Use of mental health services by women in low and middle income countries

Abstract

Purpose – The purpose of this paper is to examine sex differences in mental health service usage among upper-middle, lower-middle, and low-income countries (LICs). Design/methodology/approach – Data from 62 low- and middle-income countries (LAMICs) were collected with the World Health Organization – Assessment Instrument for Mental Health Systems (WHO-AIMS). Sex differences in mental health service utilization were assessed by comparing the proportion female in the general population with the proportion female treated for mental illness in five different types of mental health facility. Findings – Two-sided t-tests for significance (a=0.05) revealed a significant difference between the proportion female in the population and the proportion treated in inpatient facilities (community-based and mental hospitals) in LICs. There was also a trend toward decreased use of outpatient facilities by women in LICs (p=0.08). Lower-middle and upper-middle income countries showed no differences. In day treatment facilities for the entire sample, there was a significant difference between the proportion female in the population and the proportion treated female (weighted mean difference overall=0.10, p=0.035). Research limitations/implications – The authors found significantly reduced utilization of mental health services by women in LICs in community-based inpatient facilities and mental hospitals and a trend toward decreased use in outpatient facilities. Future studies investigating the factors contributing to the lower utilization of services by women in LICs are essential. Originality/value – This study presents the first comprehensive study of mental health service usage by sex in 62 LAMICs.

Major Depressive Disorder in Iran: Epidemiology, Health Care Provision, Utilization, and Challenges

“…This has also been reported in many other developing countries. 25 Except for the role of the families, the social support system is underdeveloped in Iran. There are hotlines available for emergencies, which provide services for patients with MDD, especially those with suicidal thoughts and plans.…”

“…18 This is in contrast with most lower-income countries where females and not males underutilize services, possibly due to lack of access to services and limitations for women. 25 In Iran, it is also common that families and significant others of the patients with depression confuse symptoms of depression with laziness or accuse the patient of malingering. There is also a negative attitude towards psychiatric medications and a significant proportion of the general population believes that the medications are addictive.…”

Women’s health priorities and interventions

“…Suicide is a leading cause of death in adolescent girls and in women aged 20-59 years globally. 27 Women experience more depression and anxiety than men. 28 Patterns of mental health problems differ between men and women as a result of different gender roles and responsibilities, biological differences, and variations in social contexts.…”

“…28 Patterns of mental health problems differ between men and women as a result of different gender roles and responsibilities, biological differences, and variations in social contexts. 27 Women who have been exposed to violence by intimate partners are twice as likely to have depression and alcohol use disorders and four times more likely to commit suicide, compared with women not exposed to this violence. 18 Mental health services are often limited in lower income countries, and women benefit even less from these services than do men.…”

“…18 Mental health services are often limited in lower income countries, and women benefit even less from these services than do men. 27 Chronic obstructive pulmonary disease is also a leading cause of disease and death among older women. In low income countries, the primary risk factor for women's ill health is exposure to indoor air pollution caused by the burning of solid fuels for heating and cooking.…”