This essay was included in the monograph titled “Gifted Women, Fragile Men” submitted to the European Parliament in March 2017. Read the original essay here.
Since the 1960s women have entered the workforce and have achieved financial independence. It has become socially acceptable to leave unhappy marriages. Through careers, women gain status and enjoy intellectual fulfilment and have less pressure on them to conform to narrow stereotypes of what it means to be a “woman”. The stigma that once existed around free expression of female sexuality has softened, and legislation is in place to protect women from sexual harassment. By dozens of objective measures, women in the West have never enjoyed more rights and have never been more liberated. But for all of this improvement it appears that many women are stressed, tired, overwhelmed and unhappy.
In recent years, psychologists have found that women are much more likely than men to suffer from emotional disorders. In 2013, Oxford Professor Daniel Freeman observed that women were 75 per cent more likely than men to report having depression and 60 per cent more likely to report having an anxiety disorder.
Last year, a team led by a group of researchers at Cambridge also found that women were much more likely to have experienced anxiety, particularly within Anglo and European cultures.2 These results also support a 2009 study by the economists Betsey Stevenson and Justin Wolfers, which found that women reported higher levels of happiness than men in the 1960s, but that this gender gap has now reversed.3 Freeman, a clinical psychologist, noticed a gap in the literature on sex differences in mental health conditions and investigated national mental health surveys taken from the UK, US, Europe, Australia and New Zealand. He found that women are up to 40 per cent more likely than men to develop mental health disorders, with the sharpest discrepancies being in depression and anxiety. Freeman was careful to examine whether women were more likely to report health problems than men, or more willing than men to seek help. In his 2013 book, The Stressed Sex, 1 co-written with his brother Jason, and published by Oxford University Press, the authors conclude that while self-report and women’s help-seeking behaviours may have an impact, they could not solely explain the differences found between the genders. They show that while men suffer higher rates of substance abuse, ADHD and autism, women are bearing the brunt of emotional disorders – and that the rates of these conditions are also on the rise.
In 2016, researchers at the University of Cambridge conducted a systematic review of studies that reported on the proportion of people with anxiety in a variety of contexts around the world.2 They found that women are almost twice as likely to suffer from anxiety as men, and that people living in Europe and North America are disproportionately affected. These results also converge with a study which looked at data stretching over 35 years which found that women’s happiness had declined relative to men’s. In their 2009 paper The Paradox of Declining Female Happiness, the economists Betsey Stevenson and Justin Wolfers found that women reported higher levels of happiness in the 1960s and were happier relative to men.3 But by 2009, the gender gap had reversed, with men being the happier sex. The decline in female subjective wellbeing was found to cut across both class and race and held true for women of all ages, with children and without. This cross-temporal study raised interesting questions.
A decline in happiness over 35 years cannot be attributed to such things as genetics – the cause must be largely environmental – adding weight to Freeman’s hypothesis that women are the “stressed sex”. Yet there are no simple explanations for these data. The causes of mental illness are complex and there is very rarely one single factor to blame. Psychologists will look at a range of variables in an attempt to understand why a disorder develops, and biological factors, thought processes, social structures and local cultures are all involved. When it comes to anxiety and depression, evidence suggests that the proximate causes of neurochemistry and thinking styles are heavily implicated, and can dovetail to create the conditions in which a disorder arises. Studies have found that women faced with life stressors are more likely to ruminate, while men are more likely to engage in “problem- focused coping.”4 Notwithstanding this finding, however, a study published in the Journal of Neuroscience Research in January 2017 found that while women do ruminate more than men, this is not able to explain the entirety of the marked discrepancy found in rates of depression.5 Which indicates that there must be other underlying causes.
Another trigger of emotional disorders in women, are reproductive events that affect a woman across her lifespan. It has long been known that female sex hormones can trigger emotional instability and that marked changes in hormonal levels can develop into premenstrual dysphoric disorder, postpartum depression and postmenopausal depression.5When a woman is pregnant, the surges she experiences in oestrogen (a 50 fold increase) and progesterone (a 100 fold increase) are intense.
6 These hormonal surges are thought to trigger repetitive thoughts, fixations and impulsive behaviours that can become highly distressing. 6 During pregnancy, the stress hormone cortisol also spikes, as does testosterone, preparing the mother for the vigilance required to protect her newborn. 6 After pregnancy, the drop in oestrogen and progesterone can lead to “hormonal deficiency” which is likewise associated with disruptive emotional experiences.6
Scientists now also know that becoming a mother also has long term effects on a woman’s brain.7 It was recently discovered that when women become mothers, the grey matter volume in regions subserving social cognition is pruned away during the final stages of pregnancy.7 This again, is thought to be an adaptive measure to help themother focus on her highly vulnerable infant. In this context of rearing children,women’s propensity to ruminate – while distressing for the mother – can be also be seen as an adaptation from an evolutionary standpoint. The developmental psychologist Joyce Benenson has suggested that in precarious environments (such as those that would have been shared by our ancestors) women may have evolved to worry about their own health and the health of their children, in order to survive. It is likely that women who were more vigilant about protecting their children from threats were more successful in passing along their genes to successive generations than women who were less vigilant. Therefore this susceptibility for worry may have been selected for, indeed, in her book Warriors and Worriers, Benenson has said that “anxiety is part of what it means to be a woman.”8
There are many biological mechanisms unique to women which may drive women’s propensity towards depression and anxiety. And while rumination may have originally been an adaptation, it is clear that excessive worry is not serving women well in modern western societies. The hypothesis presented in The Stressed Sex – that women are increasingly over-worked, overwhelmed, tired and rushed – remains compelling.1 It may be that women’s own biological predisposition towards anxiety may make them more reactive to stressful life events (such as giving birth) and chronic life stressors (such as working full-time while raising children). And when biological vulnerabilities towards emotional disorders are combined with the increasingly complex and busy lifestyles that most women in the west live, we may have a recipe for a widespread mental health problems.
Some will say the decline in women’s happiness are due to ongoing prejudices against women, structural barriers, and patriarchal oppression. While these issues may be a factor, especially in the context of the unequal distribution of domestic labour, it is clear that the increase in emotional disorders amongst women has arisen in concert with an increase in the amount of hours worked by women outside of the home.2 In the U.S., half of all two parent families have both parents working full-time.9 In most cases, women still do the bulk of the “second shift” when they get home; the child-care and the housework, making lunches, and packing school bags and so on. In survey results collected by Pew Research Center, 56% of working parents said that they found balancing work/life difficult, and that parenting was “tiring” and “stressful”.9
Today, life is a struggle for many middle-class working families, for both men and women. But women are particularly sensitive to social rejection, and anxiety and depression often hit us when we feel as though we don’t measure up. With so many domains to now excel in, it is understandable that women may feel less than adequate for not achieving excellence in all of them. Women make constant decisions about how to parcel out their time most efficiently. And the conflicts between careers and time spent with children as well as relationships and domestic labour are almost impossibleto resolve and create an backdrop of tension in the majority of women’s lives. Making apriority of one area always leaves another to be neglected (even just for a short time). Men too face these challenges, but for women it seems these trade-offs are pressure- cooked. The unending negotiation of conflicting life domains takes an emotional toll.
If we are to take the science of sex differences in mental health seriously, we mustacknowledge that women may be more susceptible to developing emotional disorders in response to stress. At the same time, a cautious approach needs to be taken to ensure that women are not cast as “less capable” than men, particularly in the context of high- pressure careers. Women have worked hard to be taken seriously within the professions and within the public and private spheres, and losing ground in these domains would be extremely regrettable. Nevertheless, we must also acknowledge that significant events in a woman’s life – such as giving birth – are anxiety inducing, and that women need a great deal of support when these events occur. The feminist ideal of “independence” might have to give way to a refocus on inter-dependence, both within families and within communities, if women’s stress levels are to be reined in.
Finally, discussions on this issue must not be stalled by the political sensitivity of the topic and acknowledging scientific data should not be seen as a blow to gender equality.
Recognising that women are stressed, should not precipitate unfair or unequal treatment. On the contrary, recognising sex differences in mental health may actually promote more ethical policies within the workplace, in recognition of the vital work that women do in the home. When women are bearing the brunt of emotional disorders, we must use the best tools in our intellectual toolkit to understand why, and how we can best alleviate them.
1. Freeman, D., & Freeman, J. (2013). The stressed sex: Uncovering the truth about men, women, and mental health. Oxford University Press.
2. Remes, O., Brayne, C., Linde, R., & Lafortune, L. (2016). A systematic review of reviews on the prevalence of anxiety disorders in adult populations. Brain and Behavior, 6(7).
3. Stevenson, B., & Wolfers, J. (2009). The Paradox of Declining Female Happines. American Economic Journal: Economic Policy, 1(2), 190-225.
4. McLean, C. P., & Anderson, E. R. (2009). Brave men and timid women? A review of the gender differences in fear and anxiety. Clinical psychology review, 29(6), 496-505.
5. Sundström Poromaa, I., Comasco, E., Georgakis, M. K., & Skalkidou, A. (2017). Sex differences in depression during pregnancy and the postpartum period. Journal of Neuroscience Research, 95(1-2), 719-730.
6. Albert, P. R. (2015). Why is depression more prevalent in women?. Journal of psychiatry & neuroscience: JPN, 40(4), 219.
7. Hoekzema, E., Barba-Müller, E., Pozzobon, C., Picado, M., Lucco, F., García-García, D., & Ballesteros, A. (2016). Pregnancy leads to long-lasting changes in human brain structure. Nature Neuroscience.
8. Benenson, J. F. (2014). Warriors and worriers: The survival of the sexes. Oxford University Press.
9. Pew Research Center. (2015) Raising Kids and Running a Household: How Working Parents Share the Load. Washington D.C.