Social Science, Women

Women are Far More Anxious than Men — Here’s the Science

Anxiety disorders — defined by excessive fear, restlessness, and muscle tension – are debilitating, disabling, and can increase the risk for depression and suicide. They are some of the most common mental health conditions around the world, affecting around four out of every 100 people and costing the health care system and job employers over US$42 billion each year.

People with anxiety are more likely to miss days from work and are less productive. Young people with anxiety are also less likely to enter school and complete it — translating into fewer life chances. Even though this evidence points to anxiety disorders as being important mental health issues, insufficient attention is being given to them by researchers, clinicians, and policy makers.

Researchers and I at the University of Cambridge wanted to find out who is most affected by anxiety disorders. To do this, we conducted a systematic review of studies that reported on the proportion of people with anxiety in a variety of contexts around the world, and used rigorous methods to retain the highest quality studies. Our results showed that women are almost twice as likely to suffer from anxiety as men, and that people living in Europe and North America are disproportionately affected.

Why women?

But why are women more likely to experience anxiety than men? It could be because of differences in brain chemistry and hormone fluctuations. Reproductive events across a woman’s life are associated with hormonal changes, which have been linked to anxiety. The surge in oestrogen and progesterone that occurs during pregnancy can increase the risk for obsessive compulsive disorder, characterised by disturbing and repetitive thoughts, impulses and obsessions that are distressing and debilitating.

But in addition to biological mechanisms, women and men seem to experience and react to events in their life differently. Women tend to be more prone to stress, which can increase their anxiety. Also, when faced with stressful situations, women and men tend to use different coping strategies.

Women faced with life stressors are more likely to ruminate about them, which can increase their anxiety, while men engage more in active, problem-focused coping. Other studies suggest that women are more likely to experience physical and mental abuse than men, and abuse has been linked to the development of anxiety disorders. Child abuse has been associated with changes in brain chemistry and structure, and according to previous research, women who have experienced sexual abuse may have abnormal blood flow in the hippocampus, a brain region involved in emotion processing.

The anxious West

Our review also showed that people from North America and Western Europe are more likely to be affected by anxiety than people living in other parts of the world. It is unclear what could be accounting for these differences. It could be that the criteria and instruments we are using to measure anxiety, which were largely developed on Western populations, might not be capturing cultural presentations of anxiety.

Anxiety might be manifested differently in non-Western cultures. For example, social anxiety in the West is typically manifested as an intense fear of social situations, high self-consciousness, and fear of being judged and criticised by others during interactions and performance situations.

However, in Asia, a closely related construct is taijin kyofusho, which manifests as persistent and irrational fears about causing offence and embarrassment to others, because of perceived personal inadequacies. In addition, people from other cultures might feel too embarrassed to disclose symptoms of anxiety that people in Western cultures are comfortable discussing — this would mean that the figures reported in studies on developing and underdeveloped parts of the world might be underestimates of the true proportions.

Most of the research on mental health has also been done in Europe and North America, and very few studies have examined anxiety in other parts of the world. There could indeed be large differences in the burden of anxiety between cultures, but further research using better anxiety assessment methods is needed on this.

Either way, we now know that anxiety disorders are common, costly, and associated with substantial human suffering. We also know that women and people living in developed countries seem to be most affected. This awareness of who is disproportionately affected by anxiety can help direct health service planning and provision, and treatment efforts.

What can be done?

Anxiety disorders tend to start early in life, are chronic, and more than a decade can elapse between the time when symptoms develop and help is first sought from the doctor. At this point, the anxiety has become quite severe and other mental health problems, such as depression, have developed. This makes successful treatment of any of the disorders much harder.

Early recognition of symptoms is important so that treatment can be administered. Many people have turned to cognitive behavioural therapy, which has been shown to be effective in reducing anxiety. There is also medication, and there are lifestyle changes people can make to improve their mental health, such as engaging in regular physical activity, doing mindfulness meditation and yoga.

Knowing that anxiety is more prevalent among Western and female populations, however, is a valuable step forward.

The Conversation

Olivia Remes, is a PhD Candidate at the University of Cambridge.

This article was originally published on The Conversation.

9 Comments

  1. “Women faced with life stressors are more likely to ruminate about them, which can increase their anxiety, while men engage more in active, problem-focused coping. ”

    Which, by the way, mirrors their relationship styles, especially same-sex ones.

    • Would you care to elaborate further about this relationship style you’re referring to?

      • Joyce Benenson, Warriors and Worriers, Oxford UP, 2014 (some references omitted).

        Page 151: “The single largest difference between the same-sex friendships of women versus men is that women verbally discuss vulnerabilities in themselves and their relationship partners, whereas men focus more on shared activities. This sex difference is present early in childhood, and it becomes enormous in adolescence and adulthood.”

        (Mutually disclosing vulnerability in order to build trust, function as deterrent. Selecting those who are weak means they can’t harm you. It’s a risk-averse strategy.)

        152: “Unlike boys and men, girls and women replied that their closest friends would think poorly of them if they became more successful than their friends. They also added that any greater achievement by one friend might destroy the friendship.” – https://www.researchgate.net/profile/Joyce_Benenson/publication/227797477_Sex_differences_in_reactions_to_outperforming_samesex_friends/links/55a01ff808aef92d04ce2f15.pdf

        (…) Thus, to reduce any threats to one another, girls and women focus on mutual vulnerabilities. Clinicians call this co-rumination, and it is a speciality of girls and women. Boys and men don’t do this. Unfortunately, co-rumination can lead both partners to become increasingly anxious, stressed, and depressed.” – https://www.researchgate.net/publication/5644576_Co-ruminating_increases_stress_hormones_in_women

        158: “Unsurprisingly, the reseachers found that the women apologized more than men. Interestingly, the women also reported having committed more acts that required apologies than the men did. (…) The women also reported that others committed more offenses against them. Men didn’t find others’ behavior so offensive.” – http://web.stanford.edu/~omidf/KarinaSchumann/KarinaSchumann_Home/Publications_files/Schumann.PsychScience.2010.pdf

        More on women’s “desire” for egalitarianism, which men don’t share, throughout the book. The same for male toughness. – A lengthy podcast with her: http://www.blogtalkradio.com/amyalkon/2015/04/27/dr-joyce-benenson-how-the-evolution-of-male-warriorsfemale-worriers-drives-us

        “If you want more on male relationship styles, that is task-orientation, let me know. Depending on your background, this vignette may suffice. “It’s not that either males or females are better at cooperating, or can’t cooperate with each other. Rather, there’s just a difference in how they’re cooperating.” (…) The researchers found that, on average, the male/male pairs and the male/female pairs performed similarly on the task, and both did better than the female/female pairs (…) [The obvious contradiction may be due to political correctness.].

        In the new study, the researchers said, the areas of the brain where activity was synchronized was different in the male/male pairs, compared with the female/female pairs.
        In contrast, in the mixed-sex pairs, the researchers did not observe such synchronization of brain activity, which further suggests that each sex uses different cognitive strategies when it comes to cooperation, the researchers wrote.” – http://www.livescience.com/55005-male-female-brain-cooperation.html

  2. Starting at months 7-9 of gestation,
    testosterone levels increase causing an attenuation of the “response to stress”.

    This is the source of learned response with use of “blue” and “pink” blankets:
    the response of the young infant to stress is much more adverse for the “pink blanket” folk.

    This gets enhanced with even higher testosterone levels causing
    …..”take the hill!” and “winning is the only thing” along with “risky” behaviors
    behaviors.

    The addition of progesterone to the mix of the “pink” babies, enhances the negative response to stress.

    All of this is, of course, “bell curves”:
    …….everyone’s experience is different and the curves for blue/pink overlap.
    Tens of years of neural net programming with different stress feedbacks makes a huge difference.

  3. O S says

    I would argue that women with anxiety disorders have an easier time than men. First of all, there are far more female psychologists. Second, men tend to like women who appear quiet and shy so it’s easy to find someone supportive. Men who have anxiety disorders are deemed weak and unmanly and as a result are often isolated.

    • You would argue that right out of your rectum. How does an abundance of female psychologists make having an anxiety disorder easier for a woman? Do you expect the thought of an unequal sex ratio of psychologists acts as an anxiolytic on female brains? How do you know men prefer shy and quiet women as opposed to gregarious and social ones?

      • O S says

        More female psychologists means more people who understand what they’re going through and less dismissiveness. As for shy or quiet women, take a look at any online dating site. They’re filled with self-proclaimed outgoing women. That should tell you that they’re less desirable.

  4. Bruce says

    Interesting that you note “people from other cultures might feel too embarrassed to disclose symptoms of anxiety that people in Western cultures are comfortable discussing — this would mean that the figures reported in studies on developing and underdeveloped parts of the world might be underestimates of the true proportions” when this is also true of men in the West. Women are far more likely to discuss and treat anxiety than men.

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