1. Mental & Psychological health of Women

2. What is mental & Psychological health

3. Mental health & Women

4. “Women all over the world are the biggest consumers of health care. They live longer than men and have more illness and disability than men. They receive doctor’s surgeries more than men, fill more prescriptions, have more surgical procedures and occupy about 60- 70% of hospital beds” (Ann Tinker world Bank)

5. Women are most likely than men to suffer from Major depression Lifetime risk of depression for women is 10% to 25% versus 5% to 20% for men Between 10%-15% of women who give birth will develop post-partum depression Women develop many anxiety disorders more than men. Women are 2-3 times more likely to have panic disorders. Slightly more women than men develop Alzheimer disorders. More than 75% of Migraine sufferers are women

6. Depression in Women Today depression is a major public health problem. It will be the second greatest cause of death and disability world wide by the year 2020 (WHO 1998)

7. Epidemiological data worldwide clearly demonstrates that major depression is approximately twice as common in women as in men. Its onset peaks during the child bearing years of life Depression in treated sample also shows an approximately 2:1 female male ratio. (this not due to help seeking behavior of women, same ratio exist in community prevalence)

8. Causes According to different researches purposed possible reasons of why depression is more in women than men is Genetic factors Fluctuations in hormones levels from adolescence through menopause and during menstrual cycle Social, economic, life stresses, vulnerable situation of young mothers (Dr.Shifa Naeem –Pakistan,FCPS thesis)

9. Anxiety disorders in Women Anxiety disorders are most common psychiatric disorders. In general population their prevalence is one in ten individuals (Robbins & Bland et al 1988)

10. Lifetime rates of anxiety disorders in male & female from community surveys Men %Women % Panic with Agoraphobia2.9%7.7% Simple Phobia7.2%13.9% Social Phobia2.3%3.2% PTSD6.0%1.3% Obsessive Compulsive disorder2.0%3.3% Unaiza Niaz (2000)

11. Panic Disorder Panic disorder can occur on its own or with Agoraphobia. Agoraphobia is the fear and avoidance of place from which escape might be difficult and it may develop as a consequence of panic attack.

12. The hallmark of panic disorder is panic attack,which is an acute discrete episode of somatic symptoms such as Shortness of breath Hyperventilation Chest discomfort Palpitations Trembling Shaking & cold palms Feeling of dizziness

13. Getting out of control Fear of death

14. Premenstrual Dysphoric Disorder Women have known for centuries that there are both physical and emotional symptoms before and during menstruation. In ancient cultures women were isolated and restrained from doing housework or participating in social activities.

15. Criteria Depressed mood and feeling of hopelessness Anxiety/Tension Mood swings (low mood, tension, mood swings, anger/irritability) Anger/irritability Feeling of being out of control Decreases interest (work, school, social activities) Difficulty in concentration

16. Low energy Food craving Sleep disturbance (hypersomnia or insomnia) Physical symptoms Backaches Headaches Increase in weight

17. Diagnostic criteria Minimum 5 signs and symptoms 2 consecutive cycles Functional impairment At least one mood sign or symptom (low mood, tension, mood swings, anger/irritability)

18. Causes Abnormal level of oestrogens, progesterone, follicle stimulating hormone (FSH), Luteininzing Hormone (LH),cortizone. Risk factors Women with postpartum depression Mood changes induced by contraceptives Family history of depression

19. Perimenopause & Menopause Menopause is the point at which a woman has permanently ceased menstruation. Perimenopause typically occurs 5-7 years before menopause. It is interval between regular ovulatory menstrual cycles and complete cessation of ovarian function Climacteric is a generalized term used to describe the declining ovarian function.

20. Effect of Hormonal changes on women mental health Depression Mood swings Anxiety Brain & Behavior Estrogenic effects on specific cognitive functions like short term verbal memory………………….. Visuospacial memory …………………………Estrogen Replacement therapy

21. Stress Physical changes Adjustment issues Self image

22. Strategies Awareness regarding mental health issues Quality of mental health services Improve state gender policies Work on primary prevention mental disorder Research / surveys are needed in this area