•Men are more likely to say they exercise because it gives them something to do (34 percent vs. 23 percent),
keeps them from getting sick (29 percent vs. 18 percent) and is something they are good at (19 percent vs. 11
percent).
•The things that men and women say prevent them from taking better care of themselves differ greatly
as well.
•While both genders cite lack of willpower as the No. 1 barrier to change, women are more likely than men to
cite lack of willpower as a barrier preventing them from making the lifestyle and behavior changes
recommended by a health care provider (34 percent vs. 24 percent).
•Women are far more likely than men to say that lack of willpower also has prevented them from changing
their eating habits (15 percent vs. 1 percent).When asked what they would need to change in order for their
willpower to improve, women were more likely than men to say less fatigue/more energy (56 percent vs. 44
percent) and more confidence in their ability to improve their willpower (60 percent vs. 38 percent).

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Coping
Coping refers to the different strategies that we use to manage stressful events and the
accompanying distress associated with them. If your girlfriend breaks up with you, you may go
talk to a friend about it, you may wallow in self-pity, you may try to figure out what happened,
or you may decide to go swimming to take your mind off things.
All of these represent different ways of coping. One distinction that has been made in the
literature is between emotion focused coping and problem-focused coping (Lazarus &
Folkman, 1984).
Problem-focused coping refers to attempts to alter the stressor itself. Finding a solution to the
problem, seeking the advice of others as to how to solve the problem, and coming up with a
plan to approach the problem are all problem-solving methods.
Emotion-focused coping refers to ways in which we accommodate ourselves to the stressor.
There are a variety of emotion focused coping strategies that are quite distinct from one another.
Distracting oneself from the stressor, avoiding the problem, and denying the problem’s
existence are all ways we change our reaction to the stressor rather than altering the stressor
itself. Talking about the problem to relieve distress, accepting the problem, and putting a
positive spin on the problem are also emotion-focused ways of coping.

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Investigators frequently suggest that women cope with stressful events by engaging in emotion-focused
strategies and men cope by engaging in problem-focused strategies. Although the conceptual distinction between
problem-focused coping and emotion-focusing coping is a useful one, this distinction may be less useful when
studying gender.
When coping strategies are placed into these two broad categories, sometimes expected sex differences appear
(i.e., women are more emotion focused, men are more problem focused), sometimes no sex differences appear,
and sometimes sex differences appear in the opposite direction (i.e., women are more problem focused).
The broad categories of emotion-focused coping and problem-focused coping average across distinct coping
strategies, and only some of these may show sex differences.
For example, researchers hypothesize that men are more likely than women to engage in problem focused
coping but one primary problem focused coping strategy is to seek the advice of others.
And, we know women are more likely than men to seek out others for help. People can seek different kinds of
help, however. If people seek others’ advice, they are engaging in problem-focused coping; if people seek out
others in order to express feelings, they are engaging in emotion-focused coping. In the latter case, the person is
trying to reduce distress rather than alter the stressor. Researchers do not always distinguish between these two
kinds of support-seeking strategies. However, it is possible that women are more likely than men to do both.

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Specific Coping Strategies
Partly in response to the issues raised earlier—specifically that people seem to think men engaged in problem-focused coping and women engaged
in emotion-focused coping—my colleagues and I conducted a meta-analytic review of the literature on sex comparisons in coping (Tamres,
Janicki, & Helgeson, 2002).
women are more likely than men to engage in nearly all the coping strategies, both problem focused and emotion focused.
The sizes of these sex differences were small, however. The largest differences appeared for positive self-talk (i.e., encouraging oneself), seeking
support, and rumination—all in the direction of women more than men.
Notice that each of these strategies involves the expression of feelings, either to oneself or to someone else.
One difficulty in interpreting the literature on gender and coping is that women may report more of all kinds of coping simply because women are
more distressed than men, and more distressed people try a greater range of strategies.
We found some support for this idea in the meta-analysis.
We argued that sex differences in coping would be better understood by an examination of relative coping, which refers to how likely men or
women are to use one strategy compared to another.
Instead of comparing the frequency with which women and men engage in a specific kind of coping, we compare the frequency with which
women engage in one coping strategy compared to another strategy and the frequency with which men engage in one coping strategy compared to
another strategy.

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Within the range of coping responses, are men relatively more likely to use a strategy compared to women?
For example, imagine both women and men report engaging in problem focused coping with equal frequency:
“some of the time.” For men, this may be the most frequently employed strategy, whereas women may report engaging in
other strategies “almost all of the time.”
In that case, men would engage in problem-focused coping relatively more often than women.
Meta-analysis showed that men engage in relatively more active coping strategies, and women engage in relatively more
support seeking strategies.

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What are the implications for mental health policies and programmes?
Mental health policies and programmes should incorporate an understanding of gender issues in a given context, and be developed in
consultation with women and men from communities and families and from among service-users. Gender-based barriers to accessing
mental health care need to be ad dressed in programme planning.
•A public health approach to improve primary prevention, and address risk factors, many of which are gender-specific, is needed. This
implies going beyond medicalising distress. If gender discrimination, gender based violence and gender-role stereotyping underlies at least
some part of the distress, then these need to be addressed through legislation and specific policies, programmes and interventions.
•Training for building health providers’ capacity to identify and to treat mental disorders in primary health care services needs to integrate
a gender analysis. The training should also raise awareness about specific risk factors such as gender-based violence.
•Primary care and maternal health services that are responsive to psychosocial issues and are sensitive to gender differences are well
placed to provide cost-effective mental health services. In this context, it may be important to promote the concept of ‘meaningful
assistance’ for mental health care needs, including psychosocial counselling and support to cope better with difficult life situations, and not
just prescription of drugs.
•Provision of community-based care for chronic mental disorders should be organized to ensure that facilities meet the specific needs of
women and men, and that the burden of caring does not fall dis-proportionately on women.

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Gender Differences in Mental Health and Stress

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