Author: Chidumebi Judith Idemili is a PhD student of Health Systems Research with emphasis on Health Technology Assessment and Global Health Specialization…
Authors: 1,2 Gayathri Delanerolle, 3Priyanka Jagadeesan, 1,2Heitor Cavalini, 1,2Peter Phiri
1Digital Evidence Based Medicine Lab, Oxford, UK
2 Southern Health NHS Foundation Trust, SO40 2RZ, UK
3Imperial College London
Why women’s mental health matters?
An important facet of optimal healthcare is improving patient reported and clinical outcomes in physical and mental health care offered. Mental illness in particular remains complex and, a preference to receive non-invasive treatments as well as early diagnosis has become important to patients and clinicians alike. The World Health Organization (WHO) indicates a need for differing approaches to promote wellbeing among men and women as the needs are profoundly different6. These gender differences are closely associated with socioeconomic status, social constructs and individual perceptions of healthcare requirements. These healthcare requirements include better physical and mental health care. Often mental healthcare is an afterthought although this culture is changing. Women’s mental health is considered as a priority in the UK’s NHS 10-year plan and the Women’s Health Strategy. Women are prone to experience more mental illness, such as depression and anxiety in comparison to men 1. It is important to provide mental health care for women throughout their life-course due to the changing needs at differing phases of their life; younger women are a considerably high-risk group for a variety of reasons including physiological changes. In addition, there appears to be long-standing stereotypes around disparities and inequalities associated with women’s mental health.
A closer look at the differences experienced
Psychiatric disorders have increased substantially among women. Research show that women (19%) are more likely to experience mental illness than men (12%)2. Research carried out in England on psychiatric morbidities reported a substantial increase in the rates of mental disorders in women between 1993 and 20143. Differing mental healthcare needs across the divulge nations in the UK are another consideration that impact early diagnosis, optimal management and short-medium-long term treatment.
According to the Adult Psychiatric Morbidity Survey (APMS) anxiety, depression, and self-harm have increased dramatically in groups of younger women between the ages of 16 and 25 years. Suicide rates among women are at the highest in a decade (ONS 2017)3, among younger women, especially in ethnic minority groups4. Some of the contributory factors could be domestic violence, discrimination, stigmatization, sexual violence, and barriers to seeking treatment are important points that must be looked at carefully5.
The important role of primary care
Primary care services are the first point of contact for people suffering from mental health problems. General practitioners (GP) are the first to assess, treat, manage and if required, refer women to additional mental healthcare services such as Improving Access to Psychological Therapy (IAPT) services9.IAPT centers provides non-invasive mental healthcare, mostly independent of a GP. As the clinical pressures and complex needs continue to grow with population demands, primary care services, like all other parts of the NHS are struggling to meet the demands. Thus, managing the life-course mental health needs of a woman may be further challenged. Many patient advocacy groups have called for changes including to communication, planning, delivery, and evaluation of services7.
Currently, the mental health services offered by the NHS comprise of individual counseling services with or without consulting the respective GP. This step is not always useful from a clinical management perspective since GPs are involved with managing routine clinical care for these patients. The new integrated models of care could assist with improving mental health care which also aims to reduce socio-economic and gender inequalities. Research shows us women from Black, Asian and Ethnic minorities could be disproportionality accessing mental healthcare services, thus specialised services for women could be beneficial 9. This could improve mental illness diagnosis delays reported previously. Empowering patients with such options could improve patient care and assist primary care services.
Another challenge within primary care is that many patients do not adhere to treatment, leaving conditions as anxiety and depression remain sub-optimally managed. According to the latest National Institute for Health Care Excellence (NICE) guidelines, many mental illnesses should be treated with cognitive-behavioral therapies (CBT) and anti-depressants 10. Even though NICE has presented CBT as a key treatment in mental illness, the reality could be somewhat different. A meta-analysis showed the use of CBT indicated little or modest effects when compared to other types of behavioral therapies 11 12. Thus, further research to explore these areas may be required.
Minimising inequalities, better development and use of evidence-based policies that has better shared clinical management approaches between primary care and mental health services could improve clinical and patient reported outcomes.
Women’s Mental Health research
There appears to be a paucity in women’s mental health research13. Improved research funding calls, quality improvement methods to optimize clinical care and exercise of women centric mental health research.
Better accessibility and use of electronic health record (EHR) data within primary care should be considered as a priority given the availability of this data could be financial viable way to publish epidemiological findings which is a rare yet important commodity to improve the research funding landscape.
The Women’s Mental Health Taskforce (WMHT) published revealing evidence in regards to management, accessibility, safety, respect, better understanding of trauma and dignity should be considered when managing patients. Further research into the WMHT has been slow due to the COVID-19 pandemic taking precedence. WMHT also recommended researchers to better design, collate, analyse and report data, especially for complex topics such as violence and abuse, disease sequalae, suicidality, medication review procedures at differing age groups and the association of mental health with poverty.
Clinicians, researchers and the general public should be provided with more information on complex mental health issues such as suicidality, psychosis, dementia and schizophrenia as often, perceptions around these conditions could be a rate limiting factor for conducting studies with large sample sizes. It would be beneficial for primary care providers to lead on these campaigns given that they are in a strong position to promote awareness and improve the overall understanding of the disease.
Future of women’s mental health
Whilst it is important to have gender equity and equality to receive optimal clinical care, women’s health has a long road ahead13. The implementation of new policies should be evidence based and address current issues. Funding for women’s mental health research should become routine to strengthen evidence that can improve clinical practice. In parallel, primary care, acute care and mental healthcare services should focus on using multidisciplinary approaches to provide optimal care.
Mental health and wellbeing of pregnancy women as well as those with chronic conditions should be a primary focus to ensure individualized needs are met. With many of the midwifery care being separated from primary and secondary care, it is important to keep mental healthcare in mind.
New strategies implemented should equally be supported by an increase in infrastructure and accountability at all levels of the clinical care pathways. Sustainable knowledge transfer and policies to improve communication, dissemination and implementation should be more transparent.
- Ingalhalikar M, Smith A, Parker D, Satterthwaite TD, Elliott MA, Ruparel K, Hakonarson H, Gur RE, Gur RC, Verma R. Sex differences in the structural connectome of the human brain. Proc Natl Acad Sci U S A. 2014 Jan 14;111(2):823-8. doi: 10.1073/pnas.1316909110
- AVA (2014). Case by Case: Refuge provision in London for survivors of domestic violence who uses alcohol and other drugs or have mental health problems. Available at: https://avaproject.org.uk/wp-content/uploads/2016/03/Case-by-Case-London-refugeprovision-Full-Report.pdf. ONS, 2017. Suicides in the UK: 2016 registrations. Available here
- Bhui, K., McKenzie, K. and Rasul, F., 2007. Rates, risk factors & methods of self-harm among minority ethnic groups in the UK: a systematic review. BMC Public Health, 7(1), p.336.
- Montesinos, A.H., Heinz, A., Schouler-Ocak, M. and Aichberger, M.C., 2013. Precipitating and risk factors for suicidal behavior among immigrant and ethnic minority women in Europe: a systematic review. Suicidology Online, 4, pp.60-80
- Newbigging, K. (2018). Addressing unmet needs in women’s mental health.
- Advancing mental health equalities strategy September 2020
- Fordham B, Sugavanam T, Edwards K, Hemming K, Howick J, Copsey B, Lee H, Kaidesoja M, Kirtley S, Hopewell S, das Nair R, Howard R, Stallard P, Hamer-Hunt J, Cooper Z, Lamb SE. Cognitive-behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis. Health Technol Assess. 2021 Feb;25(9):1-378. doi: 10.3310/hta25090
- James AC, Reardon T, Soler A, James G, Creswell C. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev. 2020 Nov 16;11(11):CD013162. doi: 10.1002/14651858
- Sen G, Östlin P. Gender inequity in health: why it exists and how we can change it. Glob Public Health. 2008;3(S1):1–12. doi:10.1080/17441690801900795