Recognizing Differences in Gender, Part 3:Looking at all dimensions; a psychological perspective on gender

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February, 2015Three of Three

Biology and broad social norms play an important role in shaping an individual’s health, wellness, and personal well-being. However, these two key influences do not paint a complete picture; one major influence remains — psychology of the person. What people believe and their psychological makeup shapes how they experience daily life and ultimately influences their individual health behavior choices.

In the previous two papers in this three-part series, we explored the differences that exist between males and females both biologically and socially, and how these differences affect mental health. In the first paper, we learned how specific biologic mechanisms evolved throughout our history. This evolution determined our sex-specific growth, development, and physical reactions to stress.1,2 In the second paper, we discovered how biologically driven sex-specific roles became embedded into modern society’s construction of social roles: typified gender roles, gender-based discrimination, and social hierarchy.3,4 The biological and social dimensions of health and well-being, combined with the perspective of individual psychology, can provide a more complete picture of the major influences on an individual’s engagement in health and wellness behaviors. The aim of the final paper in this series is to explore the impact of gender on human psychology and how this dimension works in tandem with biological and social factors to impact our emotional health and well-being. Taken together, the three papers in this series provide overall insights on how to ensure the programs and services you offer align with the biological, social, and psychological dimensions to have greater impact.

Psychology is the study of the mind and behavior, including “all aspects of the human experience – from the functions of the brain to the actions of nations, from child development to care for the aged.”5 Both biology (e.g., the chemical and mechanical workings of the brain) and social influences (e.g., society, intergenerational pressure, and cultural stereotypes) contribute to an individual’s psychology – the lived experience of the individual that influences how a person reacts to daily situations. As the biological and social influences manifest differently for men and women, it is not surprising that individual psychology is also shaped by gender. One area in which these psychological gender differences are more obvious is in measures of health around stress, anxiety, depression, and some physical illnesses such as heart disease or cancer.6–8

The gender disparities observed around depression, anxiety, and stress in particular are staggering, with women carrying more of the global burden that men in all three areas. Further, women have a higher prevalence rate for both 12 month and lifetime comorbidity involving three or more disorders9 and attempt suicide two to three more times than men.10 Conversely, alcohol dependence, suicide, and antisocial disorders are more prevalent among men than women.11

Disorder Men Women

Depression (percentage of cases)12 30% 70%

Anxiety (Percentage of cases)12 40% 60%

Suicide (Attempts/Deaths, 2012)13 20%/78.3% 5.4%/21.7%

Alcohol Dependence (Lifetime prevalence)9 20% 8%

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While there is no exact answer as to why there are such considerable gender differences in rates of mental health disorders, it is possible that the unique way in which men and women process certain life events —their individual psychology— may influence their health in a gender-specific way. their individual psychology— may influence their health in a gender-specific way. Men and women often cope with stressors differently, where biology and social constructs influence psychological coping styles. How one perceives and copes with a potential stressor contributes to whether or not a situation may result in depression, anxiety, or stress.

The unique way in which men and women process certain life events—their individual psychology—may influence their health in a gender specific way.

Emotion-Focused and Problem-Focused CopingCoping is generally defined as a person’s “cognitive and behavioral efforts to manage (reduce, minimize, master, or tolerate) the external demands of the person-environment transaction that is appraised as taxing or exceeding the resources of the person.”14 The act of coping encompasses the cognitive and behavioral strategies that an individual uses to manage these stressful situations and the negative emotional reactions that comes from those events.15 These strategies, or coping mechanisms, typically fall within two major groups of coping strategies: emotion-focused and problem-focused.

Emotion-Focused Coping Example Strategies

Reduces negative emotional responses such as fear, – Distractionsembarrassment, anxiety, depression and frustration – Self-control – Accepting of responsibilitiy– Seeks emotional support through friends/peers – Positive reappraisal – Escape avoidance– Avoids problem all together

Problem-Focused Coping Example Strategies

Targets the causes of stress in a practical, direct way – Confronting – Taking control– Tackles the problem or stressful situation – Seeking our further information – Evaluating pros/cons– Aims to remove/reduce the cause of the problem or negative emotion

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How one copes is influenced by gender. Women tend to utilize emotion-focused coping strategies to a greater extent than men, while men tend to enact problem-focused coping in stressful situations.7, 20, 21 For example, women are more likely than men to employ rumination as a coping strategy; rumination includes thinking about the symptoms of distress and possible consequences rather than solutions to the distress.22

Gendered psychological coping preferences are clearly influenced by the biological and social influences present within the biopsychosocial model. Specifically, biological makeup influences how men and women react to and cope with stress. As males are biologically more likely to express aggressive behavior due to hormones such as testosterone, they are more likely to react to a stressor in a “fight or flight” way, attacking the problem at hand using a problem-focused coping mechanism.23 Further, men have traditionally been socially prescribed with certain attributes such as autonomy, self-confidence, assertiveness, instrumentality and being goal-oriented.7 Taken together, these influences and expectations predispose men to utilize problem-focused coping strategies more easily.23

Women, however, face more difficulty with engaging in proactive, problem-solving responses.7 Biologically females are more likely “tend and befriend;” this tendency towards support and intimacy coupled with difficulty engaging in problem-solving responses influences women to be more emotion-focused in their coping style.24 Socially, broad socialization patterns also have an impact on coping preference. The traditional “female” gender role is attributed as dependent, seeking affiliation, emotional, a lack of assertiveness, and being subordinate to the needs of others.7 These influences align more closely with emotion-focused coping strategies.

Interestingly, the different styles of coping can explain some of the differences in mental health found across genders. As men use more problem-focused coping, they are focused more on immediately and definitively resolving their distress through confrontive coping and planful problem solving.7 When this approach is enacted with negative coping mechanisms, men tend to engage in substance abuse and/or violence more so than their female counterparts.25, 26 For example, while men are less likely to attempt suicide, they complete at rates higher than

women.27 Further, as it is socially unacceptable and often difficult for men to accept and express weakness,25 it is less likely that males will naturally engage in emotion-focused coping strategies.

Women engage in proactive, problem-solving responses less often than their male counterparts.7 The social norms historically placed on women have typically resulted with women in roles with less control.2 This historical reality may explain why females are more likely to utilize a coping mechanism that reduces the negative responses associated with stress, but not the stress itself; in a world where females traditionally had no control over the stressor itself, perhaps the solution was to confront the response to the stress. With depression, there is a relationship with having a low sense of control.28, 29 This tendency toward emotion-focused coping may provide insight on why women experience a higher burden of depression, anxiety, and stress.

Although particular coping mechanisms may be more effective in certain situations, problem-solving coping is not necessarily better than emotion-focused, and vice versa. For example, problem-focused coping attempts to remove the stressor directly, focusing on the root cause of the problem to find a long-term solution. This approach seems like it would be good all the time; however, a problem-focused approach is not effective in any situation where it is beyond the individual’s control to remove the source of the stress.16

The different styles of coping can explain some of the differences in mental health found across genders.

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Although particular coping mechanisms may be more effective in certain situations, problem-solving coping is not necessarily better than emotion-focused, and vice versa. For example, problem-focused coping attempts to remove the stressor directly, focusing on the root cause of the problem to find a long-term solution. This approach seems like it would be good all the time; however, a problem-focused approach is not effective in any situation where it is beyond the individual’s control to remove the source of the stress.16

One such example of a situation that is out of a person’s control is the death of a loved one. In this type of situation, utilizing emotion-focused strategies — such as reducing the negative emotional responses associated with the stressor, is a positive coping approach.16

Understanding the social, biological, and psychological context of gender is vital to developing an intervention that works, one that takes the lived experience of the individual, meets that person where they are, and moves them forward on the path to well-being.

FemaleTendency towards support

Tend and befriendEstrogen and oxytocin

FemaleDependent

Emotional Subordinate to the needs of others

FemaleSeek support emotion focused coping

Escape-avoidance

MaleMore Likely to express agressive behaviorFight or flightTestosterone

MaleAssertiveWeakness is unacceptableProvider for the family

MaleDeal with the root cause of problem or stressorTake action

Biological

Social

Psychological

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How men and women are influenced by biological, social, and psychological factors drives beliefs and perceptions. In turn, these beliefs or perceptions directly influence behavioral choice, including those behavioral choices that can prevent or mitigate depression, anxiety, and stress.32 Programs must be optimized for gender and personalized to the individual while delivering a proven intervention program. Thrive 4-7 embodies this philosophy by developing personally tailored self-management programs that are optimized for women; these programs are focused on improving depression, anxiety, and stress symptoms as well as overall health and well-being.

Learn about Mevii, our innovative health platform optimized for women dealing with depression, anxiety or stress. thrive47.com/mevii

Evaluation Criteria Example Addressed in Your Program?

Uses Evidence-Based Framework Biopsychosocial Model Yes No

Addresses Gender Perferences Visuals, Tone, Content, Videos Yes No

Accounts for Different Coping Styles Tailored Content and Yes No Reinforement

Responds to Individual Experience Program Personalization Yes No

Considers Gendered Stress Responses Relaxation Techniques, Yes No Skills Practice

Supports/Challenges Social Norms Prompts, Content, Yes No Practice Exercise

To support both men and women in preventing or mitigating depression, anxiety, or stress, it is important to consider all the factors of the biopsychosocial model and the unique set of circumstances of the individual. The evaluation criteria below challenges you to consider how you might incorporate the biopsychosocial perspective into the programs and services you offer, including those with a gender focus. The table below challenges you to consider how you might incorporate the biopsychosocial perspective into the programs and services you offer, including those with a gender focus.

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Founded in 2013, Thrive 4-7 is a women-owned mission driven company dedicated to creating innovative solutions that help people reach and sustain health across all dimensions of wellness. Our person-centered approach utilizes emerging mHealth technology to provide an impactful and sustainable self-management programs to improve emotional health and well-being, starting first with a focus on women who suffer with depression, anxiety, and stress. Our focus is to positively impact individuals, the healthcare industry, and our partners to further happiness and health in all.

Connie Mester, MPH – Founder and CEOConnie is part behavioral scientist, part marketing strategist and part business leader with more than 16 years experience across the healthcare landscape. With an intense passion for empowering people to live healthier and happier lives, her energy is focused on finding realistic ways to make positive impacts in health and care delivery. Her company, Thrive 4-7, is focused on that goal, effectively immersing technology into everyday life to deliver authentic and meaningful experiences. Connie believes in going beyond data— integrating behavioral science, adult learning and psychology disciplines to drive greater awareness, gain deeper understanding of individual decisions and actions, and achieve significant health advances and successes. Connie holds a Master of Public Health in health behavior and social marketing from the University of South Florida, and a Bachelor of Science in health education from the University of Florida. Her expertise spans channels and disciplines, including Fortune 100 & 500 managed care companies, government, academic settings, hospitals, and nonprofit organizations as well as consumer marketing in the pharmaceutical and medical device arenas. This broad range of experience enables her to bridge market forces with practical, person-centric solutions to accelerate positive change and make a measurable impact.

Kelly Earp, PhD, MA – Co-Founder and CSODr. Earp brings 14 years of multi-disciplinary training and research experience to her role as the Chief Science Officer for Thrive 4-7, a mission driven company dedicated to creating person-centered innovative technologies to deliver a sustainable, integrated health platform. Dr. Earp’s professional experience spans the research process as she has worked with research design, regulatory bodies, budget development, contract negotiation, partnership building, professional writing, protocol implementation, and evaluation. Dr. Earp has published in scientific journals on multiple topics including depression and care access, intervention research, cross-cultural health, and stigmatized conditions. She has earned recognition by college, university, and national level organizations, including two consecutive maternal and child health traineeship awards. She also holds concurrent affiliations with KayeM, Inc, Duke University School of Nursing, and Maryland University of Integrated Health.

Kate Sullivan, BS – Behavioral Research Assistant Kate comes to Thrive 4-7 with both international and domestic health-intensive research experiences: after graduating from Stonehill College with honors, she developed and led a year-long research study on the neglected tropical disease Lymphatic Filariasis in Leogane, Haiti as well as assisted in a hospital-wide genomic study at Boston Children Hospital in Massachusetts. Her work on chemical analysis (Stonehill College) and parasitic disease vectors (University of Vermont) has been published in peer-review journals, and has informed her pursuit of knowledge and scientific inquiry across a variety of disciplines. Kate is committed to action behind her belief that all people - no matter their race, ethnicity, gender, income, age, and religious background have the right to the highest standards of medical care, health, and wellness.

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References

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References (Continued)

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31. Billings AG, & Moos, R. H. The role of coping responses and social resources in attenuating the stress of life events. Journal of Behavioral Medicine. 1981;4:129-157.

32. Paulus M.P YAJ. Emotion and Decision-Making: Affect Driven Belief Systems in Anxiety and Depression. Trends in Cognitive Scienes. 2012;19(6):476-483.

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