Gender inequalities in depression/anxiety and the consumption of psychotropic drugs: Are we medicalising women’s mental health?
Abstract
Aims: Clinical studies show that women are more likely to be diagnosed with depression and anxiety, and to consume prescribed psychotropic drugs. Applying an intersectional perspective that considers age, education and social class, the present study assesses gender inequalities in the diagnosis of depression/anxiety and in psychotropic consumption. Methods: We analysed data from the 2018 Basque Country Health Survey (Spain; n=8014). Prevalence rates of poor mental health, diagnosis of depression/anxiety and psychotropic consumption were calculated for each sex by age and socio-economic status. Poisson regression models were calculated to estimate PRs of these variables in women, adjusted for age, mental health status and health-care visits, and for diagnosis of depression/anxiety in the case of psychotropic drug consumption. Results: Women were 2.48 times more likely than men to be diagnosed with depression or anxiety, and this difference remained significant after adjustments (prevalence ratio (PR)=1.86; 95% confidence interval (CI) 1.40–2.47). Women also took significantly more prescribed psychotropic drugs, even controlling for their poorer mental health, their higher prevalence of diagnosis and their more frequent health-care visits (PR=1.52; 95% CI 1.28–1.82). No gender inequalities were observed in those younger than 45 or with the highest level of education. Conclusions: Gender inequalities in the diagnosis and prescription of psychotropic drugs exist, and these cannot be explained by differences in mental-health status or health-care visit frequency. It seems, then, that medicalisation of mental health is occurring among women. Further evidence about the mechanisms that underlie the results is crucial to design truly gender-sensitive health policies that reduce medicalisation of women’s mental health.
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References
1. World Health Organization. Gender disparities in mental health. Geneva: World Health Organization, 2013.
2. Noordam R, Aarts N, Verhamme KM, et al. Prescription and indication trends of antidepressant drugs in the Netherlands between 1996 and 2012: a dynamic population-based study. Eur J Clin Pharmacol 2015;71:369–75.
3. Ussher JM. Are we medicalizing women’s misery? A critical review of women’s higher rates of reported depression. Fem Psychol 2010;20:9–35.
4. Cherepanov D, Palta M, Fryback DG, et al. Gender differences in health-related quality-of-life are partly explained by sociodemographic and socioeconomic variation between adult men and women in the US: evidence from four US nationally representative data sets. Qual Life Res 2010;19:1115–24.
5. Conrad P, Slodden C. The medicalization of mental disorder. In: Aneshensel CS, Phelan JC, Bierman A (eds) Handbook of the sociology of mental health. New York: Springer, 2013, pp.61–73.
6. Bell SE, Figert AE. Gender and the medicalization of healthcare. In: Kuhlmann E, Annandale E (eds) The Palgrave handbook of gender and healthcare. London: Palgrave MacMillan, 2010, pp.107–22
7. Smith DT, Mouzon DM, Elliott M. Reviewing the assumptions about men’s mental health: an exploration of the gender binary. Am J Mens Health 2018;12:78–89.
8. Salokangas RK, Vaahtera K, Pacriev S, et al. Gender differences in depressive symptoms. An artefact caused by measurement instruments? J Affect Disord 2002;68:215–20.
9. Potts MK, Burnam MA, Wells KB. Gender differences in depression detection: a comparison of clinical diagnosis and standardized assessment. J Consult Clin Psychol 1991;3:609–15.
10. Borowsky SJ, Rubenstein LV, Meredith LS, et al. Who is at risk of nondetection of mental health problems in primary care? J Gen Intern Med 2000;15:381–8.
11. Hohmann A. Gender bias in psychotropic drug prescribing in primary care. Med Care 1989;27:478–90.
12. Jacob L, Kostev K. Gender-based differences in the antidepressant treatment of patients with depression in German psychiatric practices. Ger Med Sci 2016;14:Doc02.
13. Van Os TW, Van Den Brink RH, Van Der Meer K, et al. The care provided by general practitioners for persistent depression. Eur Psychiatry 2006;21:87–92.
14. Mitchell AJ, Vaze A, Rao S. Clinical diagnosis of depression in primary care: a meta-analysis. Lancet 2009;374:609–19.
15. Bauer GR. Incorporating intersectionality theory into population health research methodology: challenges and the potential to advance health equity. Soc Sci Med 2014;110:10–7.
16. Health Department of the Basque Country. Metodología de la Encuesta de Salud 2018. Vitoria-Gasteiz: Departamento de Salud del Gobierno Vasco; 2018.
17. Bültmann U, Rugulies R, Lund T. Depressive symptoms and the risk of long-term sickness absence: a prospective study among 4747 employees in Denmark. Soc Psychiatry Psychiatr Epidemiol 2006;41:875–80.
18. Domingo-Salvany A, Bacigalupe A, Carrasco JM, et al. Propuestas de clase social neoweberiana y neomarxista a partir de la Clasificación Nacional de Ocupaciones de 2011. Gac Sanit 2013;27:263–72.
19. Hoeymans N, Garssen AA, Westert GP, et al. Measuring mental health of the Dutch population: a comparison of the GHQ-12 and the MHI-5. Health Qual Life Outcomes 2004;2:23.
20. Lim GY, Tam WW, Lu Y, et al. Prevalence of depression in the community from 30 countries between 1994 and 2014. Sci Rep 2018;8:2861.
21. Lorant V, Deliège D, Eaton W, et al. Socioeconomic inequalities in depression: a meta-analysis. Am J Epidemiol 2013;157:98–112.
22. Aragonès E, Piñol JL, Labad A. The overdiagnosis of depression in non-depressed patients in primary care. Fam Pract 2006;23:363–8.
23. Luppa M, Heinrich S, Angermeyer MC, et al. Healthcare costs associated with recognized and unrecognized depression in old age. Int Psychogeriatr 2008;20:1219–29.
24. PLOS Medicine Editors. The paradox of mental health: over-treatment and under-recognition. PLoS Med 2013;10:e1001456.
25. Wittchen HU, Kessler RC, Beesdo K, et al. Generalized anxiety and depression in primary care: prevalence, recognition, and management. J Clin Psychiatry 2002;63:24–34.
26. Verlinde E, De Laender N, De Maesschalck S, et al. The social gradient in doctor–patient communication. Int J Equity Health 2012;11:12.
27. DeVoe JE, Wallace LS, Fryer GE. Measuring patients’ perceptions of communication with healthcare providers: do differences in demographic and socioeconomic characteristics matter? Health Expect 2009;12:70–80.
28. Rumpf HJ, Meyer C, Hapke U, et al. Screening for mental health: validity of the MHI-5 using DSM-IV Axis I psychiatric disorders as gold standard. Psychiatry Res 2001;105:243–53.
29. Martín-Vázquez MJ. Adherence to antidepressants: a review of the literature. Neuropsychiatry 2016;6:236–41.
30. Orueta JF, Nuño-Solinis R, Mateos M, et al. Monitoring the prevalence of chronic conditions: which data should we use? BMC Health Serv Res 2012;12:365.
31. Tuana N. The speculum of ignorance: the women’s health movement and epistemologies of ignorance. Hypatia 2006;21:1–19.
32. Shoukai Y. Uncovering the hidden impacts of inequality on mental health: a global study. Transl Psychiatr 2018;8:98.
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Article first published online: August 5, 2020
Issue published: May 2021
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PubMed: 32755295
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This article was published in Scandinavian Journal of Public Health.
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