Tell me if this sounds familiar. You are speaking to someone, who says “this is just the way it is”, or “I didn’t have a choice”, or perhaps “I know it’s not right, but this is our fate”. Or perhaps you have read similar accounts. More often than not, these or similar words are spoken by women – and they are spoken around the world. Have you noticed the inflections in their voices, or the expressions on their faces? Have you wondered about these women and what their lives are truly like? Are these just statements of fact, or do they conceal a much bigger issue?
Globally, Women are 1.5 times more likely than men to be diagnosed with a depressive disorder. Graph 1 shows the rate of depressive disorders among women and men of all ages. In some countries, such as Brazil and Nigeria women disproportionately bear the burden of mental illness. In some cases, such as Norway, the differences between men and women are small, and others such as Oman, men have a higher burden of depression.
However, things change dramatically when we look at people over the age of 45. As the following graphs highlight, across countries whether they are high or low income, older women disproportionately are diagnosed with depressive disorders.
Graph 3 focuses on lower and middle income countries only, while graph 2 includes higher income countries as well.
Source: IHME Global Burden of Disease, n=143
Source: IHME Global Burden of Disease, n=97
So what is causing this?
Part of the reason for this pattern is health related– for instance, there is a link between depression in women and menopause. However, as they age women face additional social, economic, and health issues. Discrimination over the life cycle, whether subtle or overt, accumulates different challenges for women than men as they age in different societies. Many women, especially in low-income countries rely on their families for support including their residence, mobility, and access to health services. This dependency on others for their health and well-being has drawbacks; including social isolation stemming from poor mobility and fewer opportunities for interaction with peers; foregoing healthcare to save resources for other, younger family members, especially in poorer households; direct neglect or abuse; or stress from being dependent on children or other relatives. For instance, a study of 9615 adults from seven States in India, found that widowed women were more likely to have hypertension and stress because of poor health in general compared to married women while it has no similar effect on men.
Evidence also shows that wealthier people often have a better perception of their health compared to those with fewer resources. A study of Europeans aged 50 and above found that less wealth, significantly increased the probability of becoming sick and reduced the chance of recovery among both men and women. In situations where women’s access to resources and independence is limited, it is likely that such issues contribute to greater levels of depressive disorders among women.
From a policy perspective, it is important to ensure that mental health interventions pay special attention to older populations, especially women. This will require a multi-sectoral approach to engage and support older women and the elderly through access to transport, programs that help reduce social isolation, and financial protection for mental health as part of a comprehensive Universal Health Coverage package.
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