Gender Differences in Mental Health

Type of psychology: Psychopathology; psychotherapy; social psychology; stress

Gender differences in mental health exist in the prevalence of various diagnoses, help-seeking behaviors, and severity of impairment. Biological, psychosocial, and sociocultural explanations account for disparities in mental health between men and women.

Introduction

Gender and other social factors influence popular conceptions of mental health. Overall, the prevalence rates of most mental health disorders are almost identical for men and women; however, gender differences occur in the rates of the most common mental disorders, particularly depression, anxiety, and somatic complaints, which are more prevalent in women. Socially constructed differences between men and women regarding role responsibilities, status, and power interact with biological differences, creating variations in mental health problems, help-seeking behavior, and the response of the mental health community.

The Double Standard

In 1970, Inge Broverman and her colleagues used an adjective checklist to demonstrate that clinicians defined characteristics of mental health differently based on the sex of the person being described. Mental health professionals were asked to describe the characteristics of a healthy, mature, and socially competent man, woman, or "adult person." A normal, healthy adult of unspecified gender was described with similar adjectives as a healthy man, with adjectives such as independent, adventurous, objective, and decisive. By contrast, a normal, healthy woman was described as noncompetitive, passive, emotional, and dependent—adjectives that the mental health professionals more readily ascribed to "unhealthy" individuals.

These descriptions of mature, competent men and women revealed a double standard concerning mental health. Stereotypical male behavior was shown to serve as the norm to identify good mental health overall; however, many of the characteristics viewed as positive in terms of mental health in general were seen by these professionals as being negative in women. Consequently, if women demonstrated the characteristics that these mental health professionals attributed to healthy and socially competent women, they would be labeled abnormal (having masculine traits). This study demonstrated that the behaviors and characteristics judged by clinicians to reflect an ideal standard of mental health resembled the characteristics and behaviors deemed to be healthy for men but not for women. Broverman and her colleagues pioneered the study of sex role stereotypes and their impact on mental health services for both men and women.

Diagnoses and Distribution Patterns

Research shows that some of the most common mental health disorders (such as depression, anxiety, and anorexia nervosa) are more prevalent in women. On the other hand, mental health problems such as alcohol addiction, substance abuse, and antisocial personality disorder are more common in men. Other disorders that affect less than 2 percent of the world's population (such as schizophrenia and borderline personality disorder) are equally prevalent in both genders. Multiple diagnoses, especially the presence of three or more conditions, are more common in women than in men.

The rates of depression in surveys of both clinical patients and the general population are higher in women than in men. More than twice as many women as men report a major depressive episode in any given year. The gender disparity in rates of depression is one of the strongest findings in epidemiological psychiatry. Depression persists longer in women, and women are more likely to relapse than men.

Depression rates vary by country. According to the World Health Organization, depression is the leading cause of disease burden for women worldwide. Depressive disorders account for approximately 41 percent of the disability from neuropsychiatric disorders among women compared to 29 percent among men. Furthermore, peripartum depression, formerly called postpartum depression, affects up to one in seven American women, according to the American Psychological Association, presenting a significant public health problem for women and their families. However, clinicians are more likely to diagnose women with depression than men, even when men have similar scores on standardized measures of depression or present identical symptoms, indicating an ongoing gender bias in the assessment of mental health disorders.

Anxiety diagnoses, including panic disorder, posttraumatic stress disorder, generalized anxiety disorder, and phobias, are nearly twice as common among women than men. The National Comorbidity Survey Replication surveyed the general population of the United States and found that 23 percent of women reported suffering from an anxiety disorder in the last twelve months compared to 14 percent of men. Social anxiety disorder and obsessive-compulsive disorder, by contrast, are equally prevalent in men and women. Generalized anxiety disorder affects about 6.6 percent of women and 3.6 percent of men during their lives. Anxiety disorders are also associated with a greater illness burden in women than in men, indicating that anxiety disorders are not only more prevalent in women but also tend to have a more severe impact. According to the Centers for Disease Control and Prevention in 2022, about one in four women suffer sexual assault or rape in their lifetimes; the psychological impact of experiencing physical and sexual violence is thought to contribute to the higher rates of anxiety disorders among women. Furthermore, women are more frequently diagnosed with somatic symptom disorder, in which mental factors such as stress cause debilitating physical symptoms.

Eating disorders, including anorexia and bulimia, are more prevalent in women than in men. Women are more likely to evaluate their self-worth in terms of appearance, largely due to sociocultural expectations that highly value women's attractiveness. Furthermore, women report higher rates of discrimination related to being overweight or obese than men.

Men are more likely than women to drink in public, to drink alone, and to engage in episodic binge drinking. Men are more likely to use alcohol to manage stress and are more likely than women to become dependent on it. Twelve-month prevalence rates of alcohol abuse are nearly three times higher among men than women. However, women are more likely to seek treatment.

Furthermore, men are more likely than women to abuse drugs other than alcohol; however, rates of prescription drug abuse are nearly identical across genders. About twice as many men as women report illicit drug use. Additionally, men and women continue to use drugs for different reasons: men for thrill seeking and pleasure, and women for self-medication of abuse or trauma.

Men are more likely than women to be diagnosed with neurodevelopmental disorders such as autism spectrum disorder, intellectual disability, and attention-deficit hyperactivity disorder. About four times more men than women receive diagnoses of autism spectrum disorder. However, women with autism tend to have more severe symptoms and greater cognitive impairment than men with autism. Although schizophrenia affects men and women equally, clinicians identify the onset of symptoms in men with schizophrenia earlier (late teens or early twenties) than in women with schizophrenia (late twenties or early thirties). In contrast to autism, schizophrenia is typically more disabling in men, and symptoms more commonly found in men are harder to treat.

Almost four times as many men as women die by suicide, even though women attempt suicide at about three times the rate at which men do. Most successful suicides among both men and women are related to a diagnosed mental disorder, typically depression or substance abuse.

Treatment Disparities

Overall, women are more likely than men to seek out and make use of mental health services. Women are more likely to disclose mental health issues to general practitioners, while men are more likely to ignore mental problems in their early stages and prefer to deal with mental health specialists. Women are also more likely than men to seek psychological help, particularly regarding anxiety and depression. After admitting mental health problems, men and women are equally likely to accept help, but women are overrepresented in mental health statistics. Research generally does not include nonbinary individuals and thus little is known about prevalence, prevention, or treatment.

The problem lies in men’s reluctance to admit to mental health disorders and professionals’ frequent failure to diagnose them in men. Professionals are less likely to perceive men’s problems as psychological. Cultural patterns of male stoicism and a reluctance to ask for help may cause lower diagnosis and treatment rates in men.

More women than men use outpatient care; however, men are more likely than women to be involuntarily committed. Apparently, many men wait to seek help until a later stage of disease, when the symptoms are more severe and hospitalization more necessary. However, women are almost twice as likely to be prescribed psychotropic drugs, regardless of social class, physical health status, and type of diagnosis, and most are prescribed by a general practitioner, internist, obstetrician, or gynecologist.

Men’s mental health symptoms tend to be more severe and difficult to treat. Onset of many mental disorders in women occurs at older ages than in men, and consequently women may have a better established base of social skills and cognitive functioning, allowing them to better cope with symptoms of the disorder than younger men with the same diagnosis.

Explanations for Variations

Gender differences in patterns of diagnosis and treatment of mental illnesses have been studied since at least the 1970s. Explanations for these differences have been both biological and social.

Many scientists suggest that biology and reproductive functions may account for gender differences in mental health. Different levels of hormones between men and women are related to some diagnoses. Scientists know that estrogen reacts with serotonin, a neurotransmitter associated with mood, and some studies suggest estrogen may protect against schizophrenia. Biological reactions to stress in general, and specifically biological changes associated with motherhood, help explain higher levels of depression and anxiety in women. Though biological factors, especially hormones, play a role in mental health, social class, cultural values, and family relationships also significantly affect mental health.

Psychosocial theorists point to the fact that girls experience greater levels of violence than boys do and that their responses to this violence lead to higher rates of mental disorders in adult women. Child abuse creates long-term changes in brain circuitry and thus increases the likelihood of anxiety disorders. Rates of depression in adult women are three to four times higher for women exposed to childhood violence than for those without this exposure. A particularly strong connection between sexual abuse and posttraumatic stress disorder (PTSD) has been established. The severity of and length of exposure to violence is positively correlated with being diagnosed with a mental illness.

Sociocultural explanations focus on the dominance of a masculine model of mental health. Definitions of normality are often based on culturally determined gender roles. A social constructionist explanation of mental health differences by gender focuses on how conceptions of proper male and female behavior and characteristics are embedded into diagnostic categories of mental disorders.

Gender Stereotyping

Early socialization of children into gender-appropriate behavior may teach girls to internalize distress and boys to act out. Consequently, when subjected to stressors, women tend to experience depression and anxiety as internal responses, whereas men tend to take more external action by abusing substances, engaging in antisocial behavior, and committing suicide.

Worldwide, women’s social roles and positions in society may make them more vulnerable than men to mental health disorders. Traditional gender roles for women offer fewer personal choices and lower life satisfaction. Positive psychological health is linked to a greater number and increased diversity of social roles. A variety of roles gives an individual a stronger sense of identity, leading to fewer mental health problems.

Furthermore, gender affects control of socioeconomic determinants of mental health. Women’s greater exposure to poverty, combined with low social standing, job insecurity, and housing uncertainties, leads to more chronic stressors and increases the severity of mental health problems. Depression, anxiety, and somatic symptoms are highly related to social status and responsibility for the care of others.

The relationship between mental health and gender is complicated by issues of class, age, race, and ethnicity. Gender differences in mental health have been examined more in industrialized countries than in less developed countries, and adult women and men have been studied more than children and adolescents. Although the rates of most mental disorder diagnoses are similar for men and women, there are definite patterns regarding the types of problems men and women experience. Future research needs to consider gender discrepancies in more detail, and professionals need to consider gender disparities in planning, implementing, and evaluating mental health programs. Mental health professionals must be aware of gender stereotypes in the diagnosis and treatment of mental disorders, as these stereotypes can present a significant barrier to the accurate identification and treatment of psychological disorders in both men and women.

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