Mental health - WHO

1 Mental healthGender in ResearchG e n d e rin Mental HealthR e s e a r c hDepartment of Gender, Women and HealthFamily and Community health World health Organization 2005 All rights reserved. Publications of the World health Organization can be obtained fromWHO Press, World health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland(tel: +41 22 791 2476; fax: +41 22 791 4857; email: Requests forpermission to reproduce or translate WHO publications whether for sale or for noncom-mercial distribution should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; email: The designations employed and the presentation of the material in this publication do notimply the expression of any opinion whatsoever on the part of the World health Organiza-tion concerning the legal status of any country, territory, city or area or of its authorities, orconcerning the delimitation of its frontiers or boundaries.))

2 Dotted lines on maps representapproximate border lines for which there may not yet be full mention of specific companies or of certain manufacturers' products does not implythat they are endorsed or recommended by the World health Organization in preference toothers of a similar nature that are not mentioned. Errors and omissions excepted, thenames of proprietary products are distinguished by initial capital reasonable precautions have been taken by WHO to verify the information contained inthis publication. However, the published material is being distributed without warranty ofany kind, either express or implied. The responsibility for the interpretation and use of thematerial lies with the reader. In no event shall the World health Organization be liable fordamages arising from its named authors alone are responsible for the views expressed in this in ItalyiiGender in Mental health researchWHO Library Cataloguing-in-Publication DataPatel, in Mental health research / by Patel Vikram.

3 (Gender and health research series) disorders - epidemiology services accessibility identity factors of illness 92 4 159253 2(NLM classification: W )ISSN 1813-2812iiiAcknowledgements1 Preface2 Abstract3 List of global burden of Mental :female differences in the prevalence of mentalhealth disorders: what we know11 Suicidal behaviours12 Depression14 Alcohol use disorders17 Eating issues in access to treatment and care22 Diagnosis and treatment22 Care of the mentally gaps and recommendations for future resources36 Contents1 AcknowledgmentsThis document was prepared for theWHO Gender and health ResearchSeries by Dr Vikram Patel, Reader inInternational Mental health , LondonSchool of Hygiene & Tropical Medicine,London, England, and Sangath (Societyfor Child Development and FamilyGuidance) Goa, India. Dr Patel express-es his thanks to the Wellcome Trustand MacArthur Foundation for theirgenerous support for his research ongender and Mental health in Gender and health ResearchSeries was developed by theDepartment of Gender, Women andHealth (GWH), under the supervisionof Dr Claudia Garc a-Moreno and withsupport from Dr Salma gratefully acknowledges thevaluable comments received from:Dr Jill Astbury, University ofMelbourne, Melbourne, Australia.

4 Dr Shekhar Saxena, Department ofMental health and Substance Abuse(MSD) at WHO, and would like tothank Ann Morgan for copy-editingthis Gender and health ResearchSerieshas been developed by theDepartment of Gender, Women andHealth (GWH), with assistance frommany other WHO departments, inorder to address some of the mainissues involved in integrating genderconsiderations into health current paper on Mental healthconstitutes one of the booklets in and gender are both importantdeterminants of health . Biological sexand socially-constructed gender inter-act to produce differential risks andvulnerability to ill health , and differ-ences in health -seeking behaviour andhealth outcomes for women and widespread recognition ofthese differences, health research hashitherto, more often than not, failedto address both sex and gender ade-quately. In applied health research, includ-ing the social sciences, the problemhas traditionally been viewed as oneof rendering and interpreting sex dif-ferentials in data analysis and explor-ing the implications for policies andprogrammes.

5 However, examiningthe gender dimensions of a healthissue involves much more than this;it requires unravelling how genderroles and norms, differences inaccess to resources and power, andgender-based discrimination influ-ence male and female health andwell-being. Integrating gender considerationsin health research contributes to bet-ter science and more focused research,and, consequently, to more effectiveand efficient health policies and pro-grammes. With these ambitions inmind, the objectives of The Genderand health Research Series are to:raise awareness of the need tointegrate gender in health research;provide practical guidance on howto do this; andidentify policies and mechanismsthat can contribute to engenderinghealth series is aimed at researchers,research coordinators, managers ofresearch institutions, and researchfunding agencies. It comprises book-lets covering both a general introduc-tion to engendering the researchprocess as well as topic-specificissues such as lung cancer, tuberculo-sis, and Mental health .

6 The researchseries will be extended to other healthtopics in time. Each booklet will review the partic-ular health issue from a gender per-spective, identify best practices inaddressing gender in research and thegaps in gendered research, and makerecommendations to address thosegaps. PrefaceMental health disorders make a size-able contribution to the global burdenof disease, affecting some 450 millionpeople worldwide, yet the resourcesdevoted to Mental health problems inmost parts of the world are grosslyinadequate. The primary objective ofthis paper is to argue for a greateremphasis on gender issues in mentalhealth research. Although overallthere is little difference between menand women in the prevalence of men-tal health problems, there are markedmale:female differentials in the preva-lence of specific disorders, especiallythe more common ones.

7 Both depres-sion and eating disorders exhibit amarked female excess, whereas sub-stance abuse disorders are moreprevalent in men. Men have higherrates of completed suicide but womenhave higher rates of attempted sui-cide. In analysing the role played bygender in shaping these prevalencepatterns, an attempt is also made toexplore how gender factors mightinteract to influence certain risk fac-tors, help-seeking behaviour, treat-ment and care, outcome and finallythe impact of Mental illness. Thepaper also identifies gaps in the cur-rent knowledge base and recom-mends a number of strategies for inte-grating a gender perspective in futuremental health research. 3 Abstract4 ADHDA ttention deficient hyperactivity disorderAUDA lcohol Use DisorderDALYsDisability-adjusted life yearsEATE ating Attitudes TestHIV/AIDSH uman immunodefieciency virus/acquired immunodeficiencysyndromeLEDSB edford Life Events and Difficulties ScaleUNDPU nited Nations Development ProgrammeIARCI nternational Agency for Research on CancerYLDsYears lived with disabilityList of abreviations5 Mental disorders are now widely rec-ognized as a major contributor to theglobal burden of disease.

8 In 2000, sui-cide ranked as the thirteenth leadingcause of death, accounting for815 000 deaths or of all deathsworldwide. Just over a quarter ofthese deaths occurred in young adultmales ( those aged 15-44 years)(WHO, 2002). In terms of ill-healthand disability, the impact of poormental health is even greater: accord-ing to recent WHO estimates, nearlyone-third of all years lived with dis-ability (YLDs) worldwide can be attrib-uted to neuropsychiatric conditions( Mental disorders and neurologicaldisorders combined) (WHO, 2001b). Overall, there is very little differ-ence in the prevalence of Mental dis-orders between men and women. Tomake such a sweeping generalization,however, is to grossly oversimplifythe situation. There are in fact markedmale:female differences in the preva-lence of certain Mental disorders. Inlight of the universal acknowledge-ment of gender as a core issue forhealth and development (see Box 1,page 6), this paper explores to whatextent sex ( biological factors) andgender ( socially-constructed fac-tors) influence not just the prevalenceof Mental health disorders, but alsohow such factors interact to shapehelp-seeking behaviour, care, out-come and impact of Mental example, gender-based factorssuch as unemployment, maritalarrangements and the lethality of sui-cide methods, have all been identifiedas significant in terms of their influ-ence on the rates of suicide andattempted suicide.

9 Gender factorshave also been invoked to explainwhy women are more likely than mento suffer from depression, whereasmen are more likely to abuse , it appears that socially-constructed factors act to produce agreater impact of Mental illness onwomen, but may also contribute inspecific instances to a morefavourable outcome. This document is divided into fourmain sections. A brief overview of theglobal burden of Mental disorders,which is aimed specifically at thosereaders who do not have a specialistbackground in Mental health , followsthis introduction (see section two). Section three outlines the maind i fferences between men and womenin the prevalence of various mentalhealth disorders, including their riskfor suicide, summarizing what is cur-rently known about the role of genderas a determinant of poor mentalhealth. Section four considers genderissues in the context of the treatmentand care of the mentally ill, and in sodoing, highlights the enormous gapbetween the need for Mental healthservice provision and the resourcesavailable in most countries.

10 Sectionfive identifies the gaps in our currentknowledge base and suggests waysof making Mental health researchmore gender-sensitive. Finally, a setof specific recommendations forfuture research is provided by way ofa Introduction6 Sex and GenderSexis the term used to distinguish men and women on the basis of their bio-logical characteristics. Genderon the other hand refers to those distinguish-ing features that are socially constructed. Gender influences the control menand women have over the determinants of their health , for example, their eco-nomic position and social status, and their access to resources. Gender con-figures both the material and symbolic positions that men and women occu-py in the social hierarchy, and shapes the experiences that condition theirlives. Gender is a powerful social determinant of health that interacts withother variables such as age, family structure, income, education and social sup-port, and with a variety of behavioural then do we mean by gender-sensitive research and why is it consid-ered to be so important?