Skip to Main Content

JAMA: Stress as a Risk Factor for Mental Disorders in a Gendered Environment

December 15, 2023

The stress of unwanted life experiences is a well-known risk factor for negatively affecting our mental health.

Research within civilian populations suggests that life stress is more likely to result in psychological symptoms in women relative to men. Such symptoms are those found in posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder. Because women are more likely than men to report these symptoms after stressful life events, women often have been characterized as being more “vulnerable” to stress, and thus less resilient than men.

However, in a Viewpoint published in the journal JAMA Psychiatry, the authors – Carolyn M. Mazure, PhD, Mathilde, M. Husky, PhD, and Robert H. Pietrzak, PhD, MPH – remind us that U.S. population data indicate that women are more likely than men to experience psychosocial stressors and, as a consequence, this interpretation of increased “vulnerability” may not capture the higher risk for exposure of women to stress in our gendered environment.

As an example, the authors point to a 2023 prospective study of women and men frontline health care providers during the height of the COVID-19 pandemic showing that women were more likely than men to screen positive for PTSD, generalized anxiety disorder, and MDD symptoms over a 7-month period. However, results showed that co-occurring stressors — such as occupational role, pre-COVID-19 pandemic burnout, and family-related and work-related stressors — influenced the association between gender and these symptoms. Importantly, when the presence of these co-occurring stressors were considered, the gender difference in the prevalence of psychological symptoms was eliminated.

This Viewpoint suggests that assessing the association between gender and mental health outcomes without considering the impact of gender-specific stressors may overestimate the prevalence of psychological symptoms and disorders among women. The authors recommend that, going forward, greater consideration of context by assessing predisposing and co-occurring gender-based stressors is needed. Broadening the scope of measurement in this way could include assessing factors such as family and interpersonal stressors, pay inequality, economic mobility, work related stressors, neighborhood safety, sexual harassment, and child and family caregiving responsibilities.

Given the broad range of populations studied in stress research, the development of gender-informed measures and models of stress for different populations (e.g., general population, health care professionals, military personnel) also will be important. Essential to this approach is consideration of how gender can affect exposure to and the experience of stress, and thus aid in developing better targeted, gender-informed prevention and treatment efforts.

Submitted by Jessica Quistorff on November 03, 2023