5.3 Work, gender and mental health − examining issues further

This was an online survey carried out by ICM Research in August 2015, for Aviva UK Health. The methodology section of the press release issued by Aviva states that ‘respondents were invited from ICM’s online panel and 2,004 interviews were conducted amongst a nationally representative sample of the UK adult population’. From this information alone, and without a further examination of the sample data, the demographic characteristics or clinical diagnoses of the 2,004 respondents, it is unclear in what respects they were considered a ‘nationally representative sample of the UK adult population’. The figures quoted, based on this sample population, have been extrapolated to the general population ‘as population estimates by single year of age and sex for local authorities in the UK, mid-2014’. According to the survey, 24% of the 2,004 respondents (481 people) aged 18 and over reported having suffered from stress, anxiety or depression in the past year but had not sought help. The report extrapolates this figure to 12 million (i.e. 24% of the 50,909,098 UK adult population in 2014), so a major headline in the news item and press release, claiming that ‘12 million UK adults suffered from stress, anxiety or depression in the past year and did not seek help’ turns out to be an estimate based on a relatively small sample population, and not an actual statistic. Proportionally the sample size (2,004 respondents) represents 0.004% of the UK population figure quoted (50,909,098), so the percentages reported need to be considered in this context.

Stigma associated with having a mental health problem and embarrassment were cited. 32% of those surveyed reported that they would be too embarrassed to tell people if they had a mental health issue. For those who had previously experienced mental health problems this figure was even higher (42%).

Stress (33%), anxiety (29%) and depression (23%) were the most common mental health conditions experienced in the past year. More than half (55%) of those who reported stress did not seek support, while just under half (48%) did not seek help for anxiety. Although more people took action on depression, 29% said they did not ask for support.

According to the data provided, men were less likely than women to seek help for anxiety (51% vs 53%) or depression (69% vs 73%), whereas men were more likely to seek help for stress (48% vs 43%).

Work pressures were cited as the most common cause (34%). Financial concerns (worries over money) were also reported as a main cause for those with anxiety (27%) or depression (28%). 21% said financial concerns were a significant cause of stress. Juggling work–life balance (20%) reportedly had a significant role in causing stress, whereas relationship difficulties (25%) and body image (21%) were reported as contributing to depression. Poor body image was a notable cited cause for depression amongst 18-24 year olds (37%).

36% had successfully recovered, and 35% said their condition was being managed effectively. However, 17% did not feel they were getting the right treatment.

The study was carried out in the United States by researchers at Columbia University’s Mailman School of Public Health. Katherine Keyes, Assistant Professor of Epidemiology was the senior author. Co-authors (Seth J. Prins, Lisa Bates and Jonathan Platt) were all based in the Department of Epidemiology at Columbia University.

The work was supported in part by a National Institutes of Mental Health Psychiatric Epidemiology training grant. No conflicts of interest were reported by the authors.

The findings were based on survey data from a 2001-2002 US ‘population-representative’ sample of 22,581 working adults in America aged 30-65. The researchers tested the impact of structural wage disparities on depression and anxiety outcomes, according to criteria in the Diagnostic and Statistical Manual, version IV (DSM-IV). From the press releases, it is unclear where the sample was derived (across one or more counties or States) and in what ways the sample was considered representative of the US population (demographic information) – so it would be useful to follow up on this by looking at the published study (Platt et al., 2016). The fact that diagnostic criteria were used to assess mental health outcomes, rather than reliance on self-reports alone, suggests a degree of rigour to the methodology.

The overall odds of past-year anxiety were more than 2.5 times higher for women than for men. Where women’s income was lower than their male counterparts (matched for education and years of experience), their odds of having an anxiety disorder was more than four times higher. For women whose income equalled or exceeded their male counterparts, their odds of anxiety disorder were greatly decreased. Similarly, the odds of an American woman being diagnosed with depression in the past year was nearly twice that of men. However, among women whose income was lower than their male counterparts, the odds of major depression were nearly 2.5 times higher than men. Among women whose pay equalled or exceeded their male counterparts, their odds of depression were no different than men.

They consider pay inequality, and the underlying discrimination and biases that may be associated with it, as the reason why women experience more anxiety and depression than men. Specifically, that ‘some of the gender disparities in depression and anxiety may be due to the effects of structural gender inequality in the workforce’, and the ‘norms, expectations, opportunities surrounding the types of jobs women occupy and the way those jobs are valued and compensated relative to men’. Jonathan Platt, PhD student and lead author stated that ‘the social processes that sort women into certain jobs, compensate them less than equivalent male counterparts and create gender disparities in domestic labor have material and psychosocial consequences’. He also said ‘if women internalize these negative experiences as reflective of inferior merit rather than the result of discrimination, they may be at an increased risk for depression and anxiety disorders’. According to Katherine Keyes, senior author of the study. ‘while it is commonly believed that gender differences in depression and anxiety are biologically rooted, these results suggest that such differences are much more socially constructed than previously thought, indicating that gender disparities in psychiatric disorders are malleable and arise from unfair treatment’. They refer to a need to review policies which ‘must go beyond prohibiting overt gender discrimination’ relating their findings to a clear political agenda.

It would not be possible to infer a causal relationship from the information provided. The authors place emphasis on gender discrimination as a prominent explanation for mental health disparities between men and women. Although the findings highlight an association between gender disparity in pay and mental health outcome based on this sample population, a causal relationship or the direction of interaction has not been established, so the claim that ‘gender disparities in psychiatric disorders are malleable and arise from unfair treatment’ cannot be substantiated. Similarly, this particular study did not investigate whether women ‘internalize these negative experiences as reflective of inferior merit rather than the result of discrimination’ so the impact that this might have on increased risk for depression would warrant further research but is speculative in the context of this study. The press release does refer to past research that has looked at factors like differences in sex hormones and coping mechanism, but has so far not provided an adequate explanation. The same could arguably be said of the issue of disparity in pay – while a (partial) contributory factor, this too ‘has not provided an adequate explanation’ when subjected to a critical reflection. Apart from those already mentioned (sex hormones, coping mechanisms, pay gap) what other factors could be contributing to the gender disparity? Income is a strong predictor of health outcomes, including mental health (the lower the income, the greater the risk), but questions remain around psychological factors, differences between full-time and part-time employment, employment choices (working hours), occupational and employer differences (including social environment, management structure, working arrangements), diet and lifestyle, pre-existing health conditions and so on. It would therefore be worth following up by reading the published paper and seeing to what extent these issues have been considered and what other confounding factors (other than education and experience) have been taken into account.