Disparities and Opportunities in Mental Health Care for Women

Antonio Rodriguez_AdobeStock

SPECIAL REPORT: WOMEN'S MENTAL HEALTH

Welcome to this Special Report on Women’s Mental Health. Although the management of men’s mental health is obviously important, there are extra considerations connected to women’s mental health. These considerations range from hormonal changes triggering psychiatric symptoms to taking into account in utero exposure of children to psychiatric medications and/or untreated psychiatric illness to the extra dose of stigma that women often face when seeking help for mental health conditions, particularly if they are from a minoritized population.

For years, women have been lumped in with men for research for both medical and mental health conditions, even when clinical experience dictates that psychiatric illness, in particular, is experienced differently in women and must be managed differently. One can even argue that focusing on minimizing women’s mental health and limiting or eliminating such conditions as postpartum depression and postpartum psychosis could lead to better health and mental health outcomes for whole communities.

The CDC–Kaiser Permanente ACE study on adverse childhood experiences (ACEs) supports this idea because findings showed a dose response relationship between the number of ACEs experienced in childhood and negative long-term health and well-being outcomes, including cardiovascular health, substance abuse, and psychiatric illness, among others.¹

Exposure to psychiatric illness in the household was one of the measured ACEs, and although this includes exposure to paternal (and other family members’) psychiatric illness, the only predictable time of onset of psychiatric illness overall is the postpartum time period. Fifteen percent of new mothers will experience postpartum depression from the general population. This percentage rises to at least 25% or more in mothers with a preexisting psychiatric illness, particularly if medications were stopped for pregnancy.

All mental health clinicians should be watching new mothers with a history of psychiatric illness closely and intervening to prevent or at least minimize the postpartum psychiatric illness for the sake of the mother, the family, and particularly the exposed children.

By focusing on identifying and treating maternal psychiatric illness, we can start to decrease long-term effects on the children and potentially decrease their risk for psychiatric illness as well. Identification and treatment of mental health conditions in men is also paramount, but the fact that we can identify a high-risk period for women means that we should be extra vigilant and get our rate of identification from less than 50% to closer to 100%.

I will turn now to the articles in this Special Report. Disparities in how we deliver health care exist not only for women in general, but also for minoritized groups—and when both of these characteristics are combined in women from minoritized groups, it results in staggering differences in how both health care and mental health care are delivered and received. The article “Addressing Racial and Ethnic Disparities in Women’s Mental Health Care” describes these differences and how we can overcome them beautifully.

Also, a few psychiatric illnesses are specific to women, such as postpartum psychosis. Although some clinicians are reluctant to aggressively treat psychiatric illness during pregnancy and lactation, the article “Postpartum Psychosis: Improving the Likelihood of Early Intervention” makes the case for close monitoring and quick action in the setting of postpartum psychosis because the outcome of untreated postpartum psychosis can and does result in tragic outcomes.

The common theme among these articles is an emphasis not only on the differences in women’s mental health, but on the importance of thinking carefully and thoughtfully about how delivering mental health care to women is different from delivering it to men.

There is an urgency for competent, thoughtful mental health care for women—not only because the differences have been ignored in the past, but because women’s mental health so often affects health and mental health outcomes for their children. Making sure that every mother is healthy from a mental health perspective can improve outcomes for everybody in the long run.

Dr Payne is vice chair of research, professor of psychiatry and neurobehavioral sciences, and director of the Reproductive Psychiatry Research Program at the University of Virginia in Charlottesville.

Reference

1. Merrick MT, Ford DC, Ports KA, et al. Vital signs: estimated proportion of adult health problems attributable to adverse childhood experiences and implications for prevention - 25 states, 2015-2017. MMWR Morb Mortal Wkly Rep. 2019;68(44):999-1005.