Mental illness is associated with a significant burden of morbidity and disability. The prevalence of psychiatric disorders is increasing at an alarming rate. Despite being very common the mental illnesses are being under diagnosed and under reported. Less than half of those who meet the diagnostic criteria are diagnosed by doctors. The general population is very reluctant to seek help too, stigma being the biggest hurdle especially in the third world countries, like ours.
Gender is a critical determinant of mental health and mental illness.
Gender determines the differential power and control men and women have over the socioeconomic determinants of their mental health and lives, their social position, status and treatment in society and their susceptibility and exposure to specific mental health risks. Gender differences have been reported in age of onset of symptoms, frequency of psychotic symptoms, course of these disorders, social adjustment and long term outcome.
WOMEN MENTAL HEALTH: SOME FACTS:
Mental illness is associated with a significant burden of morbidity and disability. The prevalence of psychiatric disorders is increasing at an alarming rate. Despite being very common the mental illnesses are being under diagnosed and under reported. Less than half of those who meet the diagnostic criteria are diagnosed by doctors. The general population is very reluctant to seek help too, stigma being the biggest hurdle especially in the third world countries, like ours.
Gender is a critical determinant of mental health and mental illness.
Gender determines the differential power and control men and women have over the socioeconomic determinants of their mental health and lives, their social position, status and treatment in society and their susceptibility and exposure to specific mental health risks. Gender differences have been reported in age of onset of symptoms, frequency of psychotic symptoms, course of these disorders, social adjustment and long term outcome.
IT IS CONSIDERED THAT WOMEN ARE MORE VULNERABLE TO PSYCHIATRIC DISORDERS: WHY?
It is essential that women look after their mental health although busy lifestyles often make this difficult.
More women than men are the main carer for their children and they may care for other dependent relatives too. Intensive caring can affect emotional health, physical health, social activities and finances. Women are 10 times more involved in household chores and elderly care then men in Pakistan.
Women often juggle multiple roles they may be mothers, partners and carers as well as doing paid work and running a household
Women are over represented in low income, low status jobs often part-time and are more likely to live in poverty than men. Majority of the women are financially dependent on men and hence more vulnerable to the injustice ,violence and inequality in their rights.
Working mainly in the home on housework and concerns about personal safety can make women particularly isolated.
Physical and sexual abuse of girls and women can have a long-term impact on their mental health, especially if no support has been received around past abuses. Domestic violence and divorce considered to be a taboo makes women more vulnerable psychologically.
Mental health problems affecting more women than men
Some women find it hard to talk about difficult feelings and ‘internalise’ them, which can lead to problems such as depression and eating disorders.
Less literacy rate is also an important factor.
WHAT ARE THE DIFFERENT CHALLENGES WOMEN EXPERIENCE IN OUR SOCIETY?
Gender is one of the organizing principles of Pakistani society. Patriarchal values embedded in local traditions and culture predetermine the social value of gender. An artificial divide between production and reproduction, has placed women in reproductive roles as mothers and wives in the private arena of home and men in a productive role as breadwinners in the public arena. This has led to a low level of resource investment in women by the family and the State. Thus, low investment in women, compounded by the negative social biases, and cultural practices; the concept of honour linked with women’s sexuality; restrictions on women’s mobility; and the internalization of Patriarchy by women themselves, becomes, the basis for gender discrimination and disparities in all spheres of life.
Women are less educated. Women with requisite educational qualification also find the employers don’t have the ability to address the needs of their women employees. This partly explains the phenomenon of highly educated women for example doctors opting out of careers they are qualified for. Their degrees or their qualifications are often seen as an asset in terms of improving their marriage prospects rather than contributing to society at large .The conflict of their passion and their responsibilities males them more vulnerable to mental health issues.
WHAT ARE THE VARIOUS PREGNACY RELATED PSYCHIATRIC ISSUES?
Pregnancy is usually considered to be a time of happiness for the women, however it can bring various mental health challenges for her .these conditions are usually under diagnosed as they are considered to be the consequences of hormonal changes and also under treated as majority of the medications are considered unsafe in pregnancy. Although up to 70% of women report some negative mood symptoms during pregnancy, the prevalence of women who meet the diagnostic criteria for depression has been shown to be between 13.6% at 32 weeks gestation and 17% at 35 to 36 weeks gestation.
Depression is the most common psychiatric disorder associated with pregnancy. Pregnant women may also suffer from anxiety disorders, such as panic disorder, obsessive-compulsive disorder, and eating disorders. While it is rare for women to experience first-onset psychoses during pregnancy, relapse rates are high for women previously diagnosed with some form of psychosis.
Several risk factors and psychosocial correlates have been identified as contributing to depression during pregnancy. The most clearly identified risk factors include a previous history of depression, discontinuation of medication by a woman who has a history of depression, a previous history of postpartum depression, and a family history of depression.
Several key psychosocial correlates may also contribute to depression during pregnancy: a negative attitude toward the pregnancy, a lack of social support, maternal stress associated with negative life events, and a partner or family member who is unhappy about the pregnancy.
There are specific types of post-partum psychiatric disorders which need to be identified and treated (also prevented). During the postpartum period, about 85% of women experience some type of mood disturbance. For most the symptoms are mild and short-lived; however, 10 to 15% of women develop more significant symptoms of depression or anxiety. Postpartum psychiatric illness is typically divided into three categories:
- postpartum blues
- postpartum depression
- postpartum psychosis.
It may be useful to conceptualize these disorders as existing along a continuum, where postpartum blues is the mildest and postpartum psychosis the most severe form of postpartum psychiatric illness.
HOW DO WE IDENTIFY THEM?
Postpartum Blues
It appears that about 50 to 85% of women experience postpartum blues during the first few weeks after delivery. Rather than feelings of sadness, women with the blues more commonly report mood lability, tearfulness, anxiety or irritability. These symptoms typically peak on the fourth or fifth day after delivery and may last for a few hours or a few days, remitting spontaneously within two weeks of delivery. While these symptoms are unpredictable and often unsettling, they do not interfere with a woman’s ability to function. No specific treatment is required; however, If symptoms of depression persist for longer than two weeks, the patient should be evaluated to rule out a more serious mood disorder.
Postpartum Depression
PPD typically emerges over the first two to three postpartum months but may occur at any point after delivery. Some women actually note the onset of milder depressive symptoms during pregnancy. Postpartum depression is clinically indistinguishable from depression occurring at other times during a woman’s life. The symptoms of postpartum depression include:
- Depressed or sad mood
- Tearfulness
- Loss of interest in usual activities
- Feelings of guilt
- Feelings of worthlessness or incompetence
- Fatigue
- Sleep disturbance
- Change in appetite
- Poor concentration
- Suicidal thoughts
Significant anxiety symptoms may also occur. Generalized anxiety is common, but some women also develop panic attacks or hypochondriasis. Postpartum obsessive-compulsive disorder has also been reported, where women report disturbing and intrusive thoughts of harming their infant.
Postpartum Psychosis
Postpartum psychosis is the most severe form of postpartum psychiatric illness. Its presentation is often dramatic, with onset of symptoms as early as the first 48 to 72 hours after delivery. The majority of women with puerperal psychosis develop symptoms within the first two postpartum weeks.
The earliest signs are restlessness, irritability, and insomnia. Women with this disorder exhibit a rapidly shifting depressed or elated mood, disorientation or confusion, and erratic or disorganized behavior. Delusional beliefs are common and often center on the infant. Auditory hallucinations that instruct the mother to harm herself or her infant may also occur. Risk for infanticide, as well as suicide, is significant in this population.
WHAT SHOULD ONE DO IF SHE DEVELPS POST PARTUM DEPRESSION?
If you think you may have postpartum depression, or if your partner or family members are concerned that you do, it is important to see A MENTAL HEALTH PROFESSIONAL as soon as possible. Do not wait until your postpartum check-up.
HOW WOMEN CAN MAINTAIN POSITIVE MENTAL HEALTH
- Keep going with a positive attitude to yourself and to your responsibilities.
- It is important to be a good mother, a good wife and a daughter but at the same time never forget that u do exist as an independent human being. It’s ok to take some time for your own self.
- Work your strengths.
- Do something you’re good at to build self-confidence, then tackle a tougher task.
- Strive for financial independence, be it a job or some home based earning.
- Think of something in your life you want to improve, and figure out what you can do to take a step in the right direction.
- Close, quality, relationships are key for a happy, healthy life.
- Trying to be optimistic doesn’t mean ignoring the uglier sides of life. It just means focusing on the positive as much as possible.
- Hang out with a funny friend, watch a comedy or check out cute videos online. Laughter helps reduce anxiety.
- Practice forgiveness, People who forgive have better mental health and report being more satisfied with their lives.
- Do something with friends and family – have a cookout, go to a park, or play a game. People are 12 times more likely to feel happy on days that they spend 6-7 hours with friends and family. “
- Anyone who has never made a mistake has never tried anything new.” -Albert Einstein. Try something outside of your comfort zone to make room for adventure and excitement in your life.