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Women have very specific mental health issues relating to the biosocial fact of their gender, a fact only recently (since 1993) taken account of in pharmaceutical trials. Women use more health care services in the United States, take more psychopharmacological agents; are more than 50% more likely than men to be prescribed antidepressants or anxiolytic medications during a medical visit, and more likely to be diagnosed with a psychiatric. Women are traditionally more likely to be disadvantaged due to lower wages, greater likelihood of sexual and domestic violence, have lower socio-economic status and experience greater anxiety and depression in their lives. They also tend to use less alcohol than men to conceal their psychological states. Full blown schizophrenia in women is more often co-morbidly associated with somatic manifestations as well as anxiety and depression than in men. Women are also more likely to suffer from eating disorders and body image issues than men. Female/male differences in matters of mental health are multiple.
Biological differences in brain anatomy and hormonal differences throughout a woman's lifespan and unconfined to ethnicity contribute to differences in psychoactive effects. The authors of this fine book (both experienced medical practitioners of University of California, Los Angeles, School of Medicine Women's Life Centre) note that estrogen's antidopaminergic and serotonin-enhancing effects and the modulation of g-aminobutyric acid (GABA) receptors by metabolites of progesterone may play a role in psychiatric disorders in women. The contraceptive pill may possibly influence the effects of psychotropic medication. Likewise the effect of the menstrual cycle on psychotropic medication levels is unclear, according to the authors (p.4), although, across the cycle, the levels may vary. Fluctuating hormonal levels of peri- and menopause may also contribute to a rise and fall of the body's capacity to absorb effectively psychotropic medication.
All these gender-specific matters, and more, should form the basis of the mental health assessment of women attending any medical practice. The Clinical Manual of Women's Mental Health, in its clear layout and account, provides a clear and concise presentation of clinically significant considerations, and medical differential diagnoses, that will be a most valuable book for other health workers as well as medicos, including non-prescribing professionals such as counsellors, clinical psychologists, and social workers.
The book is divided into ten chapters. Etiologies of treatments are clearly explained and the authors discuss which treatments are scientifically and clinically found to be effective, and which are not effective. Pharmacological treatments are presented, as are non-pharmacological ones. The latter include education, support, family intervention, stress reduction, dietary changes reducing salt, alcohol and caffeine, reduction of nicotine, cognitive-behavioral approaches, exercise and relaxation techniques.
The layout of each chapter includes principles, epidemiology, etiology, and psychological and risk factors of a mental health condition along with treatments, often not just for women but also for male clients, that emphasizes similarities and contrasts between the sexes. A table summarizing the contents of each chapter supplies the reader with valuable at hand information. The book is a manual in the best sense of the word; its direct, factual, clear prose is immediately accessible and useable as is.
This excellent book, an update of the second edition of the authors' Concise Guide to Women's Mental Health, should sit on the desks of every health professional. A most useful book indeed.
© 2007 Elizabeth McCardell
Elizabeth McCardell, PhD, Independent scholar, Australia.