The best of times? Student days, mental illness, and gender
By Daniel Freeman and Jason Freeman
Students are often told — perhaps by excited friends or nostalgic parents — that university is the best time of their life. Well, for some people these years may live up to their billing. For many others, however, things aren’t so straightforward. College can prove more of a trial than a pleasure.
In truth it’s hardly surprising that many students struggle with university life. For one thing, it’s probably the first time they’ve lived away from home. College involves all sorts of potentially daunting changes and challenges with the young person’s support network of family and friends usually many miles away.
It isn’t only university life that students may be struggling with. Many common psychological problems also tend to develop around this stage of life. Depression, phobias, social anxiety, panic disorder, insomnia, alcohol problems, eating disorders, sexual problems — all typically begin during adolescence or early adulthood.
Whether students arrive at university with these problems, or develop them while there, coping with mental health issues alone and in a strange town can be particularly difficult. It’s not made any easier by the assumption that you should be having a ball.
When we think about mental health, one issue that is often overlooked is gender. Yet who is more likely to develop almost all of the psychological problems we’ve mentioned? The answer is clear: women.
Indeed, although it’s commonly asserted that rates of psychological disorder are virtually identical for men and women, when one takes a careful look at the most reliable epidemiological data a very different picture emerges.
Contrary to received wisdom, overall rates of psychological disorder are not the same for both sexes. In fact, they are around 20-40% higher in women than in men. Depression, for example, affects approximately twice as many women as men. The same is true for anxiety disorders. Women are anywhere from three to ten times more likely to develop eating disorders such as anorexia and bulimia nervosa. There’s good evidence to suggest that women are more vulnerable to both sleep disorders (primarily insomnia) and sexual problems (such as loss of desire, arousal problems, and pain during sex — all of which are classified as psychological issues).
This doesn’t mean, of course, that mental illness is an exclusively female problem — far from it. Very large numbers of men experience depression and anxiety, for example.
Nevertheless, though men tend to be prone to so-called externalizing disorders such as alcohol and drug problems and anti-social personality disorder, while women are more susceptible to emotional problems like depression and anxiety, the figures aren’t equal. If the epidemiological data is reliable, women clearly outnumber men for psychological disorders as a whole.
How do we explain this phenomenon? Why is it that women appear to be more vulnerable to mental illness than men? Well, this is an under-researched area. In the case of certain disorders — depression, most notably — some useful work has been done on gender. For most conditions, however, we have little evidence for why men and women are affected differently.
Things are especially tricky because mental illness is seldom the result of just one factor: a complex mix of genetic, biological, psychological, and social causes is often involved. Yet patterns do emerge from the limited research that has been conducted into the links between gender and mental health. What stands out is the stress caused by life events and social roles.
It’s certainly plausible that women experience higher levels of stress because of the demands of their social role. Increasingly, women are expected to function as career woman, homemaker, and breadwinner — all while being perfectly shaped and impeccably dressed: “superwoman” indeed. Given that domestic work is undervalued, and considering that women tend to be paid less, find it harder to advance in a career, have to juggle multiple roles, and are bombarded with images of apparent female “perfection”, it would be surprising if there weren’t some emotional cost. Women are also much more likely to have experienced childhood sexual abuse, a trauma that all too often results in lasting damage.
How do these environmental factors affect the individual? At a psychological level, the evidence suggests that they can undermine women’s self-concept — that is, the way a person thinks about themselves. These are the kind of pressures that can leave women feeling as if they’ve somehow failed; as if they don’t have what it takes to be successful; as if they’ve been left behind. Body image worries may be especially damaging. Then there’s the fact that women are taught to place such importance on social relationships. Such relationships can be a fantastic source of strength, of course. But to some extent we’re relying on other people for our happiness: a risky business. If things don’t work out, our self-concept can take a knock.
Perhaps then, part of the reason why so many common psychological disorders begin in adolescence and early adulthood is because this is the time when young people start to take on the demands of their conventional adult role. If those demands are more stressful for women than men that may help explain why we see young women start to outnumber young men when it comes to psychological problems.
But we need more evidence. The best answers will come from longitudinal studies: following representative cohorts over a number of years from childhood into adulthood, and carefully measuring the interaction between biological factors, life events, and mental illness.
Such research is complex and expensive, but given the extent of the burden on society and individuals alike, understanding what causes mental illness and thus being better placed to prevent and treat it should need no justification. Yet we cannot assume, as so many have done, that gender is merely a marginal issue in mental health. In fact, it may often be a crucial element of the puzzle.
Daniel Freeman is Professor of Clinical Psychology and MRC Senior Clinical Fellow, Oxford University. Jason Freeman is a freelance writer and editor. Together they wrote The Stressed Sex: Uncovering the Truth About Men, Women, and Mental Health, Anxiety: A Very Short Introduction, and Paranoia: The 21st Century Fear.
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Image Credits: (1) Stressed student. Photo by Alexeys, iStockphoto. (2) Hard study. Photo by Oliver, iStockphoto.