Mental illness has dramatically increased worldwide since the COVID-19 pandemic began, with one in five American adults seeking mental health treatment in 2020, including 16.5% taking prescription medications for mental health.1 In the U.K., national surveys showed a spike for moderate to severe depressive symptoms in 2021, with a minor decline by July and August that year.2
Women disproportionately outnumber men regarding mental health diagnoses and treatment, with over 25% of women receiving mental health treatment in the past year compared to just 14.6% of men.1 Why does this gender gap exist? And how should doctors approach mental health treatment for different genders? This guide looks at the statistics, causes, and treatments of mental illness in women.
Many factors demonstrate disparities among mental health diagnoses and treatment, with gender being one. Other factors include:
The differences among specific mental health diagnoses vary significantly between men and women. While women are more often diagnosed with issues like depression and anxiety, men are more often diagnosed with substance abuse. Men commit suicide at higher rates than women, possibly due to social stigmas related to getting mental health help.
Below, we'll look at some of the most common mental health disorders and how they affect women.
The mental health gender gap is most prominently displayed in diagnoses of depression and anxiety. Depression is one of the most widespread mental illnesses, affecting up to 5% of adults worldwide.3 According to the American Psychiatric Association, women experience depression at double the rate of men, with one in nine women having experienced a major depressive episode in the last year.4
Major depression can be debilitating, leading to additional issues like:
In addition to major depression, women also have higher rates than men of:
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes several anxiety disorders. Among them are:5
According to the World Health Organization, the COVID-19 pandemic triggered a 25% increase in anxiety disorders globally, with young people and women among those most hit.6 And based on earlier diagnostic interview data from 2001 to 2003, the NIH estimated that 23.4% of adult women showed the prevalence of any anxiety disorder in the past year, while 14.3% of men suffered from a condition.5
Post-traumatic stress disorder (PTSD) is among the anxiety disorders that disproportionately affect women, perhaps partly because a higher percentage of women experience sexual assault. According to the National Center for PTSD, approximately one in ten women experience PTSD in their lives compared with 4% of men.9
Like depression, anxiety can affect all aspects of a person’s life: from work to friendships to simply eating and functioning. Untreated anxiety can result in physical health problems and other mental health issues as well, including:
Eating disorders will affect almost 10% of Americans in their lifetimes, with a recent growing surge among children, transgender individuals, older adults, and military personnel.7 The COVID-19 pandemic severely affected individuals with eating disorders, driving up calls to national eating disorder hotlines by over 70% since 2020.7
Despite growing numbers in other demographics, women still comprise the majority of individuals with eating disorders, constituting approximately 85% to 95% of those with anorexia nervosa or bulimia.4
Eating disorders significantly increase a woman's mortality rate, leading to 48% higher healthcare costs than the general population and contributing to disability and reduced quality of life.8
Substance abuse issues, including alcoholism, illicit drug use, and misuse of prescription medications, impact men more than women. However, women are at equal risk for developing a substance use disorder, especially if they have comorbid depression, anxiety, or other mental health issues.
Long-term drinking has more detrimental health impacts on women, leading to death rates 50% to 100% higher than in men. This includes alcohol-related deaths such as:10
Substance use rose significantly during the pandemic — 13% of Americans reported starting or increasing their use of substances as of June 2020, and overdoses during the early months of the pandemic rose by 18%.11
Suicide is the 12th leading cause of death in the U.S., with just under 46,000 Americans dying by suicide in 2020 and suicidal ideation rising.12 Men die by suicide at significantly higher percentages than women (3.88 times more), potentially due to social stigmas relating to mental healthcare. On the other hand, women attempt suicide 1.5 times more than men.12
Ensuring adequate mental healthcare is available for all populations — whether rural, urban, rich, or poor — is critical for suicide prevention, as many mental illnesses coincide with suicidal ideation and thoughts of self-harm.
According to U.S. and European reports, two-thirds of clinically diagnosed cases of dementia are women.13 Theories for this gender divergence vary, but most researchers associate the correlation with women's life expectancy. Dementia and Alzheimer's disease risks increase with age, and women are more likely than men to live past 80.
While researchers can't definitively say why the disparity exists between women's and men's mental health, several leading theories exist.
Perhaps the most prominent theory of the mental health gender gap is that women are more willing to seek treatment when encountering mental health issues. In the past year, 25.6% of women in America sought mental health treatment, compared with 14% of men.1 Likewise, women are more likely to have taken medication for mental illness, at 21.2% versus 11.5% of men.1
In some environments, men may perceive asking for help as a sign of weakness. Thus, men may go undiagnosed and untreated for mental health issues, increasing suicide risks for many over time. Managing mental health issues on your own and without support can be an isolating and devastating experience. And yet social stigmas around mental healthcare still prevent many from seeking help.
The last factor is that physicians are less likely to diagnose depression in men than in women, even when presented with the same symptoms. Doctors prevailingly prescribe antidepressant medications to women more than they do to men.4
Genetics plays a significant role in a person’s mental health. In studies on identical twins, researchers have indicated that 40% of variations among risks for depression are due to genetics.14 Further, a person with depression is three times more likely to have a first-degree relative with depression as well.14 Genetic links are also seen in other mental health conditions, including:
Researchers, doctors, and psychiatrists have long associated women's mental health risks with hormones — and this theory has much legitimacy. Women experience hormonal fluctuations each month, and the onset of depression in girls coincides with puberty. The rates of teenage depression are rising, with one in five adolescent girls experiencing a major depressive episode in the past 12 months in 2017, compared with just 7% of boys.15
Prenatal and postpartum depression can also have significant impacts on a woman's life as a mother. According to the CDC, one in eight women experiences postpartum depression, with estimates varying based on age, race, ethnicity, and region.16 Prenatal and postpartum depression can be challenging to treat, as many SSRIs cannot be administered after the first trimester due to the risk of congenital disabilities.
Lastly, many women experience issues with depression and anxiety during the transition through menopause, when hormones again fluctuate wildly. Unfortunately, studies have shown that women undergoing hormone therapy (HT) were associated with worse psychological well-being than individuals not participating in HT.17
Stress affects women and men differently, and women are more likely to report feeling overwhelmed by stress than men. According to a 2010 report from the American Psychological Association, 49% of women reported increased stress in the past five years, and 79% said that money was a source of stress.18
Certain stressors are more common among women, including:
Early childhood trauma can have devastating and lasting impacts on psychological development and social perceptions. Childhood sexual, physical, and psychological abuse can lead to issues like:
Depression and other mental illnesses often manifest differently in women and men. Factors like coping with stress and reacting to obstacles impact our mental health. When coping mechanisms negatively impact mental health, we risk sliding down a slippery slope. For example, women make up more than half of people with binge eating disorder, which is often associated with anxiety and depression.19
Here are some other factors that may account for the gender gap in mental healthcare:
Treatment for mental health issues is generally the same for women and men, although women may gravitate toward some therapies more than others. Treatment often takes the form of a three-stage process, depending on the specific issues you’re dealing with:
Therapy options have expanded significantly in the past decade, and finding a professional who can work with your needs is essential.
Psychotherapy can take many forms, but the primary three are cognitive-behavioral therapy, interpersonal therapy, and psychodynamic therapy. Many therapists use a blended approach to these. There is no “right” therapy — it’s about what works for the individual.
Cognitive-behavioral therapy (CBT) is a psychosocial intervention that aims to help patients create new patterns of behaviors and thoughts. It helps reduce symptoms of many mental health disorders, including depression, anxiety, and PTSD. Through CBT, a patient learns to recognize negative internal imagery and thoughts and assess and transform them into positive affirmations. CBT is different from traditional psychoanalytic therapy because it is problem-focused and action-oriented, giving patients new coping mechanisms and information-processing skills.
Interpersonal psychotherapy (IPT) is a short-term therapy that focuses on resolving interpersonal problems. First developed at Yale University as a treatment for depression, IPT has since demonstrated efficacy as a maintenance treatment and has been modified to treat other mental health conditions like eating disorders and substance use disorders.
Psychodynamic therapy is a form of psychoanalysis aimed at revealing the patient's unconscious to relieve conflict within the mind. This form of therapy is today's replacement for mid-20th century psychoanalysis. In this type of therapy setting, a patient would discuss their past and current relationships with a therapist, who would then help the patient to analyze patterns of behavior in their life and make new choices.
In addition to the one-on-one therapies described above, group and family-based therapies can be highly effective for many people. Family or couples therapy brings spouses, partners, or family members into sessions to discuss relational issues and behavioral problems and work toward solutions. Those in group therapy draw support from other group members with a leader's guidance to explore human interactions and achieve new ways of thinking.
According to studies, antidepressants provide relief for 40% to 60% of those who take them, compared to 25% to 40% of those taking a placebo.20 Antidepressants are equally effective for both genders, but personal effects vary.
The first-line choice for many mental health providers is SSRIs, or selective serotonin reuptake inhibitors. These drugs impact the brain's serotonin system, influencing mood, anxiety, arousal, impulses, and aggression. Common SSRIs include:
Other common antidepressants impact the neurotransmitters norepinephrine and dopamine, such as Wellbutrin (Bupropion), or combine effects, as in the following drugs:
When beginning any new antidepressant or medication for mental illness, one factor to keep in mind is that they all have side effects. Many SSRIs impact sexual response, diminishing sexual desire or making it difficult for women to reach orgasm. Other potential side effects include:
Although rarely prescribed today, TCAs (tricyclic antidepressants) and MAOIs (monoamine oxidase inhibitors) have their own sets of side effects, including:
Finding the proper medication is a process and one that you should work through closely with your doctor or medical professional. Some medicines carry risks of deepened depression, suicidal ideation, and erratic mood swings. If you encounter worsened symptoms, discuss them immediately with your doctor so that they may adjust your medication and/or dosage.
Alternative therapies are treatments that aren’t standard across most Western medical practices. While most cases of depression and other mental illnesses are treated through a combination of psychotherapy and medication, some individuals reach successful results with other integrative therapies, including:
In addition to these options, researchers have recently opened the doors to several new therapies involving psychedelic drugs, including psilocybin, ketamine, DMT, and others. In a 2022 study from Johns Hopkins Medicine, researchers found that psilocybin treatment for major depression may be effective for up to a year in patients.21
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Terlizzi, E. and Norris, T. (2021, October). Mental health treatment among adults: United States, 2020. CDC/National Center for Health Statistics. Retrieved on June 9, 2022, from https://www.cdc.gov/nchs/products/databriefs/db419.htm.
Baker, C. (2021, December 13). Mental health statistics: Prevalence, services, and funding in England. UK Parliament House of Commons Library. Retrieved on June 9, 2022, from https://commonslibrary.parliament.uk/research-briefings/sn06988/.
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Any anxiety disorder: Fact sheet. National Institute of Mental Health. Retrieved on June 9, 2022, from https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder.
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National Eating Disorders Awareness Week, 2022 (2022, February 18). A Presidential Document by the Executive Office of the President. National Archives, Federal Register. Retrieved on June 9, 2022, from https://www.federalregister.gov/documents/2022/02/24/2022-04096/national-eating-disorders-awareness-week-2022.
Van Hoeken, D. and Hoek, H. (2020, August 17). Review of the burden of eating disorders: Mortality, disability, costs, quality of life, and family burden. Current Opinion in Psychiatry, PubMed Central. Retrieved on June 9, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575017/.
Vernor, D. (2019, October) PTSD is more likely in women than men. National Alliance on Mental Illness. Retrieved on June 9, 2022, from https://www.nami.org/Blogs/NAMI-Blog/October-2019/PTSD-is-More-Likely-in-Women-Than-Men.
Substance use in women research report: Sex and gender differences in substance use (2020, April). U.S. Department of Health and Human Services, National Institutes of Health. Retrieved on June 9, 2022, from https://nida.nih.gov/publications/research-reports/substance-use-in-women/sex-gender-differences-in-substance-use.
Abramson, A. (2021, March 1). Substance use during the pandemic. American Psychological Association. Retrieved on June 9, 2022, from https://www.apa.org/monitor/2021/03/substance-use-pandemic.
Suicide statistics (2022). American Foundation for Suicide Prevention. Retrieved on June 9, 2022, from https://afsp.org/suicide-statistics/.
Beam, C., Kaneshiro, C., Yun Jang, J., Reynolds, C., Pedersen, N., and Gatza, M. (2019, January 1). Differences between women and men in incidence rates of dementia and Alzheimer’s disease. National Library of Medicine, PubMed Central. Retrieved on June 9, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6226313/.
Dunn, E., Brown, R., Dai, Y., Rosand, J., Nugent, N., Amstadter, A., and Smoller, J. (2015, January-February). Genetic determinants of depression: Recent findings and future directions. Harvard Review of Psychiatry. National Library of Medicine, PubMed Central. Retrieved on June 10, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4309382/.
Geiger, A. and Davis, L. (2019, July 12). A growing number of American teenagers – particularly girls – are facing depression. Pew Research Center. Retrieved on June 10, 2022, from https://www.pewresearch.org/fact-tank/2019/07/12/a-growing-number-of-american-teenagers-particularly-girls-are-facing-depression/.
Depression among women: Fact sheet. Centers for Disease Control and Prevention. Retrieved on June 10, 2022, from https://www.cdc.gov/reproductivehealth/depression/index.htm#Postpartum.
Toffol E., Heikinheimo, O., and Partonen, T. (2013, June 20). Associations between psychological well-being, mental health, and hormone therapy in perimenopausal and postmenopausal women: Results of two population-based studies. National Library of Medicine, PubMed. Retrieved on June 10, 2022, from https://pubmed.ncbi.nlm.nih.gov/23277355/.
2010 Stress in America: Gender and stress. American Psychological Association. Retrieved on June 10, 2022, from https://www.apa.org/news/press/releases/stress/2010/gender-stress#.
Binge eating disorder. Office on Women's Health, U.S. Department of Health & Human Services. Retrieved on June 10, 2022, from https://www.womenshealth.gov/mental-health/mental-health-conditions/eating-disorders/binge-eating-disorder.
Depression: How effective are antidepressants? (2020, June 18). Informed Health. National Library of Medicine. Retrieved on June 11, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK361016/.
Psilocybin Treatment for Major Depression Effective for Up to a Year for Most Patients, Study Shows (2022, February 15). John Hopkins Medicine. Retrieved on June 11, 2022, from https://www.hopkinsmedicine.org/news/newsroom/news-releases/psilocybin-treatment-for-major-depression-effective-for-up-to-a-year-for-most-patients-study-shows.