Transforming mental health services to address gender disparities in depression risk factors

ABSTRACT

Depression in older women is a significant and growing problem. Women who experience life stressors across the life span are at higher risk for developing depression than their male counterparts. Research has focused primarily on identifying and reducing the symptoms of depression for the general aging population, disregarding gender-specific differences in the foundational causes of depression. This article examines how women’s unique experiences influence the development of depression and highlights how the current mental health system could better meet older women’s needs by moving from a gender-neutral model to one that emphasizes women’s experiences.     

Resilience in low-income African American women living and aging with HIV

Women are living with HIV into middle and older age and are likely to face multiple comorbidities and stressors as they age. This study focused on understanding how women who experience multiple forms of oppression and ongoing adversity are still able to adapt and stand strong. Using a theoretical framework of resilience and a feminist research ideology, interviews of eight middle-aged and older African American women living with HIV were analyzed. Despite experiences of HIV-related discrimination, trauma, and violence, these women demonstrated a remarkable ability to adapt and maintain support. Implications for research and practice are discussed.     

The Social Value of "Physiological Autonomy":

This paper examines the experience of incontinence and continence as described by twelve communitydwelling older women. Variation in these experiences is vitiated when the dichotomy of continentlincontinent is imposed as the most appropriate "symbolic ordering" for the experience. Loss of bladder control, what older women called "leaking," may be treated analytically as a particular kind of unrestrained behavior that interferes with "physiological autonomy." Thus incontinence poses real and symbolic challenges to the older woman's status as an adult.     

Proud to be a woman: Womanhood,old age,and emotions

ABSTRACT

This article takes its starting point in the discussions regarding intersecting discourses of gender and age and the lived experience of older women. The main objective is to discuss the experience of womanhood among older women and to demonstrate their active role in creating spaces for themselves and their friends and affecting each other. The study is based on narrative interviews with female members of the University of the Third Age (U3A). The main findings describe older women who actively engage with discourses of gender to embark on positive constructions of womanhood. They create their own spaces for women’s activism that are filled with positive emotions mobilized to support each other. This article discusses such findings and their relevance to the study of old age and gender. As a result, it serves as an invitation to think and feel differently about older women and their experience of womanhood.     

Experienced health in older women with rheumatoid arthritis

This study explored how older women with chronic illness and disability experience their own health. Data were collected in in-depth interviews with ten older women with rheumatoid arthritis. Data analysis and interpretation was carried out within a phenomenological- hermeneutic frame of understanding, which revealed five major themes: health as coping with everyday life, health as freedom, health as absence of inconvenience, health as togetherness and health as mental well-being. For older people with chronic illness and disability, good health found expression in general well-being. It was perceived as a state of equilibrium that the respondents sought to maintain through their own active choices.     

Posttraumatic stress disorder and older women

This article examines the literature related to the identification and treatment of post traumatic stress disorder in older women. From this review, several key findings emerge. Consistent in the research literature is the fact that American women are more at risk for PTSD than are men as a result of the high frequency of sexual and domestic physical abuse that women experience. Studies on older women and PTSD indicate that older women are underdiagnosed and are more typically perceived as suffering from depression, anxiety or poor physical health. It was found consistently that older women who present with age-related stressors may not be asked about earlier trauma history or it may not be understood within the context of trauma related variables. In several research studies, trauma history was often not identified either as a result of current assessment practice or because women from certain age cohorts did not disclose trauma-related data to health professionals. Key researchers emphasize the necessity of clinicians, staff and medical personnel to attend to the historical variables present in trauma histories of older women. Researchers underscore the importance of understanding the impact of early and repeated trauma, especially interpersonal trauma, on the physical health and social functioning of older women- even though a significant amount of time may have elapsed since exposure. These findings indicate that further study of PTSD in older women is warranted. The paper concludes with a discussion of assessment and treatment options.     

Counter-mapping migration: irregular migrants’ stories through cognitive mapping

Map-making has played a crucial role in the politics of bordering and ordering. Irregular migrants challenge these politics of confinement on a regular basis; despite this, or perhaps precisely because of it, their stories are hidden in state-centric discourses. Through a counter-mapping approach, this paper focuses on our understanding of how irregular migrants experience their journey. Specifically, an analysis of cognitive maps created by Central American irregular migrants in transit through Mexico on their journey to the US is presented. The strength of this approach is that it highlights the scenarios and practices veiled by the macronarratives of the securitisation of migration. At the same time, it underscores the fact that for irregular transmigrants border control is widespread through their entire journey, thus challenging the border’s notion of fixity. This paper aims to contribute to methodologies used in the study of mobilities and to the broader understanding of how bordering processes are lived and defied by migrants.     

Posttraumatic Stress Disorder and Older Women

SUMMARY

This article examines the literature related to the identification and treatment of posttraumatic stress disorder in older women. From this review, several key findings emerge. Consistent in the research literature is the fact that American women are more at risk for PTSD than are men as a result of the high frequency of sexual and domestic physical abuse that women experience. Studies on older women and PTSD indicate that older women are under-diagnosed and are more typically perceived as suffering from depression, anxiety or poor physical health. It was found consistently that older women who present with age-related stressors may not be asked about earlier trauma history or it may not be understood within the context of trauma-related variables. In several research studies, trauma history was often not identified either as a result of current assessment practice or because women from certain age cohorts did not disclose trauma-related data to health professionals. Key researchers emphasize the necessity of clinicians, staff and medical personnel to attend to the historical variables present in trauma histories of older women. Researchers underscore the importance of understanding the impact of early and repeated trauma, especially interpersonal trauma, on the physical health and social functioning of older women–even though a significant amount of time may have elapsed since exposure. These findings indicate that further study of PTSD in older women is warranted. The paper concludes with a discussion of assessment and treatment options.     

Chronic Musculoskeletal Pain:

Two diseases, osteoporosis and osteoarthritis, are responsible for a majority of the chronic musculoskeletal pain that older women experience. Osteoporosis is the metabolic bone disease most common in older women and is responsible for fractures, kyphosis, and chronic pain. Osteoarthritis, the most commonly diagnosed musculoskeletal problem in older women, causes degeneration of the weight-bearing joints in the body, resulting in limited function and chronic pain. In this paper, these and other common disorders are briefly described and typical coping strategies used by older women in pain are reviewed. In addition, potential multidisciplinary treatment regimens are discussed.     

Unclaimed treasures:older women's reflections on lifelong singlehood

Ever-single, older women are a diverse group, whose experiences of singlehood have received little attention from researchers. In this qualitative study, eight women between the ages of 65 and 77 living in a mid-sized Southwestern Ontario city were interviewed about being ever single, including their perspectives of the benefits and drawbacks of this status at their current age. Data were collected in semi-structured interviews, and the constant comparative method was used for data analysis. Emergent themes illustrated how the women's stories of singlehood were affected by the sociopolitical contexts of their youth. Upon reflection, the women articulated the benefits of lifelong singlehood, strongly emphasizing their independence and "ability to be alone," which was viewed as very important as they aged. The drawbacks of singlehood focused on loneliness and the absence of a social support network, which took on particular importance as the women experienced increasing age and frailty. Overall, the participants expressed satisfaction with their marital status and defied common stereotypes about older, single women. Implications of these findings relate to the social structure of marital status and its impact upon the lives of women who remain single.     

Using community-based participatory research to address Chinese older women’s health needs: Toward sustainability

ABSTRACT

Although community-based participatory research (CBPR) has been recognized as a useful approach for eliminating health disparities, less attention is given to how CBPR projects may address gender inequalities in health for immigrant older women. The goal of this article is to share culturally sensitive strategies and lessons learned from the PINE study—a population-based study of U.S. Chinese older adults that was strictly guided by the CBPR approach. Working with Chinese older women requires trust, respect, and understanding of their unique historical, social, and cultural positions. We also discuss implications for developing impact-driven research partnerships that meet the needs of this vulnerable population.     

Sexual spanking, the self, and the construction of deviance

Using interview and observation data from a group of consensual, heterosexual adults interested in sexual spanking, I describe members' sexual stories and stigma neutralization techniques. Sexual stories are situated within broader cultural contexts that help individuals construct meaning and identities. I describe group members' stories about their initial interest in sexualized spankings. Focusing on a specific event at one party, I show how these stories help to create scene-specific stigma neutralization techniques. Participants strive to differentiate themselves from sadomasochistic activities and to create normative behavioral expectations within their scenes. I conclude that all of this can ultimately be viewed as part of the complex sexual adaptations that people make.     

Introduction: the need to address older women's mental health issues

Women are the primary consumers of mental health services. Ironically, research addressing their unique needs lags behind that of men's issues. The aging process introduces an important variable that accentuates the relative lack of information and specific treatment guidelines for older women who are confronted by mental health problems. This volume offers a comprehensive overview for the health professional who is seeking a greater depth of understanding with respect to the study of mental health problems in general, and how these issues pertain specifically to women and the aging process. A second goal of this project is to provide the practicing therapist and counselor with a research update and a broad clinical perspective offered by seasoned clinicians. Using current psychiatric diagnosis as a framework, the contributions address the range of mental health problems, including dementia and cognitive impairment, schizophrenia, alcohol abuse, mood and anxiety disorders, traumatic and dissociative conditions, sexual and eating disorders, and personality disorders. It is hoped that this book will inform, inspire and encourage students and health professionals in their work with middle aged and older women who are facing mental health challenges.     

Public Policy,Health Care and Older Women

For the first time in history, long life has become a problem. The most serious problem facing the older generation is the availability and affordability of health care. While the life expectancy of both men and women cbntinues to increase, the older population of the U.S. is becoming increasingly feminine. In the last two decades there has been a dramatic fall in poverty among the aged, yet for many elderly persons and especially older women, Social Security benefits barely keep them above the poverty level. Access to medical care has improved with Medicaid and Medicare, but not to the extent the aging population had anticipated. Proposals for universal health care have been put forth by politicians, legislators and professional organizations, some of which acknowledge the unique health problems of aging women while others are discriminatory to the aged in general and women in particular. Many believe women must assert themselves if their health care needs are to be adequately and fairly addressed. To this end, more women than ever are becoming involved in the political process, running for and being elected to local, state and national offices. It is anticipated that these women will be sensitive to the health care needs of older women and put forth efforts to develop and implement policies which address these needs.     

The transition to motherhood: Towards a broader understanding of perinatal distress

BackgroundA substantial body of research has focused on maternal perinatal mood and wellbeing, with the focus predominantly being on depression, and to a lesser extent, anxiety. Perinatal maternal stress has also been investigated recently, but to a far lesser extent. The present paper questions whether the term ‘perinatal distress’ accurately captures the range of challenges experienced by women during the perinatal period, when the scope of ‘distress’ is limited to the experience of depression and anxiety alone.MethodA review of the perinatal literature was conducted using several databases, to identify studies that have focused on the experience of stress as a distinct affective state in the perinatal period.FindingsThe findings of two recent studies which have employed a broader conceptualisation of perinatal distress to encompass the experience of stress as well as depression and anxiety are outlined. These recent studies have identified the experience of stress both in conjunction with and independent of depression and anxiety.ConclusionIt is argued that future studies should investigate the concept of stress as a separate affective state throughout the perinatal period, in order to further assess how it differs from depression and/or anxiety. A more comprehensive understanding of women's experiences during their transition to motherhood, and whether ‘stress’ plays a critical role in the development and maintenance of perinatal anxiety and/or depression is needed.     

“You Can't Spend Years with Someone and Just Cast Them Aside”: Augmented Identity in Older British Widows

Widowhood forces women to reconstruct their identities. This article discusses how this reconstruction occurs. Interviews were conducted with 65 older widows exploring their experiences: Of those, 81% spoke about identity. This reconstruction can be understood in terms of continuing bonds with the deceased, loosening bonds, and personal growth. Women discussed these transitions in four ways: personal struggle, resistance to social expectations, empowerment, and using rhetoric. The reconstructed identity is not that of wife but rather that of an augmented identity of wife/widow. The tensions between how the widows see themselves, and how society sees them are explored.     

Unclaimed Treasures: Older Women's Reflections on Lifelong Singlehood

ABSTRACT

Ever-single, older women are a diverse group, whose experiences of singlehood have received little attention from researchers. In this qualitative study, eight women between the ages of 65 and 77 living in a mid-sized Southwestern Ontario city were interviewed about being ever single, including their perspectives of the benefits and drawbacks of this status at their current age. Data were collected in semi-structured interviews, and the constant comparative method was used for data analysis. Emergent themes illustrated how the women's stories of singlehood were affected by the sociopolitical contexts of their youth. Upon reflection, the women articulated the benefits of lifelong singlehood, strongly emphasizing their independence and “ability to be alone,” which was viewed as very important as they aged. The drawbacks of singlehood focused on loneliness and the absence of a social support network, which took on particular importance as the women experienced increasing age and frailty. Overall, the participants expressed satisfaction with their marital status and defied common stereotypes about older, single women. Implications of these findings relate to the social structure of marital status and its impact upon the lives of women who remain single.     

The Paradox of Evil/Homosexuality

In this article, I analyze “personal experience stories around the homosexual” that entered into the parliamentary debates on the Sexual Offences Act in Britain in the 1950s and 1960s and shaped understandings of sexual citizenship in particular ways. Specific attention is paid to the effects of political storytelling involved in the making of British sexual citizens. I explore how the paradoxical figure of the evil homosexual emerges and how politicians, in telling stories of the evil homosexuality, police the border that can effectively separate sexual outsiders from sexual citizens. I conclude with an analysis of these stories, and how their telling is closely linked to the postwar social welfare thinking in Britain.     

Retired or Homemaker:

In this study we exolore the role definitions that older women choose for themselves and the sociodemographic factors and activities that differentiate women who choose different labels. Of 864 black and white women from a 1986 national survey, 197 defmed themselves as both retired and homemaker; 363 called themselves homemakers only and 304 retired only. Marital status, having a retired spouse, hours of housework, education, and having been employed after age 51 significantly differentiated the groups. Retired homemakers were similar to homemakers on the first three factors and similar to the retired on the remaining two. The forced classification of these in-between women into only one role may explain contradictory results in past comparisons of retired women and homemakers.     

Ageing in a foreign country: voices of Iranian women ageing in Canada

Older Iranian women, who immigrated to Canada in later adulthood, experience unique issues as they age. In order to better understand this experience, in-depth, personal and semi-structured interviews were conducted with five immigrant/refugee Iranian women who immigrated to Canada in their later life. Analysis revealed that although each woman's story conveyed individual differences and idiosyncrasies, all the stories highlighted the critical interweaving of the aging experience and the immigration experience: neither experience could be understood in isolation of the other; each aspect gave meaning to the other experience. Two interrelated messages dominated the women's stories: first was the importance of each woman's immigration story for grounding her experience of the aging process in Canada. Second, each woman's personal story suggested that the immigration experiences were accorded priority for accounting for her experiences in Canada. Specifically, cultural identity (i.e., social class, education, religious affiliation and immigration status) offered a valuable cloak for overshadowing the force of the aging process and the aging process emerged as an elusive force that lurked in the background without ever being fully acknowledged or given power in their lives. The implications of these findings in relation to theory development on intersectionality and professional practice are discussed.