Recent years have seen a sharp uptick in the incidence of mental health crises throughout the world. The covid-19 pandemic – the devastation it wrought, has no doubt contributed tremendously to it. Only the coming years will demonstrate the full impact of it; a looming crisis for which the medical fraternity should be well prepared.
Speaking of our country, there still remains a lot of stigma around mental illness. Also while psychotic disorders like schizophrenia are more likely to be clinically diagnosed by dint of the symptoms they cause, neurotic disorders like depression, anxiety, OCD remain undiagnosed in not a few.
Historically, women have always suffered from underutilization of health services, a pattern which only repeats itself in the case of mental health challenges.
In this article, we discuss in some detail the common mental health challenges/disorders experienced by women.
- Neurotic disorders – studies have found that neurotic disorders like depression, anxiety are twice as likely to be present in women than men. Untreated, these disorders not only significantly impair the quality of life, but in extreme cases can lead to suicide. This underlines the importance of timely diagnosis and treatment.
- Eating disorders – studies reveal that eating disorders like anorexia nervosa and bulimia nervosa are up to four times more common in girls (aged 15-19) than boys. Combined with the massive peer pressure to look a certain way and the unrealistic standards set by the beauty industry, our girls are under much stress. It is worthwhile to note that often these disorders occur concurrently with depression/anxiety. These then should be carefully assessed for and treated by the diagnosing physician.
- Postpartum psychiatric disorders – this spectrum includes postpartum blues, depression and psychosis. Blues are characterized by depressed affect and tearfulness and resolve within 2 weeks. The only treatment needed is support. Postpartum depression lasts more than 2 weeks with onset within a year of delivery. This affects a whopping 18.6% of Indian mothers. Other than crippling the quality of a mother’s life, this is also associated with the children of affected women growing to be underweight and stunted. They also have greater cognitive and behavioral problems later in life. Postpartum psychosis, though rare (0.1-0.2 % incidence rate), is a serious diagnosis. Characterized by delusions, hallucinations and thoughts of harming self/the baby, it necessitates hospitalization.
- Premenstrual dysphoric disorder (PMDD) – beginning a few days before menses and lasting till a few days after its onset, this entails symptoms of premenstrual syndrome (PMS) like bloating, breast tenderness and headaches along with mood changes/anxiety and depression. Difficulty concentrating and excessive emotional sensitivity can be seen too. Some women may even experience suicidal thoughts. In a study, the prevalence of PMDD in India was pegged at 8%, which given our population size, is substantial.
- PCOS – Polycystic ovarian syndrome, a disorder vastly common in the Indian diaspora, is associated with an increased incidence of several mood disorders. This study, reported major depression in 23% of patients, Generalized anxiety disorder(GAD) in 15% of women and Obsessive-compulsive disorder(OCD) in a significant 6%. Given that a large percentage of PCOS itself remains undiagnosed, the concurrent mood disorders then present us with an additional mental health challenge.
The treatment modalities available today are extensive, making the management of these disorders very effective. Anti-depressants like SSRIs are the mainstay of treatment in conditions like depression, anxiety, PMDD, panic and eating disorders. Postpartum psychosis is treated with anti-psychotics. PMDD and PCOS are additionally treated with hormonal birth control pills (OCPs) as required. Other than that Cognitive behavioral therapy (CBT) plays an important role too. Support groups, peer and family support also go a long way in managing these disorders.
Nutritional counseling will come in handy for various eating disorders.
Startups and other organizations working in the sector
Gradually as conversations around mental health gain traction, a lot of communities are emerging to provide solutions. Here are some of them:
- Talk to heal: based out of Jaipur, they offer a confidential space for people to voice their concerns. Various events and workshops are also held to raise awareness about various mental health issues.
- Rocket health: they are a comprehensive platform offering online consultation with psychologists, psychiatrists and have an anonymous support group too. In addition, they also operate in the sexual well-being sector, offering confidential delivery of various contraceptives.
- Ginger:– founded at the MIT media lab, they are a seamless blend of human care and AI. They are unique in offering 24*7 support. Apart from text and video consultations, self-guided activities are available too. The software gathers data to help clinicians track progress and modify the treatment approach accordingly.
- Headspace: essentially a mindfulness platform, they offer various meditations and guided tracks to alleviate stress, anxiety and improve focus and sleep.
- Yourdost: This is another portal connecting people with therapists. Founded in 2014, they additionally offer academic and addiction support. Their blog is a repository of the challenges faced and overcome by others, nudging the sufferers to seek out help.
In our society, mental health has largely been relegated to the sidelines. It’s time it received its due. Health care workers – physicians, therapists, and the general public all need to join forces to banish the taboo surrounding mental illnesses. Timely treatment and support can largely help mitigate these disorders.
That a mental health crisis will be our next pandemic, is an opinion widely being endorsed by many. And as this one has taught us, it’s never too early to start preparing for one.
Shreya is an MBBS graduate, with a keen interest in psychiatry and Public health. Outside of work, she likes reading, playing with dogs, and hiking.