WOMEN ARE MORE SUSCEPTIBLE TO ANXIETY AND DEPRESSION
Why is that, and what can we do about it?
This month, Katz Institute for Women's Health interviewed Kristina M. Deligiannidis, MD, director of women’s behavioral health at Zucker Hillside Hospital.
The country has a mental health crisis on its hands, with rising rates of anxiety, suicide and depression.
“What’s hidden in the scary statistics, but researchers have noticed for some time, is that girls and women suffer from depression and anxiety disorders at twice the rate of boys and men. And it might have a lot to do with hormones,” says Kristina M. Deligiannidis, MD, director of women’s behavioral health at Zucker Hillside Hospital.
Before puberty, girls and boys have similar rates of anxiety and depression. During adolescence, however, the rates of anxiety and depression double for girls compared to boys—and later rise further for women around menopause. After menopause, the rates of anxiety and depression between men and women become comparable again.
It might be tempting to dismiss this as evidence of the trope that women are simply more emotional than men. But research points to deeper, multifactorial explanations:
For starters, women and girls endure societal expectations, biases and stressors that men and boys are not subject to.
Stress affects women’s brains differently than men’s, due to interactions with different hormones, as well as fluctuating hormone levels over a woman’s life.
Women may be more concerned with interpersonal relationships than men and tend to ruminate on relationships, their school or work performance, and other areas of their lives, being self-critical. Society encourages this kind of rumination and self-judgment for women in ways it does not for men.
Prolonged, elevated stress hormone levels due to long-term stress negatively affect body processes, which can make women more susceptible to a host of illnesses, including mental health disorders.
These disparities can have catastrophic consequences. More than 10% of new mothers suffer from perinatal depression. Suicide is the leading cause of pregnancy-related death in the first year postpartum. Women ages 45 to 54 have the highest rate of suicide among women.
Rather than chalking up the disparity to trite stereotypes, heavy investments must be made in women’s health research. Women and girls also need tools that will help protect them when they are most vulnerable. Here’s what needs to happen today to address the anxiety and depression disparities across women’s life spans:
Tools for young girls: Puberty goes on for years and begins as early as age 9. It’s important to give children tools to navigate relationships, school and their own emotions. Education about puberty and changes taking place both physically and emotionally is necessary so that they don’t come as a surprise. They should know that it’s normal and happens to everyone, even at different ages.
Cognitive behavioral tools can help girls identify the triggers for strong emotional reactions or anxious thoughts and help them learn effective ways to manage those feelings. We can reassure girls that they are safe and that often, the worst thing they can imagine is also usually the least likely thing that will happen.
Tools for women: Women are society’s primary caregivers and health care managers, not to mention critical components of the workforce. That’s a lot of work—and a lot of responsibility. While we can address medical vulnerabilities, we also need social, systemic changes to protect women from undue mental health burdens: everything from improved access to perinatal care and parental-leave policies to realistic expectations for work and home life.
Beyond giving women the tools they need to succeed, we also need to work diligently to understand the interactions between the brain, female hormones and the body. And this effort takes research and investment:
Research is the future of medicine, and funding is critical. Research of female conditions outside of oncology make up less than 2% of the current health care pipeline, a baffling fact when women make up more than half the population. Research has led to innovations in the care of women with perinatal depression, and a first-of-its-kind medication to address the illness. Research has also led to innovation in treating the most distressing symptoms of menopause.
Research to understand brain steroids, which are related to the female sex hormone progesterone, may lead to potential treatment for conditions that affect men and women, including Alzheimer’s disease, seizure disorders and traumatic brain injury. The White House has committed $200 million to fund new, interdisciplinary women’s health research, which is welcome news.
We need to have a bigger workforce conducting research into women’s health. Right now, there’s a small number of people who dedicate their lives to women’s health research. We need curious, skilled people to follow their interests and investigate critical questions.
Knowledge from research must be made actionable—and that happens in clinician education. It’s only recently that medical schools are teaching clinicians that disorders can present differently among the sexes. Clinicians cannot treat everyone as the prototypical male—not even men!
“The mental health burden for girls and women is a problem we can solve,” Deligiannidis says, “if we commit the resources necessary to understand why the disparities exist and develop interventions that will protect girls and women from the most significant consequences.”
If you or someone you know is struggling with anxiety or depression, help is available:
For emergencies, call or text 988 to connect with the 24-hour suicide and crisis lifeline.
Learn more about Northwell Health’s behavioral health resources and consider visiting a specialized team member at Zucker Hillside Hospital facilities.
CDC: Coping with Stress—and additional tools for women, teens, and parents.