We are pleased to present this evidence based review which contains a reappraisal of the status of women’s mental health problems in different regions of the world. It updates and reactualizes a first publication on Psychosocial and Mental Health Aspects of Women’s Health issued by the Divisions of Mental and Family Health in 1993.
Over the years, the work of many WHO departments has converged with the concerns of the Key Centre for Women's Health in Society, University of Melbourne, in documenting the impact of discrimination and low socio-economic status on the health of women. More recently, there has been a shift from a focus on “women” to a focus on “gender” as a critical determinant of health. We are committed to the integration of gender issues in all our work and to the utilization of gender analysis in the development of mental health policies and programmes. In line with the recommendations articulated in the Beijing Platform of Action, the Programme of Action of the International Conference on Population and Development, and the Convention on the Elimination of All Forms of Discrimination Against Women, we are strengthening attention to the tremendous health burden of women that is created by gender discrimination, poverty, social position, and various forms of violence against women.
In the Global Burden of Disease, it is estimated that depression will become the second most important cause of disease burden in the world by the year 2020. Women in developed and developing countries alike are almost twice as likely as men to experience depression. Another two of the leading causes of disease burden estimated for the year 2020, namely violence and self inflicted injuries, have special relevance for women’s mental health.
This document adopts a health determinants framework for examining the evidence related to women’s poor mental health. From this perspective, public policy including economic policy, socio-cultural and environmental factors, community and social support, stressors and life events, personal behaviour and skills, and availability and access to health services, are all seen to exercise a role in determining women’s mental health status. Similarly, when considering the differences between women and men, a gender approach has been used. While this does not exclude biological or sex differences, it considers the critical roles that social and cultural factors and unequal power relations between men and women play in promoting or impeding mental health. Such inequalities create, maintain and exacerbate exposure to risk factors that endanger women’s mental health, and are most graphically illustrated in the significantly different rates of depression between men and women, poverty and its impact, and the phenomenal prevalence of violence against women.
The document collects and analyses the latest research evidence pertaining to the study of these issues and identifies the most pertinent risk factors and social causes that account for much of the poor mental health of millions of women around the globe. It also highlights the current gaps in knowledge that must be addressed through cross-cultural epidemiological, behavioural and operational research, especially in the developing countries, since most of the present research is directed at the situation in the richer, developed countries. Finally, the document provides pointers to the most.
Although it is not intended to be used as a guideline per se, it is our hope that readers will benefit from the analysis of evidence provided in this document and be guided on the priorities for research and action in this critical area. As a follow up to this review, we will address the need for a more practical, user-friendly guide to assist health workers and managers in becoming aware of their vital role in alleviating the mental health problems of women through a variety of individual and community based interventions. In the meantime, WHO along with its collaborating centres, will continue to provide technical support to countries upon their request, to develop culturally sensitive policies and programmes addressing the individual and social risk factors that account for the pervasive damage to so many women’s mental wellbeing in all countries of the world.
Contents
Acknowledgements
Preface
Introduction
PART ONE : GENDER DEVELOPMENT AND HEALTH
Background
Social position, poverty and health
Influences on women's well being: Gender development
Economic policies, access and equity
Economic policies and women's social position
Social position, righs and mental health promotion
Women's mental health concerns
PART TWO : DEPRESSION IN WOMEN
Social theories of depression
Social theories of depression in women
Characteristic features of severe events: humiliation and entrapment
Social mentalities and rank
Severe events and rates of depression
Summary
PART THREE : POVERTY, SOCIAL POSITION AND MENTAL HEALTH
Relationship between social class and mental health
Measurement of women’s socio-economic status (SES)
Behavioural risk factors, physical and psychological comorbidity
Need to link physical and mental health
Chronic difficulties and acute crises
Summary
Place, severe events and depression
Core ties, identity and the ethic of care
PART FOUR : VIOLENCE AGAINST WOMEN
The problem
Terminology
Violence in health care
Prevalence of violence against women in 'peace' time
Physical partner violence
Violence and reproductive functioning
Sexual violence in adulthood
Reactions to violence
Child sexual abuse
Multiple forms of violence
Revictimisation
Consequences of violence
Common features of violence and depression
Suicidal behaviour
Depression and anxiety
Post-traumatic stress
Comorbidity and the burden of violence
Barriers to understanding
Accounting for violence
Coping with violence
Summary
Reducing the psychological impact of violence
Psychosocial factors
Need for multilevel analysis
BIBLIOGRAPHY
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Over the years, the work of many WHO departments has converged with the concerns of the Key Centre for Women's Health in Society, University of Melbourne, in documenting the impact of discrimination and low socio-economic status on the health of women. More recently, there has been a shift from a focus on “women” to a focus on “gender” as a critical determinant of health. We are committed to the integration of gender issues in all our work and to the utilization of gender analysis in the development of mental health policies and programmes. In line with the recommendations articulated in the Beijing Platform of Action, the Programme of Action of the International Conference on Population and Development, and the Convention on the Elimination of All Forms of Discrimination Against Women, we are strengthening attention to the tremendous health burden of women that is created by gender discrimination, poverty, social position, and various forms of violence against women.
In the Global Burden of Disease, it is estimated that depression will become the second most important cause of disease burden in the world by the year 2020. Women in developed and developing countries alike are almost twice as likely as men to experience depression. Another two of the leading causes of disease burden estimated for the year 2020, namely violence and self inflicted injuries, have special relevance for women’s mental health.
This document adopts a health determinants framework for examining the evidence related to women’s poor mental health. From this perspective, public policy including economic policy, socio-cultural and environmental factors, community and social support, stressors and life events, personal behaviour and skills, and availability and access to health services, are all seen to exercise a role in determining women’s mental health status. Similarly, when considering the differences between women and men, a gender approach has been used. While this does not exclude biological or sex differences, it considers the critical roles that social and cultural factors and unequal power relations between men and women play in promoting or impeding mental health. Such inequalities create, maintain and exacerbate exposure to risk factors that endanger women’s mental health, and are most graphically illustrated in the significantly different rates of depression between men and women, poverty and its impact, and the phenomenal prevalence of violence against women.
The document collects and analyses the latest research evidence pertaining to the study of these issues and identifies the most pertinent risk factors and social causes that account for much of the poor mental health of millions of women around the globe. It also highlights the current gaps in knowledge that must be addressed through cross-cultural epidemiological, behavioural and operational research, especially in the developing countries, since most of the present research is directed at the situation in the richer, developed countries. Finally, the document provides pointers to the most.
Although it is not intended to be used as a guideline per se, it is our hope that readers will benefit from the analysis of evidence provided in this document and be guided on the priorities for research and action in this critical area. As a follow up to this review, we will address the need for a more practical, user-friendly guide to assist health workers and managers in becoming aware of their vital role in alleviating the mental health problems of women through a variety of individual and community based interventions. In the meantime, WHO along with its collaborating centres, will continue to provide technical support to countries upon their request, to develop culturally sensitive policies and programmes addressing the individual and social risk factors that account for the pervasive damage to so many women’s mental wellbeing in all countries of the world.
Contents
Acknowledgements
Preface
Introduction
PART ONE : GENDER DEVELOPMENT AND HEALTH
Background
Social position, poverty and health
Influences on women's well being: Gender development
Economic policies, access and equity
Economic policies and women's social position
Social position, righs and mental health promotion
Women's mental health concerns
PART TWO : DEPRESSION IN WOMEN
Social theories of depression
Social theories of depression in women
Characteristic features of severe events: humiliation and entrapment
Social mentalities and rank
Severe events and rates of depression
Summary
PART THREE : POVERTY, SOCIAL POSITION AND MENTAL HEALTH
Relationship between social class and mental health
Measurement of women’s socio-economic status (SES)
Behavioural risk factors, physical and psychological comorbidity
Need to link physical and mental health
Chronic difficulties and acute crises
Summary
Place, severe events and depression
Core ties, identity and the ethic of care
PART FOUR : VIOLENCE AGAINST WOMEN
The problem
Terminology
Violence in health care
Prevalence of violence against women in 'peace' time
Physical partner violence
Violence and reproductive functioning
Sexual violence in adulthood
Reactions to violence
Child sexual abuse
Multiple forms of violence
Revictimisation
Consequences of violence
Common features of violence and depression
Suicidal behaviour
Depression and anxiety
Post-traumatic stress
Comorbidity and the burden of violence
Barriers to understanding
Accounting for violence
Coping with violence
Summary
Reducing the psychological impact of violence
Psychosocial factors
Need for multilevel analysis
BIBLIOGRAPHY
Download
PDF Ebook
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