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The NIMH Women's Mental Health Program:
Establishing the Public Health Context for Women's Mental Health, Mary
C. Blehar, PhD
In 1999, Steven Hyman, MD, director of the National Institute of Mental
Health (NIMH), created an Institute-wide Women's Mental Health Program.
He appointed Mary Blehar, PhD, a psychologist and former chief of the
NIMH Mood and Anxiety Disorders Research Branch to head the Program.
Drs. Hyman and Blehar view the program as providing a focus within NIMH
for women's mental health by integrating diverse research on this topic
supported throughout NIMH. The program also serves as a place where
research findings can be readily translated into policy. This article
highlights some of the current activities of the program, now in its
second year.
The epidemiology and disability burden of mental
disorders provide compelling evidence of the value of a focus on women's
mental health. Overall,
women and men do not differ in the likelihood that they will be
diagnosed with a mental disorder, but they differ strikingly in the
prevalence and clinical course of specific disorders. Starting in
childhood, girls have higher rates of anxiety disorders than boys.
After puberty, women have higher rates than men of
major and minor depression, dysthymia, and anxiety disorders including
posttraumatic stress disorder and eating disorders.
Women are also more likely to be in the mental health services system
and more likely to receive psychotherapies and psychotropic medications.
Women have special issues related to their
childbearing and childrearing roles.
Women are more likely to make suicide attempts than men, although men
are more likely to complete suicide.
Women with depression and anxiety are more likely than men to report
somatic symptoms.
Among elderly adults, there are strong links between comorbid medical
illnesses, mental health and functional outcomes, and these links may
differ between women and men.
Prevalence differences are not found for all disorders, such as
schizophrenia and bipolar disorder, but men and women nonetheless differ
in clinical aspects.
Women with prior history of bipolar disorder have increased risk for
recurrence postpartum, suggesting a role for hormonal factors in onset.
There is evidence of a second peak of new onset of
schizophrenia in women around the time of menopause.
Men with schizophrenia tend to have earlier onsets and more profound
cognitive deficits than women, suggesting that estrogens may play a role
in moderating psychosis in women.
Men are more likely to be affected with some mental disorders than are
women. For instance, autism, learning disabilities, and
attention-deficit disorder are more common in males-suggesting that
females are relatively protected against neurodevelopmental disorders.
In late life, more women than men develop Alzheimer disease, raising the
possibility that estrogen loss following menopause is a risk factor for
cognitive deficits in late life.
One study has provided a clear public health context for mental
disorders. This study, the Global Burden of Disease, provides a score
(the DALY or disability-adjusted life year) that measures lost years of
healthy life due to premature death as well as years lived with
disability. The study's significance is that for the first time the
burden of illnesses was
shifted from an almost exclusive focus on premature mortality to one
that includes chronic illnesses. The study also enabled a comparison of
the burden of different illnesses.
Based on 1990 data, depression ranked first in DALYs for females age 5
and older worldwide. When the measure of years lived with disability is
disaggregated from the DALY score and considered alone, the Global
Burden of Disease study found that for females ages 5 and older
worldwide, unipolar major depression, bipolar disorder, schizophrenia
and obsessive-compulsive disorder were among the top 10 sources of
disability.
The public health burden of mental disorders in women is great because
of the high prevalence of disorders that affect them disproportionately
and clinical course features (eg, early onset, recurrence, chronicity).
Since disorders such as depression have peak onset in women's
child-bearing years, they also affect families.
Reducing disease burden in women may be one of the most effective means
of reducing disease burden in children. More-over, studying gender
differences indicates that men and women differ not only in risk factors
but also in protective factors for different disorders. This approach
may lead to better interventions for both men and women with mental
disorders.
Setting a Research Agenda
One of the goals of the Women's Mental Health Program is to set a
research agenda that connects the women's mental health field with other
NIMH neuroscience, interventions, and services research. To facilitate
this, the NIMH-wide Women's Mental Health Research Consortium was
created. Consortium members are drawn from NIMH research, training,
policy, and public information components to facilitate
multidisciplinary research and the linking of research to dissemination
and public policy.
Beth Powell
AMHCA Director of Public Policy and Professional Issues
801 N. Fairfax Street, Suite 304
Alexandria, VA 22314
703-548-6002, ext. 105
www.amhca.org
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