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Women
and Fear, Stress, or Depression
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The title of
the lead story in the Style section of the Washington Post
on Thursday, November 29, 2001 was "The great worry divide."
Washington Post staff writer, Paul Farhi, was writing about
the difference between the reactions of men and women to the
September 11 terrorist attacks. Two couples that Mr. Farhi
interviewed are quoted, as is Deborah Tannen, Georgetown University
linguist, and author of the popular book on communication
between men and women; "You Just Don't Understand: Women
and Men in Conversation."
Two other sources that are quoted are a poll taken by the
Pew Research Center in October and an article in a November
15, 2001 issue of The New England Journal of Medicine (NEJM).
Interested individuals can read a summary of the PEW poll
"No Rise in Fears
or Reported Depression," The Pew Research Center
for the People and the Press. Despite the title of this report,
PEW researchers are quoted in the Washington Post article
as noting that over 50 % of the women polled said that they
were "somewhat" or "very" concerned about
future attacks; whereas only 30% of men polled expressed this
a concern for new attacks. More women than men reported insomnia
or feeling depressed, and the NEJM article seems to support
this. The NEJM citation is in the Special Report section of
the issue and is not available in full-text on the NEJM site
to non-subscribers. Look for Schuster, MA, et al. (2001).
A national survey of stress reactions after the September
11, 2001, terrorist attacks. NEJM, 345(20), 1507-1512.
Are women more frightened, stressed or depressed by the September
11 terrorist attacks and the following biochemical terrorism
with Anthrax letters, or just more willing to express these
feelings? Do women require more care by family members and
health care providers, or are these intuitive responses to
the environment that may be more accurate than stated male
responses?
Again, just posing a question and providing some resources
to pursue if interested. In addition to the web sites and
list of articles, the 1998 book, " The Gift of Fear:
Survival Signals That Protect Us from Violence," by Gavin
De Becker, provides much food for thought.
A great resource for women's health issues is Medscape
- Women's Health.
l. Below, I have copied a few of the sections from this site
pertinent to this week's subject and to the broader of the
Task Force on Occupation in Societal Crises.
Disaster and Trauma
Regularly updated collection of Medscape's key clinical content.
Medscape's editors have put together this collection of news,
notices, articles, and related links to provide healthcare
professionals the latest information and resources related
to caring for those affected by the September 11th terrorist
attacks on New York City and Washington, DC. This information
will be updated regularly.
Posttraumatic Stress Disorder
Medscape Articles
Trauma and PTSD: Aftermaths of the WTC Disaster - An Interview
With Yael Danieli, PhD
[Medscape Original Article]
Posttraumatic Stress Disorder: An Interview With Marilyn Bowman,
PhD
Special interview about posttraumatic stress disorder.
How to Help Children When Disaster Strikes
[Brown Univ Child Adolesc Behav Ltr]
Trauma and PTSD: Aftermaths of the WTC Disaster - An Interview
With Bessel A. van der Kolk, MD
Posttraumatic Stress Disorder: An Interview With Marilyn Bowman,
PhD
Practice Guidelines
Expert Consensus
Treatment Guidelines for Posttraumatic Stress Disorder
Treatment of Anxiety Disorders - US Surgeon General
Practice
Parameters for the Assessment and Treatment of Children and
Adolescents With Posttraumatic Stress Disorder
Related Links
Anthrax Offers Lessons in
How to Handle Bad News
(New York Times, October 23, 2001)
Making
Trauma Therapy Safe
The Post-Traumatic
Response in Children and Adolescents
Disaster
Mental Health Services: A Guidebook for Clinicians and Administrators
Field
Manual for Mental Health and Human Service Workers in Major
Disasters
Patient Information
What to
Tell Children about Terrorist Bombings
Expert Consensus
Treatment Guidelines for Posttraumatic Stress Disorder: A
Guide for Patients and Families
Managing
Traumatic Stress: Tips for Recovering From Disasters and Other
Traumatic Events
(American Psychological Association)
Some references on women
and fear, stress, or depression
Bracegirdle, H. (1991). The Female Stereotype and Occupational
Therapy for Women with Depression.
The British Journal of Occupational Therapy, 54(5), 193-194.
ABSTRACT: This article, the first in a series of three, examines
the possibility that women's greatly increased risk of developing
depression may result from a number of social processes. A
review of the feminist psychological literature challenges
the assumption that biological vulnerability and personality
factors are largely responsible for women's suffering. Theories
that look at the sex-role socialization on girl's self-concept
and emotional adjustment are briefly considered. Then the
traditional and prevalent role of housewife and its effects
on mental health are described. Finally there is a look at
the power relationships between the sexes that probably underpin
both women's socialization and their customary roles.
Capaldi DM, & Owen LD (2001). Physical aggression in
a community sample of at-risk young couples: gender comparisons
for high frequency, injury, and fear. Journal of Family Psychology,
15(3), 425-40.
ABSTARCT: The associations of frequent physical aggression,
injury, and fear were examined for a community-based sample
of at-risk young couples who were dating, cohabiting, or married.
It was hypothesized that frequent physical aggression toward
a partner, in the range of shelter samples, is largely caused
by antisocial behavior and mutual couple conflict and, thus,
that there would be greater similarity across genders in such
behavior than has previously been supposed. It was also predicted
that levels of injury and fear would be higher in women but
that some men would experience these impacts. Findings indicated
similarity across genders both in the prevalence of frequent
aggression and in its association with antisocial behavior.
Furthermore, such aggression was likely to be bidirectional
in couples. Contrary to the hypothesis of the study, rates
of injury and fear for the women were not significantly higher
than for the men.
Davis, J & Kutter, CJ (1998). Independent living skills
in posttraumatic stress disorder in women who are homeless:
Implications for future practice. The American Journal of
Occupational Therapy, 52(1), 39-44.
ABSTRACT: OBJECTIVE. Service delivery through community-based
programs is the future of occupational therapy. This study
examined independent living skills, traumatic experiences,
and symptoms of Posttraumatic Stress Disorder (PTSD) in a
sample of women residing in supportive housing program for
women and families who are homeless in order to determine
the needs of this population and the possible role of occupational
therapy in such a community-based program. METHOD. Twenty-four
women residing in a supportive housing shelter in Kansas City,
Missouri volunteered to participate in this study. The participants
were evaluated for independent living skills with the Kohlman
Evaluation of Living Skills. A structured interview format
was used to determine whether participants experienced a trauma
and whether they met diagnostic criteria for PTSD. RESULTS.
Results indicated that women who are homeless have deficits
in independent living skills, especially in the area of money
management. Results also indicated that traumatic experiences
and PTSD are more prevalent among women who are homeless than
among women in the general population. The relationship between
independent living skills and PTSD among women who are homeless
was not made clear in this study. CONCLUSION. The information
gathered in this study underscores the importance of identifying
and addressing occupational and mental health issues of women
who are homeless. Results suggest that occupational therapists
have a major role to play, evaluating and facilitating independent
living skills, as members of multidisciplinary treatment teams
in supportive housing programs for persons who are homeless
Feder, J. (1991). Women, depression, and work: Treatment
strategies for the depressed patient. Occupational Therapy
Practice. 2(4), 58-67.
Fontana A, Litz B, & Rosenheck R. (2000). Impact of combat
and sexual harassment on the severity of posttraumatic stress
disorder among men and women peacekeepers in Somalia. Journal
of Nervous and Mental Disease, 188(3), 163-9.
ABSTRACT: The impact of combat and sexual harassment on the
severity of posttraumatic stress disorder (PTSD) is compared
for 1,307 men and 197 women peacekeepers who served in the
same military units. A theoretical model was proposed to express
the nature of the impact. Structural equation modeling was
used to evaluate the model separately for men and women. Good-fitting,
parsimonious models were developed that showed substantial
similarity for men and women. For men, severity of PTSD symptoms
was impacted by exposure to combat directly and indirectly
through fear and sexual harassment. For women, severity of
PTSD symptoms was impacted by combat indirectly through the
same two influences, although the mechanisms involving fear
and sexual harassment were somewhat different. For both genders,
moreover, PTSD severity was impacted directly by exposure
to the dying of the Somali people. These similarities suggest
that in modern stressful overseas military missions, both
genders may be susceptible to the same types of risk for the
development of PTSD. The incidence and impact of sexual harassment
is particularly noteworthy in the case of men and calls for
more detailed investigation in future studies.
Jang KL, Stein MB, Taylor S, & Livesley WJ. (1999). Gender
differences in the etiology of anxiety sensitivity: a twin
study. Journal of Gender Specific Medicine, 2(2), 39-44.
ABSTRACT: OBJECTIVE: To estimate the magnitude of genetic
and environmental factors on anxiety sensitivity by gender.
DESIGN: Classic twins reared-together study design. PATIENTS:
A community sample of 337 twin pairs, including 179 monozygotic
(45 brother and 134 sister pairs) and 158 dizygotic (28 brother,
94 sister, and 36 brother-sister pairs). METHOD: Twin pairs
completed the Anxiety Sensitivity Index (ASI) using a postal
survey design. The ASI is composed of three factors: (1) fear
of anxiety-related somatic sensations; (2) fear of cognitive
dyscontrol due to beliefs that sensations like depersonalization
are signs of mental illness (e.g., fear of concentration problems);
and (3) fear of publicly observable anxiety reactions (e.g.,
fear of trembling). Biometrical modeling techniques were used
to estimate heritability of the ASI dimensions by gender.
RESULTS: ASI factors are heritable only in women, accounting
for 37% to 48% of the total variance (median, 44.5%). Environmental
factors accounted for all the variability in men. CONCLUSIONS:
These findings have implications for understanding the etiology
of panic disorder. Previous research suggests that anxiety
sensitivity is a risk factor or diathesis for this disorder,
and that panic disorder is more prevalent in women than men.
Our findings suggest the hypothesis that the increased prevalence
in women may occur because anxiety sensitivity is heritable
in women.
Lougher, L. (1983). The Critical Role of Occupational Therapy
in the Treatment of Depressed Women. The British Journal of
Occupational Therapy, 46(11), 324-326.
Prior PM & Hayes BC. (2001). Gender trends in occupancy
rates in mental health beds in Northern Ireland. Social Science
Medicine, 52(4), 537-45.
ABSTRACT: Based on census material from 1926 to 1991, this
study focuses on gender differences in occupancy rates in
mental health beds in Northern Ireland. More specifically,
using two sets of research literature--the relationships between
war and mental health and gender and mental health respectively--it
explores changing patterns in bed occupancy in terms of both
gender and age differences within this society. The results
suggest that, although men and women no longer vary in terms
of their overall occupancy rates within mental health facilities
in Northern Ireland, within their respective male and female
sub-populations, however, some notable age-specific differences
have now emerged. Since 1981, whereas increases in mental
health bed occupancy among women have been exclusively confined
to the old (65 years or older), among males, it is the very
young, specifically men aged 15-24 years, who have demonstrated
the most dramatic rise in bed usage. It is important to note,
however, that these age-specific gender increases cannot be
accounted for by demographic changes in the general population.
The authors suggest that, at least as far as men are concerned,
the increasing pattern of vulnerability among the young may
be attributed to the impact of changing definitions of mental
disorder rather than to the effect of political violence on
mental health. It is to this group of individuals--the cohort
of men born since the outbreak of civil unrest in Northern
Ireland in 1969--that future research should be directed
Rogers, JC & Holm, MB (2000). Daily-living skills and
habits of older women with depression. The Occupational Therapy
Journal of Research, 20 (Supplement 1), 68S-85S.
NOTES: Proceedings of Habits I Conference, Asilomar Conference
Center, Pacific Grove, CA, January 4-8, 1999 Five patterns
of relationships among perceived daily-living skills, perceived
daily-living habits, and demonstrated skills were identified
in community-based older women with major depression.
ABSTRACT: This study used a prospective, within-group comparison
design to examine differences in the severity of disability
in a community-based sample of 59 older women being treated
for depression. The independent variables were three constructs:
perceived skills, perceive habits, and demonstrated skills.
The dependent variables were functional mobility, personal
care, and instrumental activities of daily living. Results
indicated that the expression of overall disability differed
significantly among the three constructs. Participants' perceptions
of their skill independence were greater than their ability
to demonstrate independence in those skills and their demonstrated
skills of task independence were greater than their perceived
ability habitually to use those skills independently. Objective,
Performance-based skill measures, indicated greater disability
than subjective, self-report skill measures, and supported
the view that in older adults, depression-related disability
reflects a combination of skill and habit deficits. Item analyses
revealed five distinct patterns of relationships among perceived
skills, perceived habits and demonstrated skills. Practitioners
need to be aware of the constructs being used to measure disability
because the severity of disability may depend on the construct
being used. Furthermore, the types of interventions appropriate
for disability related to each construct or pattern of constructs
may vary.
Slusarcick AL, Ursano RJ, Fullerton CS & Dinneen MP.
(1999). Stress and coping in male and female health care providers
during the Persian Gulf War: the USNS Comfort hospital ship.
Military Medicine, 164(3), 166-73.
The development of the USNS Comfort hospital ship during
the Persian Gulf War provided an opportunity to examine the
relationship of gender to stress and coping in health care
providers exposed to wartime stressors. Just before the outbreak
of Operation Desert Storm, medical personnel (N = 250) rated
the stressfulness of current wartime experiences and the helpfulness
of stress-reducing resources onboard ship in a combat theater.
The responses of men and women were compared; to identify
the dimensions of these responses, a principal factor analysis
(orthogonal rotation) was performed. Generally, men and women
ranked stressors and stress reducers similarly; women scored
higher on the stress ratings. Two factors, similar for men
and women, were identified in the stress ratings: fear of
injury and trauma-related work demands. The dimensions of
the stress reducers, however, were different for men and women.
The findings support retrospective studies and suggest that
different mechanisms of stress reduction may be operative
even though men and women are performing the same activity
Voge VM, & King RE. (1997). Interpersonal relationship
and prisoner of war concerns of rated military male
and female aircrew. Aviation, Space and Environmental Medicine,
68(10), 879-85.
ABSTRACT: BACKGROUND: The issue of women flying military
aircraft in a combat role has been very controversial. HYPOTHESIS:
To succeed, female military aircrew are very similar to their
male peers. METHODS: We conducted a comprehensive anonymous
questionnaire survey of all U.S. Army and U.S. Air Force rated
female
aircrew, with an equal number of age and duty matched male
aircrew. We are reporting on the interpersonal relationship
and prisoner of war (P.O.W.) responses here. RESULTS: Male
and female aircrew respond in a similar manner to posed questions,
although differences do exist. Women reported: unequal treatment
by opposite gender peers; problems relating to peers, superiors
and subordinates; their gender influences assignments; the
need to perform to higher standards and the need to work harder
to be accepted as equals; ability to bond equally to their
own and opposite gender peers; improved squadron cohesiveness
in mixed gender squadrons; problems with peers' spouses; and,
in a P.O.W. situation, fear of rape and sexual abuse. Men
reported: women get inappropriate privileges and get special
"breaks"; a gender difference in how flight duties
are performed; worsened squadron cohesiveness in mixed gender
squadrons; less likeliness to recommend their career path
to their daughters; and a higher concern for welfare of families
in a P.O.W. situation. CONCLUSIONS: Although responding in
a similar manner to most questions, male and female military
aircrew differ in the perception of their ability to function
in mixed squadrons because of their gender. Some of these
perceptions can be modified through training, others may need
to be resolved through high level orders/policy; while in
others, the military may have to accept women are different
from men in some aspects
Wise LA, Zierler S, Krieger N, & Harlow BL. Adult onset
of major depressive disorder in relation to early life violent
victimisation: a case-control study. (2001) Lancet, 358(9285),
881-7.
ABSTRACT: BACKGROUND: Major depressive disorder is a significant
cause of morbidity among women in the USA. Women are twice
as likely as men to be diagnosed with major depressive disorder,
yet no known risk factors can account for this sex difference.
We aimed to assess violent victimisation as a risk factor
for depression in women. METHODS: We undertook a case-control
study to assess the association between violent victimisation
early in life and major depressive disorder in women. We randomly
selected a population-based sample of women, aged 36-45 years,
from the greater Boston area. In 1999, 236 cases and 496 controls
(n=732) completed a self-administered questionnaire designed
to ascertain a lifetime history of exposure to violent victimisation.
Our main outcome measure was major depressive disorder, assessed
by structured clinical interview for
Diagnostic Statistical Manual IV (DSM-IV) criteria. FINDINGS:
363 (50%) of 732 respondents reported experience or fear of
abuse as a child or adolescent. 68 were excluded because they
reported violence as an adult only. Compared with women who
reported no abuse, risk of depression was increased in women
who reported any abuse as a child or adolescent (relative
risk 2.5, 95% CI 1.9-3.0), physical abuse only (2.4, 1.8-3.0),
sexual abuse only (1.8, 1.2-2.8), and both physical and sexual
abuse (3.3, 2.5-4.1). Severity of abuse had a linear dose-response
relation with depression. INTERPRETATION: Our results suggest
a positive association between violent victimisation early
in life and major depressive disorder in women.
Compiled by Mary Binderman, MSLS
American Occupational Therapy Foundation
Bethesda, MD.
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