A Public Health Perspective of Women’s Mental Health (eBook)

Bruce Lubotsky Levin, DrPH, MPHBruce Lubotsky Levin is Associate Professor and Head of the Graduate Studies in Behavioral Health Program at the Louis de la Parte Florida Mental Health Institute & at the College of Public Health (COPH), both at the University of South Florida (USF). Dr. Levin is Editor-in-Chief of the Journal of Behavioral Health Services & Research and Director of the USF Graduate Certificate in Mental Health Planning, Evaluation, & Accountability Program. He is the Senior Editor of Mental Health Services: A Public Health Perspective, Third Edition (Oxford University Press, 2010); Introduction to Public Health for Pharmacists (Jones & Bartlett, 2007); Mental Health Services: A Public Health Perspective, Second Edition (Oxford University Press, 2004); Women’s Mental Health Services: A Public Health Perspective (Sage Publications, 1998); and Mental Health Services: A Public Health Perspective (Oxford University Press, 1996). He is also Co-Editor of the text Building a Virtual Library (Information Science Publishing, 2003). In 2001, Dr. Levin received the Harold C. Piepenbrink Award for outstanding contributions to behavioral health services from the Association of Behavioral Healthcare Management. Dr. Levin earned his undergraduate degree from the University of Wisconsin-Madison and his graduate degrees from The University of Texas. His research interests include managed behavioral health care, mental health policy, graduate behavioral health education, and mental health informatics. He currently teaches graduate behavioral health courses at the USF COPH.Marion Ann Becker, PhD, MA, RNMarion Becker is a Professor in the Department of Aging and Mental Health Disparities at the University of South Florida (USF) Louis de la Parte Florida Mental Health Institute. She also holds appointments in the USF School of Social Work, USF College of Public Health, and USF College of Nursing, where she teaches a number of graduate level courses, including the epidemiology of mental disorders, women’s mental health, and case management. Dr. Becker is a psychiatric nurse with a doctorate in Social Welfare from the University of Wisconsin-Madison. Her research focuses on the problems of providing high quality, cost-effective behavioral health services and quality of life outcomes for vulnerable populations. Dr. Becker is the developer of the Wisconsin Quality of Life Index (W-QLI), a core development in quality of life outcomes research in mental health. In 1997, she received the National Alliance for the Mentally Ill (NAMI) Research Award for her quality of life outcomes research. Dr. Becker has served as Principle Investigator and Co-Principle Investigator on numerous outcome studies. Most recently, she served as Co-Principle Investigator and Lead Evaluator for the Triad Women's Project, a multi-million dollar competitive federal grant designed to create and evaluate specialized interventions for women with alcohol, drug abuse, and mental disorders who have histories of interpersonal violence. Dr. Becker continues her research focus on women’s mental health, quality of life outcomes across the life span, and linking outcomes research to clinical practice.

Foreword 5
Preface 7
Contents 11
Editors and Contributors 13
Part I Overview & Epidemiology of Mental Disorders in Women
Public Health and Women’s Mental Health 25
Introduction 25
Chapter Objectives 26
A Public Health Approach 26
Selected Issues: Women and Mental Health 27
Epidemiology and Health Disparities 28
Services Delivery 28
Health Literacy 29
Trauma, Violence, and Abuse 29
Action Steps for Improving Women’s Mental Health 29
Implications for Women’s Mental Health 30
References 30
Introduction 33
Epidemiology of Mental Disorders in Girls and Female Adolescents 33
Epidemiologic Research and Sensitivity to Girls and Female Adolescents 34
Prevalence of Disorders Among Girls and Female Adolescents 36
Attention-Deficit and Disruptive Behavior Disorders 42
Anxiety Disorders 44
Mood Disorders 46
Eating Disorders 47
Implications for Women’s Mental Heath 48
References 49
Introduction 58
Mental Conditions in Adult Women: Epidemiology and Impact 58
Epidemiology of Women’s Mental Health 59
Overview 60
Mood Disorders 64
Anxiety Disorders 66
Nonaffective Psychoses (NAP), Including Schizophrenia 69
Substance Use Disorders (SUDs) 70
Limitations on Women’s Freedom to Participate 73
Health 74
Security 75
Parenting 76
Treatment 76
Implications for Women’s Mental Health 77
References 77
Introduction 85
Epidemiology of Mental Disorders in Older Women 85
Major Mood Disorders Depression 86
Bipolar Disorder 87
Anxiety Disorders 88
Late-Onset Schizophrenia 89
Substance Use and Abuse 90
Eating Disorders 91
Dementia Alzheimer’s Disease 92
Lewy Body Disease 93
Vascular Dementia and Dementias Due to General Medical Conditions 94
Suicidal Behavior 94
Implications for Women’s Mental Health 96
References 96
Introduction 101
Scope of the Problem 101
Physical Illness and Medical Needs of Women with Mental Disorders 101
Premature Death 102
Increased Disability and Functional Limitations 102
High and Unexplained Rates of Medical Service Utilization 104
Pervasive Acute and Chronic Somatic Conditions 104
Risk of Diabetes and Metabolic Syndrome 105
Cardiovascular Disease 106
Risk of Cancer 106
Chronic Pain 106
Multimorbidity 107
Comorbidity with Substance Use 108
Plausible Contributory Factors 108
Individual Risk Factors 109
Environmental Risk Factors 109
Medical Care and Service Delivery Problems 111
Medical Providers’ Lack of Expertise in Mental Health 113
Implications for Women’s Mental Health 116
References 118
Part II Selected Disorders 126
Depression and Postpartum Disorders 127
Depression in Women 127
Prevalence and Etiology 127
Phenomenology of Depression in Women 128
Treatment and Health Service Issues 129
Perinatal Depression 130
Prevalence and Features of Perinatal Depression 130
Perinatal Depression: Treatment and Health Services Issues 131
Implications for Women’s Mental Health 134
References 134
Introduction 139
Eating Disorders 139
Epidemiology of Eating Disorders 140
Classification and Diagnostic Criteria 140
Anorexia Nervosa 141
Bulimia Nervosa 141
Eating Disorders Not Otherwise Specified (EDNOS) 143
Incidence and Prevalence of AN 143
Incidence and Prevalence of BN 144
Incidence and Prevalence of BED and NES 144
Risk Factors and Correlates 145
Common Risk Factors and Correlates for AN, BN, and BED 145
Shared Risk Factors and Correlates 147
Specific to AN 147
Specific to BN 148
Specific to BED and NES 148
Eating Disorders and Comorbidities 148
Anorexia Nervosa 149
Bulimia Nervosa 150
Binge Eating Disorder 150
Night Eating Syndrome 151
Medical Complications 151
Treatment 152
Anorexia Nervosa 153
Bulimia Nervosa 153
Binge Eating Disorder 154
Night Eating Syndrome 155
Cost of Treatment 155
Insurance Parity 155
Implications for Women’s Mental Health 156
References 156
Introduction 160
Menopause 160
Symptoms 161
Menopause Transition and Depression 162
Psychosocial Factors 164
Hormonal Changes 165
Neurobiological Factors 167
Estrogen/Hormone Therapy and Depression 168
Surgical Menopause 169
Implications for Treatment 170
Other Psychiatric Disorders and Menopause Transition 171
Anxiety 171
Bipolar Disorder 172
Schizophrenia 172
Implications for Treatment 172
Sexuality and Menopause 173
Implications for Treatment 174
Implications for Women’s Mental Health 175
References 175
Introduction 182
Substance Abuse 182
Prevalence 183
Diagnostic Criteria 183
Etiology 184
Comorbidities 186
Psychiatric Disorders 186
Physical Disorders 187
Special Populations 187
Women of Childbearing Age/Pregnancy 187
Prevention/Early Brief Intervention Strategies for At- Risk Drinking 189
Prevention/Early Intervention Strategies with Women of Childbearing Age 190
Brief Interventions for Women at Risk for Alcohol- Exposed Pregnancies 190
Older Adult Women 191
Gender-Related Treatment Research 192
Barriers to Treatment 194
Conclusion 195
Implications for Women’s Mental Health 195
References 195
Introduction 202
HIV/AIDS and Mental Disorders 202
Women and HIV 203
Gender Inequalities 203
Access to Treatment and Care 204
Risk of Transmission to and by Women 205
Male Condom 205
Female Condom 206
Mother-to-Infant 206
Women, HIV, and Mental Health 206
HIV Risks for Women with Mental Disorders 207
HIV-Positive Women and Mental Disorders 208
Preventing Transmission to and by Women 209
Implications for Women’s Mental Health 212
References 213
Part III Services Delivery & Emerging Research
Services in an Era of Managed Care 217
Introduction 217
Background 217
Mental Health Services Under Managed Care: Key Features 218
Organizational Arrangements 218
Financial Managed Care Mechanisms 221
Nonfinancial Managed Care Mechanisms 223
Mental Health Services Delivery System in the Context of Managed Care 225
Public Versus Private 226
Mental Health Benefits 227
Parity 228
Treatment Settings, Approaches and Providers 230
Selected Issues in Managed Behavioral Health Care Access 233
Coordination/Integration of Services 235
Quality Management 236
Implications for Women’s Mental Health 237
References 238
Introduction 244
Evidence-Based Medicine 244
What is Evidence-Based Medicine? 245
Randomized Controlled Trials and Meta-analyses 245
Navigating Through Evidence-Based Medicine 246
Applying Evidence-Based Practice for the Management of Depression 247
Medication Options for Depression 249
Therapy for the Treatment of Depression 250
Alternative Strategies for the Management of Depression 250
Future Evidence-Based Studies for the Management of Depression 251
Treatment Response Based on Gender or Age 251
Option of No Treatment for Depression 251
Evidence-Based Treatment of Premenstrual Dysphoric Disorder 252
Evidence-Based Treatment of Depression During Pregnancy 252
Antidepressant Use in Pregnancy 252
Treatment of Postpartum Depression 253
Antidepressant Use and Breastfeeding 255
Implications for Women’s Mental Health 255
Future Directions 256
References 256
Introduction 259
Mental Health Issues of Incarcerated Women 259
Incarcerated Women with Mental Health Problems Prevalence of Mental Disorders 260
Co-occurring Substance Use and Abuse 261
Acute and Chronic Health Conditions 261
Childhood and Adult Experiences of Violence 262
An Organizing Paradigm: The Adult Consequences of Childhood Trauma 262
Principles of Trauma-Informed Treatment 263
Trauma-Informed Mental Health Treatment 265
Trauma-Informed Supervision and Clinical Practice 266
Trauma-Specific Services 268
Considerations When Adapting Community-Based Trauma Treatment to Corrections 270
Implications for Women’s Mental Health 271
Research and Evaluation Information 271
Training of Correctional and Behavioral Health Staff 272
Review and Revision of Supervisory Practices 272
Adaptation and Wide Dissemination of Trauma Interventions 272
References 272
Introduction 275
Services in the Workplace 275
Women’s Work and Well-Being 276
The First Shift: Women’s Experiences at Work 277
The Second Shift: Women’s “Other” Work 280
The Intersection of Paid and Unpaid Work 283
Workplace Services, Benefits, and Policies 286
Addressing Emotional and Physical Health Concerns 288
Alleviating Women’s Burden of the Dual Workload 291
Implications for Women’s Mental Health 300
References 301
Introduction 309
Organizational Stress and Trauma-Informed Services 309
Trauma-Organized Systems 310
Parallel Process 311
Parallel Processes Between Clients and Staff 311
Parallel Processes at the Organizational Level 312
The Organizational Impact of Chronic Stress Chronic Stressors and Collective Trauma 313
Lack of Basic Safety 314
Loss of Emotional Management 315
Dissociation, Amnesia, and Fragmentation of Function 316
Systematic Error 317
Increased Authoritarianism 317
Impaired Cognition and Silencing of Dissent 318
Impoverished Relationships 318
Disempowerment and Helplessness 319
Increased Aggression 319
Unresolved Grief 320
Loss of Meaning and Demoralization 320
Implications for Women’s Mental Health 321
References 322
Introduction 326
Services in Rural Areas 326
Rural Areas 327
Common Elements of Rural Residence 328
Specific Mental Health and Substance Abuse Concerns in Rural Communities 330
Depression 330
Suicide 332
Violence Against Rural Women 332
Substance Abuse 334
Obesity and Exercise 335
Serious Mental Illness 337
Accidents and Traumatic Injuries 337
Other Chronic Conditions 338
Special Populations 338
Barriers to Service Delivery in Rural Areas 339
Implications for Women’s Mental Health: Developing, Assessing, and Implementing Effective Approaches and Interventions 340
References 344
Introduction 347
Social Epidemiology and Mental Health 347
Social and Community Contexts 347
Social Class, Gender, Race, and Mental Health 348
Gender Inequality 348
Gender and Race Inequality 349
The Community Context of Women’s Mental Health 350
A Contextual Approach to Women’s Mental Health Services Research 351
Implications of Contextual Approach 352
The Social Context of Recovery Services 353
Implications for Women’s Mental Health 354
References 355
Introduction 358
Racial and Ethnic Disparities 358
Minority Women’s Mental Health 359
Culture and Mental Health 360
Mental Health Services Utilization 363
Implications for Women’s Mental Health 364
References 365
Introduction 369
Parenting and Recovery for Mothers with Mental Disorders 369
An Ecological Perspective on Parenting and Recovery 370
Mothers with Mental Disorders 372
Key Intervention Components and Processes 375
Assessment 376
Treatment 376
Existing Interventions for Mothers with Mental Disorders 377
Theories of Change 377
Program Components 378
Key Issues for Policy and Services Delivery 378
Implications for Women’s Mental Health 378
References 380
Navigating the Worlds of Information 383
Background 384
Organizing Information 385
Types of Information 386
Indexing and/or Abstracting Services 386
Table of Contents Services 387
Citation Databases 387
Numeric and Spatial Databases 388
Tools and Tips: Thesauri, Controlled Vocabulary, and Filters 388
Caveats 390
Sources of Information 390
National Library of Medicine (NLM) Gateway 391
The Cochrane Collaboration: Cochrane Reviews 392
The PILOTS Database: An Electronic Index to the Traumatic Stress Literature 392
Centers for Disease Control and Prevention (CDC): WISQARS ™ , YPLL, NVDRS, ARDI 392
Alcohol and Alcohol Problems Science Database: ETOH 393
Center for the Study and Prevention of Violence (CSPV): VioLit, VioEval 393
FedStats.gov: Topics, MapStats, Statistical Reference Shelf 394
The National Academies Press (NAP) 395
Current and Emerging Technologies 395
Implications for Women’s Mental Health 398
References 399
Index 401