GENDER MEDICINE/VOL. 7, NO. 6, 2010

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Editorial

Gender Medicine and Mental Health—A Challenge for Psychiatry

Mental disorders are common throughout the world. An estimated 26.2% of Americans 18 years of age and older experience a diagnosable mental disorder in a given year.1 Moreover, mental disorders are the leading cause of disability in the United States, Canada, and Europe for people aged 15 to 44 years. Many individuals have more than one mental disorder at a given time,1 and in fact, nearly half (45%) of those with any mental disorder meet criteria for ≥2 disorders, with severity strongly related to comorbidity.2

The burden of mental illness on health and productivity in this country and throughout the world has long been underestimated. Data from the massive Global Burden of Disease study (conducted by the World Health Organization, the World Bank, and Harvard University) revealed that mental illness, including suicide, accounted for >15% of the burden of disease in established market economies such as the United States, Canada, and Europe. This is more than the disease burden caused by all cancers.3–5

Two prominent problems psychiatrists grapple with are which factors contribute to individuals developing the particular mental illnesses they do, and how the future course of their illnesses can be predicted and modulated. Specifically, we seek to understand how illness develops as a consequence of a matrix of factors that impinge on each person, one of these being gender. Gender is an example of a complex factor that may influence the development and course of mental illnesses. While sex is genetically determined, the way a man or woman lives within his or her assigned sex shapes not only resilience but also vulnerability to mental illnesses.

Research in this area is still in its infancy. Although we are aware that women experience depressive disorders approximately twice as often as do men, we have to make sure that this finding is not due to men coping with depression in different ways so that it remains undetected. Women seem to have a greater tendency for bipolar II disorder, a rapid cycling course, and to be at particular risk for developing affective and anxiety symptoms across the reproductive cycle6; however, we know very little about the underlying factors causing this specific vulnerability. Furthermore, we have to answer the question of why it is that males more frequently have attention-deficit hyperactivity disorder,7 antisocial personality disorder,8 schizophrenia,9 and learning disabilities.10

What is the underlying pathophysiology that explains these clinical differences? Besides excellent clinical assessments, we need gender-specific genetic studies, functional neuroimaging research, and neuro- endocrinological studies (to name just a few) to improve our understanding of why men and women differ in their resilience and vulnerability to mental disorders, and how sexual hormones influence brain development and thus shape the risk of developing specific mental disorders.

I am privileged to serve as the Associate Editor of the new Psychiatry Section of Gender Medicine. My aim is to attract manuscripts—both original papers and review articles—about gender-specific matters in psy-chiatric basic science, mood and personality disorders, schizophrenia anxiety, and substance abuse disorders. I hope to raise the profile of gender-specific matters in medicine and to help facilitate discussion about the biology, physiology, epidemiology, clinical aspects, and pharmacotherapy of psychiatric disorders. I would also like to encourage the submission of manuscripts.

Gender Medicine has a rapid publication timeline, which is intended to expedite the review process and make innovative research available to the medical community as quickly as possible. Our goal is to be the primary outlet for gender-specific research in psychiatry. We hope that both researchers and readers will consider Gender Medicine their main source for improving knowledge and fueling discussion in the field.

Stephanie Krüger, MDAssociate Editor

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REFERENCES 1. US Department of Health and Human Services. Mental health: A report of the Surgeon General. Overview of

mental illness. http://www.surgeongeneral.gov/library/mentalhealth/chapter2/sec2.html. Accessed April 19, 2007.

2. Berto P, D’Ilario D, Ruffo P, et al. Depression: Cost-of-illness studies in the international literature, a review.

J Ment Health Policy Econ. 2000;3:3–10.

3. Kessler RC, Ames M, Hymel PA, et al. Using the World Health Organization Health and Work Performance

Questionnaire (HPQ) to evaluate the indirect workplace costs of illness. J Occup Environ Med. 2004;46(Suppl

6):S23–S37.

4. Kessler RC, Frank RG. The impact of psychiatric disorders on work loss days. Psychol Med. 1997;27:861–873.

5. Patel A, Knapp M. The cost of mental health: Report to the Health Education Authority. Working paper. London,

UK: Centre for Economics of Mental Health, Institute of Psychiatry; 1997.

6. Yonkers KA, Wisner KL, Stewart DE, et al. The management of depression during pregnancy: A report from the

American Psychiatric Association and the American College of Obstetricians and Gynecologists. Obstet

Gynecol. 2009;114:703–713.

7. Rucklidge JJ. Gender differences in attention-deficit/hyperactivity disorder. Psychiatr Clin North Am.

2010;33:357–373.

8. Rutherford MJ, Alterman AI, Cacciola JS, McKay JR. Gender differences in the relationship of antisocial person-

ality disorder criteria to Psychopathy Checklist-Revised scores. J Pers Disord. 1998;12:69–76.

9. Abel KM, Drake R, Goldstein JM. Sex differences in schizophrenia. Int Rev Psychiatry. 2010;22:417–428.

10. Liederman J, Kantrowitz L, Flannery K. Male vulnerability to reading disability is not likely to be a myth: A call

for new data. J Learn Disabil. 2005;38:109–129.

doi:10.1016/j.genm.2010.11.006