Women ’s and Children’s Mental Health

Flashcards relating to key vocabulary terms from the lecture notes.

Hysteria

Term used until the 18th century to describe all women’s mental health disorders and attributed to movement of the uterus.

Which countries have the most DALYs attributed to mental disorders?

1. australia

2. new zealand

3. iran

4. oman/UAE

5. jordan

What mental disorder group has the most DALYs?

1. depression

2. anxiety

3. drug use disorders

What are the differences between men’s and women’s mental health for the following disorders?

1. schizophrenia

2. bipolar affective disorder

3. depression, anxiety, panic, and phobias

4. eating disorders

5. alcohol

6. other

1. occurs at a later age and has more mood symptoms

2. more likely to present with depression than mania

3. more common in women than men (up to 2x more)

4. ten times more common in women

5. lower rates but brain damage more likely

6. mental disorders associated with pregnancy

What are the three things are behind gender differences in mental illnesses globally?

1. social status of women

2. gender-based violence

3. pregnancy

Gender Roles Hypothesis

Gender differences in the prevalence of mental disorders are due to differences in the typical stressors, coping resources, and opportunity structures for expressing distress made available differentially to women and men in different countries at different points throughout history.

How do differences in social position between men and women contribute to mental health risk?

• unequal distribution of power, income, goods, services, decision making, human rights

• inequality of participation, personal safety, reproductive choices

• discrimination:

  • female feticide/preference for male children

  • worse nutrition and health

  • less education

  • forced marriage

  • child/adolescent marriage

  • financial dependence

  • honor killing

• social expectations (appearance)

What is the cultural significance of motherhood?

• motherhood is the primary source of support, status, value, and economic security for women in many societies

• women are often maltreated/divorces if they become infertile

• parents and young women closely follow the rules of marriage, including FGM

What are the impacts of unpaid work and care giving on women?

• women have the primary responsibility for unpaid work (household tasks and care giving)

  • about 80% of the responsibility falls on women

• precludes (makes impossible) income independence

• care givers are six times more likely than non-caregivers to experience depression and anxiety

• higher usage of medications, worse self-rated health, happiness, energy, confidence

• increased social isolation

Gender-Based Violence

Reflects and reinforces inequities between men and women and compromises the health, dignity, security, and autonomy of its victims; encompasses a wide range of human rights violations.

Intimate Partner Violence

Physical, sexual, or psychological harm by a current or former partner or spouse.

What are the health impacts of intimate partner violence?

1. mental health

   • twice as likely to experience depression

   • almost twice as likely to have alcohol use disorders

2. sexual/reproductive health

   • more likely to have a low birth-weight baby

   • more likely to acquire STDs

3. physical health

   • experience injuries as a result of IPV

   • 38% of all murders of women globally were reported as being committed by their intimate partners

Describe gender violence at each of these stages in a woman’s life.

1. prenatal

2. infancy

3. childhood

4. adolescence

5. reproductive age

6. old age

1. prenatal sex selection, battering during pregnancy, coerced pregnancy/rape

2. female infanticide, emotional and physical abuse, differential access to food and medical care

3. FGM, incest and SA, differential access to food and medical care, and education, child prostitution

4. dating and courtship violence, economically coerced sex, sexual abuse in the workplace, rape, sexual harassment, forced prostitution

5. abuse of women by intimate partners, marital rape, dowry abuse and murders, partner homicide, psychological abuse, sexual abuse in the workplace, sexual harassment, rape, abuse of women with disabilities

6. abuse of widows, elder abuse

The vast majority of women who experience violence never seek help or file reports. What are the barriers to help-seeking?

1. socio-cultural barriers

   • beginning in the home

2. structural barriers

   • emerge once a survivor has decided to seek help

How many women worldwide have experienced physical and/or sexual violence?

1 in 3 women

What impact does war and disaster situation have on MNCH?

• worldwide 117.3 mil people have been forcibly displaced due to persecution, conflict, violence, human rights violation, and events seriously disturbing the public order

• 80% are women and children

• in regions of armed conflict women and girls are exposed to higher risks of sexual violence and exploitation, along with future stigmatization

• destruction of necessities of life and a lack of opportunities to generate income make women and children and children vulnerable to sexual exploitation and trafficking

• destruction of health care infrastructure and services increases maternal and child mortality and morbidity

• women are three times more likely than men to experience depression in response to these events

What are the biological risk factors for mental illness before, during, and after pregnancy?

• nutrition status

• chronic disease

• infections

• substance use

• problems with pregnancy

What are the psychological risk factors for mental illness before, during, and after pregnancy?

• personality and coping skills

• past experiences of abuse or neglect

• past mental health problems

What are the social risk factors for mental illness before, during, and after pregnancy?

• violence

• income insecurity

• excessive caring burden

• insufficient emotional and social support

• single mother

• lack of family planning options

• having female baby (sometimes)

• poor in-law relations

What are the cultural risk factors for mental illness before, during, and after pregnancy?

if a woman’s culture usually provides post-partum support, but she doesn’t receive it

Mental health disorders cause problems during pregnancy. What are characteristics of people with mental health disorders as it relates to reproduction?

they are…

• less likely to use family planning options

• later presentation for prenatal care

• at a higher risk for poor obstetric outcomes

• maternal stress hormones can pass through the placenta and may reduce birth weight

What are the two complications that can occur after pregnancy leading to mental health disorders in women?

1. pregnancy loss

   • can lead to bereavement reactions, anxiety, guilt, powerlessness, self-blame, and sadness

   • feelings are amplified with multiple miscarriages

   • increased risk of major depression

2. obstetric fistula

   • can lead to social ostracization, major depression, grief, loss of confidence, and suicidal thoughts

How can the mental health disorders of the mother cause problems once the child is born?

• maternal stress hormones that pass through the placenta may be associated with later child behavioral disorders/emotional problems

• maternal distress can cause neglect, harm, and attachment problems for the child

• maternal distraction can cause higher levels of child stunting (due to poor nutrition), diarrhea, infections, and missing vaccinations

What are some challenges that a mother may face post-partum?

• disconnect between theory, expectation, and reality

• excessively idealized situation

• conflicting advice

• chronic sleep deficit

• feelings of being out of control/overwhelmed

• poor social or marital support

Post-Partum Blues

A transient period of weepiness occurring in the majority of new mothers.

Post-Partum Depression

Depression occurring from 2 weeks to anywhere up to a year after childbirth.

• about 20% of women develop it

What are the risk-factors for post-partum depression?

• birth-related trauma

• history of depression

• poor social support

• poverty

• unplanned pregnancy

What impacts does post-partum depression have on children?

• insecure attachment

• poor nutrition and attendance to health care

• less likely to be vaccinated

Post-Partum Psychosis

• A rare but severe mental illness that can occur after childbirth, characterized by mania, depression, confusion, hallucinations, paranoia, and delusions.

• occurs immediately to 6 weeks after childbirth

What are the risk factors for post-partum psychosis?

• having bipolar affective disorder, schizoaffective disorder or schizophrenia

• having relative who had PPP

Can PPP be treated?

Yes

Filicide

The act of a parent killing their own child.

True or false: about half of mental illnesses start before age 14

true

What is the key time for child mental health disorders?

infancy

• type of mother predicts future social and emotional development

• separation, poor bonding, maltreatment, negative attitudes from mother leads to anxiety, insecurity

• post-natal depression/psychosis can harm attachment

What are the long-term impacts of childhood mental health issues?

• more likely to experience problems at school and be absent

• more likely to be suspended or expelled

• more likely to drop out of high school (44%)

• lower levels of academic achievement

• children in welfare system are less likely to be placed in a permanent home, more likely to be moved around and end up in juvie

Risk factors for child mental illness (individual attributes/behaviors and genetic and biological factors)

• learning disability

• chromosomal abnormalities

• prenatal exposure to alcohol or drugs

• oxygen deprivation at birth

• maternal illnesses during pregnancy

• physical illness

• low self esteem

Risk factors for child mental illness (social and economic circumstances)

• parental mental illness, alcoholism, or jail

• parents who separate or divorce

• bereavement

• neglect and family conflict

• maternal distress when child is a toddler

• being part of a military family, especially during parent’s deployment

• poverty and/or homelessness

• bullying

• physical, sexual, and/or emotional abuse

• poor educational attainment

• acting as a caregiver for a relative

• in child welfare/social services

• in juvenile justice system

risk factors for child mental illness (environmental)

• discrimination and inequalities (due to racial minority, gender, etc)

• predominating cultural beliefs and practices

• poor access to essentials of living

• exposure to wars or disasters

What are the WHO recommendations for treating mental disorders?

• instead of providing care in large psychiatric hospitals, countries should integrate mental health into primary health care, provide mental health care in general hospitals and develop community-based mental health services

• community-based care (only hospitals when necessary)

• talking therapies

• occupational therapy

• development of better medications than we have today

What is Vikram Patel’s approach to treating mental health?

SUNDAR

Simplify the message

UNpack the treatment

Deliver where the people are

Affordable and available human resources

Reallocation of specialists to train and supervise

What is the current status of delivering mental health care to children in developing countries?

• little progress has been made in integrating into primary pediatric care

• current research does not support that training primary care workers results in long-term improvements in treatment fro children

• most mental illnesses identified and diagnosed by the education system

mhGAP recommendations for developmental disorders (intellectual disability and autism)

• psycho-education and parent training

• educational support and teacher training

• community-based rehabilitation

• protecting human rights

• support for carers, including treating any maternal depression

• follow up regularly

mhGAP recommendations for behavioral disorders (hyperkinetic disorder/ADHD/oppositional defiant)

• family psycho-education

• education support and teacher training

• caregiver support

• medication under care of specialist only

  • very last resort!

  • questionable efficacy, many side effects, and long-term addiction potential