5.1 Are women more likely to suffer from an anxiety disorder than men? Revisiting the question

• Women, people under the age of 35, and those living with chronic physical conditions are disproportionately affected by anxiety disorders (Remes et al., 2016).

• The prevalence rates of anxiety disorders in females were almost twice that found for males when data were compared across different countries (Remes et al., 2016).

• Although a lack of representation from developing and under-developed parts of the world could have affected the prevalence estimates and there is a need for further study of the prevalence of anxiety in these parts of the world, DALYs attributable to anxiety disorders were also 1.9 fold higher in females than in males according to the WHO Global Burden of Disease 2010 study data (Whiteford et al., 2015).

• The higher rate in females appears to have remained constant between 1990 and 2010 (Whiteford et al., 2015).

• In Great Britain, between 2013-14 and 2015-16, the mean prevalence rate for work-related stress, anxiety and depression was 1.5 times higher for females than for males (1820 compared to 1190 per 100,000) (HSE, 2016).

So evidence from different sources suggests that both prevalence and DALYs attributed to anxiety disorders are higher in women than in men. The UK data suggests there are further disparities in terms of age groups affected. While these data serve as useful indicators, they do not provide any clues as to causation, the direction of the effect or the extent to which different factors could influence development of anxiety disorders in women. Neither do they offer further insight into differences in the prevalence of different types of anxiety disorders related to gender.

Higher prevalence rates in women and younger adults (males and females under the age of 35) could be a result of complex interactions between biological, psychosocial and lifestyle factors, and susceptibility to anxiety disorders. Claims made for reasons why women have ‘higher levels of anxiety’ being primarily down to roles as working mothers or linked to the modern day demands on women − that they are more likely to be employed now than in the past, simultaneously looking after family, caring for elderly relatives, managing the household and juggling commitments with work (Mail Online, 2016) − need careful scrutiny, and should be supported by research evidence. Without detailed, large-scale, longitudinal studies (where data are gathered over an extended period of time, spanning months to years), and well-controlled comparison studies that take account of confounding factors such as age, diet, lifestyle, marital and employment status, physical and psychological health, family and socio-economic circumstances (e.g. cultural and personal attitudes towards mental health, and help-seeking behaviours) claims such as this remain speculative. Psychological and biological as well as psychosocial differences between the sexes in the response to stress require further evaluation. Relevant questions include:

• Are women likely to respond to self-reported questionnaires, to disclose and talk about their emotions, and to seek help (and consequently receive a clinical diagnosis) more often than men?

• Do women and men use the same coping strategies when faced with stress?

• Are women more likely to ‘internalise’ their thoughts and be more prone to rumination and anxious or negative thinking than men?

• Are men more likely to ‘externalise’ their emotions and to develop other problems, for example by turning more to alcohol or substance use?

• Could biological differences influence the development of anxiety disorders?

• What bearing do culture, societal attitudes towards mental health and psychosocial factors have on these perceived differences (e.g. differences between ‘Western’ versus ‘Far-Eastern’ cultures)?

• Are there key cultural differences between males and females in terms of attitudes and beliefs around the subject of stress and mental health problems?

The questions highlighted above emphasise the significant gaps in research that remain. Let’s now examine the evidence around work and mental health.