The secrecy of . . . mental health

In comparison to 30 years ago, women are three times more likely than men to experience a mental health concern. Previously, the statistic sat at twice as likely.

The societal pressures and expectations pinned on women throughout their lives play a significant role in mental health as the social and emotional demands on women impact their mental health at every stage of life.

“Each developmental stage of being a woman brings new opportunities and challenges to navigate,” says Dr Anne-Marie Casey, chair of the Perinatal and Infant Mental Health SIG (special interest group) with the Psychological Society of Ireland (PSI).

From early childhood, through to adolescence, working life, motherhood, menopause, and retirement, Dr Casey – who is also senior clinical psychologist at Children’s Health Ireland at Crumlin – says that “each stage brings new physiological and biological changes, as well as a new psychosocial stage of development.

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“Women need to negotiate their roles and identity with care and attention to the changes and transitions they experience, and to give a sense of success in negotiating the ups and downs of their lifespan in the context of the society they live in.”

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Dr Jillian Doyle, senior clinical psychologist with PSI and the Rotunda Perinatal Mental Health team, emphasises that the feelings of vulnerability that come with varying life events can lead a woman to either accessing support and moving through them, or shying away from the much-needed avenues of discourse, internalising feelings of shame and discomfort.

“Matresence or the time where a woman moves into her own sense of being a mother and develops a parenting skillset is a fraught time for any woman,” she says. “There is a huge responsibility laid at her feet to develop the skills to keep another human alive and not only this but to help them reach their potential.

“This developmental leap is asked of a woman at a time of great physical vulnerability. Potential sequalae of pregnancy, for example incontinence, swollen and leaking breasts and pain all have to be managed alongside the psychological growth that is required.”

Dr Doyle reiterates that not feeling capable enough to confide in others or think beyond the idea that there is “something wrong with me” can have a detrimental impact on a woman’s mental health. “Another important life stage for women is menopause,” she says. “This physiological stage of life often coincides with changes in the family constellation as children become more independent.

“Physiological changes associated with menopause, including weight gain, cessation of menstruation, changes in libido, hair thinning, and facial hair growth, all have the potential to negatively impact a woman’s sense of self and her identity. Women need to be supported as they negotiate these challenges and grow into new elements of themselves. Women and society as a whole need to be able to acknowledge the normality of change and celebrate women.”

Dr Casey points out that, historically, women in Ireland have not had the same opportunities as men. “When we look back at mother and baby homes, laundry houses, and the fact that until 1973, women in the Civil Service were forced to retire when they got married, there is a pattern of discrimination against women and infants,” she says. “These historical events can have a rippling impact that can be passed through the generations, and without bringing important attention and care to women, we are at danger of repeating history unknown to us.”

Women’s mental health, across the board, needs specific attention as, Dr Casey says, the statistics speak for themselves. “When we think of younger Irish women, the Healthy Ireland survey in 2016 found that young women 15-24 years old had the highest level of mental health needs,” she says. “Ten per cent of adolescent females are at risk of eating disorders with one-third endorsing regular dieting. For middle-aged Irish women, 16 per cent of pregnant women are at risk of depression.

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“Reproductive health and infertility can bring extra stressors and a high percentage of middle-aged women have caring responsibilities looking after the home and family which has been shown to put women at higher risk of mental health difficulties. Marginalised women, including asylum seekers, LGBTQI+ and women with disabilities, experience higher rates of mental health difficulties than their peers, and have added challenges accessing mental health services because of racism and discrimination.

“Suicide rates are five times higher in Traveller women than in the general population. In an Irish study, 90 per cent of homeless women had at least one mental health diagnosis. For older adult women, dementia is statistically higher in women than men and depression again is more common in older adult women than men.”

It is important to understand and recognise the biological differences that can impact the diagnosis and treatment of mental health issues. However, not all gender fits into the two categories of male and female as Casey states that “As we move away from binary categories of gender, we may be interested in how mental health is experienced individually rather than a male versus gender approach to these experiences.”

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She assures that there is no definitive answer to the complex question of how mental health is experienced differently between genders. “Research indicates that historical gender differences show higher rates of mood and anxiety disorders among women, which can be categorised as ways of internalising emotional experiences,” she says.

“A metanalysis on depression which included data from 30 countries and 90 research papers showed higher prevalence of depression in women than men. Men show higher levels of antisocial personality and substance-use disorders, which are characterised as externalising behaviours of their emotional experiences. National Health Service figures indicate only 36 per cent of referrals to talking therapies are from men.

“Men may tend to externalise their depression with anger and, at the extreme, in suicide, whereas research suggests women tend to internalise their low mood, experiencing withdrawal, social isolation and loneliness in their experiences of depression. Although variation is noted in the literature among men and women in terms of mental health presentations, these differences may be explained by factors outside of gender, for example social inequalities and the shaping of appropriate and inappropriate emotional experiences from a young age within families and society.”

The stigma of mental health is being actively tackled, however there may remain an internalised and individually experienced shame and guilt that can act as a barrier to women accessing mental health services. Dr Casey reiterates that women’s mental health is part of a larger discussion around the visibility and representation of women in the workforce, the pay gaps, equitable division of gender in the workplace, on State boards, equal share of childcare in relationships with more paternal leave and recognition of the important role of fathers in childrearing in families.

“Until we have parity of positions in society, in the workforce, and with choices and flexibility for women which match those offered to men, we will not have equal opportunities,” she says. “While there is gender discrimination of women, we continue to silence and stigmatise the experience of women in society.”

The secrecy of . . .

1. Periods
2. PND
3. Contraception
4. Miscarriage
5. Menopause
6. Infertility