Improving Women’s Mental Health

Mental health continues to be one of the most under-researched and under-resourced areas of global health. As laid out in this brief, women in LMICs are at higher risk and face higher rates of depression, anxiety, migraine, and other debilitating mental disorders compared to men. Vulnerability, stigma, and lack of access to resources make this burden particularly acute. The growing body of evidence on cost-effective solutions can provide much needed relief to women world-wide if they are appropriately invested in and scaled-up. 

 

Key Messages from DCP3 on Mental Health in Women

 

  • Women in low– and middle-income countries are at higher risk and face higher rates of depression, anxiety, migraine, and other debilitating mental disorders compared to men. In contrast to under-five mortality, mortality due to HIV, and maternal illnesses, mental health-related death and disability rates have remained constant over the past 30 years, indicating an urgent and persisting need to more adequately address the prevention, care, and treatment of these disorders.
 
  • Most mental disorders begin in women’s late teens and twenties but they occur across the lifespan– affecting several key stages of women’s lives, impacting family stability and economic well-being. Vulnerability, stigma, and lack of access to resources makes this burden particularly acute for women in low- and lower-middle-income-countries.
 
  • Disease Control Priorities, 3rd edition has identified six interventions to address women’s mental health needs that are both cost-effective and feasible in low-resource settings. Achieving 80% coverage in low– and lower-middle-income countries will require an additional US$ 1.7 and US$ 3.4 per capita per year of investment, respectively.

 

Recommendations for Policy Makers

 

Rapidly expand evidence-based mental health care services. The burden of mental health conditions in women living in low- and middle-income countries is high and growing. Reaching these women requires ensuring adequate resourcing for drugs and provider therapy. The growing body of evidence on cost-effective interventions and potential policy solutions can provide much needed relief to women world-wide if they are appropriately invested in and scaled-up.

Address social and cultural barriers that increase women’s risk of mental health disorder and limit their access to care. Substantial barriers exist that prohibit or delay seeking mental health care, particularly for women and girls. Additionally, the gendered differences in mental and neurological disorders highlight the need for policymakers and health providers to consider the differing needs of men and women in the diagnosis, prevention, and treatment of these disorders.

Integrate mental health training and basic services into antenatal care. Women on average access primary care at higher rates than men in low– and middle-income countries, driven by existing services for reproductive and maternal health needs. Integrating screening programs in these settings is an obvious first step for early diagnosis and expansion of coverage of essential mental health services for women.

Explicitly consider the needs of women at different ages in national mental health strategies. The mental health needs of women change with age, as do the opportunities for intervening. Increased global attention on adolescent health and education, specifically girls’ education, provides an opportunity to integrate education– and messaging-related interventions into existing school and classroom structures. Supporting women in their roles as caregivers through young adulthood and middle-age can reduce key risk factors. It should be borne in mind that as women age additional resources will be needed for the ongoing care and safety of those with Alzheimer’s and other dementias.

 

SOURCE MATERIAL AND ADDITIONAL RESOURCES

  • Chisholm, D., Dua, T., Laxminarayan, R., Medina-Mora, M.E., Patel, V. “Mental, neurological, and substance use disorders”, 3rd edn. Disease Control Priorities, 3rd edition. Washington, DC: International Bank for Reconstruction and Development /The World Bank, 2015.
     
  • Charlson, F., Baxter, A., Dua, T., Degenhardt, L., Whiteford, H., Vos, T. “Excess Mortality from Mental, Neurological, and Substance Use Disorders in the Global Burden of Disease Study 2010.” In: Chisholm, D., Dua, T., Laxminarayan, R., Medina-Mora, M.E., Patel, V. “Mental, neurological, and substance use disorders”, 3rd edn. Disease Control Priorities, 3rd edition. Washington, DC: International Bank for Reconstruction and Development /The World Bank, 2015.
     
  • Hyman, S., Parikh, R., Collins, P., Patel, V. “Adult Mental Disorders” In: Chisholm, D., Dua, T., Laxminarayan, R., Medina-Mora, M.E., Patel, V. “Mental, neurological, and substance use disorders”, 3rd edn. Disease Control Priorities, 3rd edition. Washington, DC: International Bank for Reconstruction and Development /The World Bank, 2015.
     
  • Institute for Health Metrics and Evaluation. Global Burden of Disease. Seattle: 2018. Data Visualizations: GBD Compare.
     
  • Institute for Health Metrics and Evaluation. Global Burden of Disease. Seattle: 2018. GBD Results Tool.
     
  • Patel, V., Saxena, S., Lund C., Thornicroft, G., Baingana, F., Bolton, P. The Lancet Commission on global mental health and sustainable development. The Lancet 392; 10157; 1553-1598. October 2018. DOI: https://doi.org/10.1016/S0140-6736(18)31612-X
  • Reducing Mortality within Universal Health Coverage: The DCP3 Model. Watkins, D., Norheim, O., Jha, P., Jamison, D. Working Paper #21. 2017.
     
  • Thakur, K., Albanese, E., Giannakopoulos, P., Jette, N., Linde, M., Prince, M., Steiner, T., Dua, T. “Neurological Disorders” In: Chisholm, D., Dua, T., Laxminarayan, R., Medina-Mora, M.E., Patel, V. “Mental, neurological, and substance use disorders”, 3rd edn. Disease Control Priorities, 3rd edition. Washington, DC: International Bank for Reconstruction and Development /The World Bank, 2015.
     
  • Whiteford, H., Ferrari, A., Degenhardt, L., Feigin, V., Vos, T. “Global Burden of Mental, Neurological, and Substance Use Disorders: An Analysis from the Global Burden of Disease Study 2010.” In: Chisholm, D., Dua, T., Laxminarayan, R., Medina-Mora, M.E., Patel, V. “Mental, neurological, and substance use disorders”, 3rd edn. Disease Control Priorities, 3rd edition. Washington, DC: International Bank for Reconstruction and Development /The World Bank, 2015.
     
  • World Health Organization. Global Health Estimates. Geneva; 2016. Causes of Death 2000-2016.
     
  • World Health Organization. Global Health Estimates. Geneva; 2016. DALYs 2000-2016.