Women with severe mental illness have worse physical health
In recent decades, there has been a growing interest in studying physical health problems in women with severe mental illness (Seeman, 2018). It is well known that women with schizophrenia experience gynecological problems more frequently than women without this mental disorder, but there is little research focused on this area (Magnus et al., 2021). In this article, we will attempt to determine whether women with severe mental illness, compared to women without, have a greater risk of experiencing physical health problems. We will also examine which factors may theoretically increase the risk of developing general health problems and whether or not interventions are possible to reduce them. Furthermore, we will discuss which specific programs can be designed to provide gender-differentiated care and the role of partial hospitalization programs in the treatment and follow-up of these women.
What is known so far is that women with mental health conditions often have to continue caring for their families and are frequently forced to reduce their working hours to care for their children, parents, or other relatives (Ennis et al., 2013). This intensive caregiving role has significant socioeconomic consequences. The reduction in working hours leads to a decrease in income, which, in turn, increases the stress levels these women must endure. These stress levels are in addition to the stress of the illness itself and the vulnerability and anxiety they experience due to having a severe mental health condition.
This drop in income not only affects their socioeconomic level and their ability to take care of their own mental health, but it can also influence their overall health, including their gynecological health.
Why do women suffer more from mental health disorders?
Although some studies show that women seek help and request follow-up and treatment more frequently than men, there are many barriers that hinder regular, frequent and, above all, optimal follow-up (Ochoa et al., 2012).
Social and economic barriers, coupled with stigma, make it difficult to modify risk factors for diseases such as cancer.
For example, users suffering from schizophrenia have a significantly higher risk of mortality from breast, lung, and colon cancer compared to the general population (González-Rodríguez et al., 2020).
For years, these differences in cancer mortality have been attributed to potentially modifiable risk factors, such as lifestyle and health-affecting behaviors: smoking, a high-fat diet, and lack of physical activity. However, when we focus on schizophrenia or other severe mental disorders, there are other barriers that hinder changing or reducing risk factors, including poverty, lack of economic resources, cognitive symptoms (problems with memory, attention, planning, etc.), stress, and the stigma surrounding mental illness.
Regarding cancer risk and cancer mortality, there are well-established strategies for early detection and primary prevention in individuals with schizophrenia or other severe mental disorders (González-Rodríguez et al., 2020). When we speak of strategies , we are referring to specific interventions that can be implemented to modify certain lifestyles and thus reduce cancer risk. Interventions focused on health behaviors, for example, can center on smoking cessation, which is directly associated with the risk of developing lung cancer, among other diseases. Continuing and monitoring gynecological cancer screenings (such as mammograms) in women with severe mental disorders can also improve early cancer detection in these women.
Specifically, previous studies indicate that women with severe mental disorders attend cancer screening programs and gynecological consultations less frequently (Lindamer et al., 2003), a fact that increases the risk of late diagnosis and, therefore, the risk of mortality due to the disease.
Furthermore, regarding the aforementioned stigma, some clinical trials in medical oncology exclude individuals with severe mental disorders, who are precisely those with increased mortality rates. So much so that, moreover, drugs used to treat some cancers are not specifically tested in populations with schizophrenia or other severe mental disorders, making it impossible to know if these patients exhibit specific or different responses to medications compared to the rest of the population. Some authors have drawn attention to this issue, and changes in this regard are expected (González-Rodríguez et al., 2020).
But the impact of stigma on physical health, cancer risk, and mortality goes far beyond that. It is well known that schizophrenia and other severe mental disorders are stigmatized illnesses. This is partly because some healthcare professionals do not pay enough attention to certain physical conditions or do not offer specific services due to a lack of knowledge (González-Rodríguez et al., 2021a).
Users with schizophrenia often have difficulty communicating when expressing pain or other symptoms. Furthermore, it has been suggested that some individuals with this disorder have a reduced sensitivity to pain and, therefore, tolerate it better, which could delay medical diagnoses in some cases (González-Rodríguez et al., 2021a).
Understanding the different ways symptoms manifest in people with schizophrenia can help improve the early detection of certain medical conditions in this population, including cancer. This requires specific training for healthcare professionals.
Furthermore, it is important to consider that the overall health of men and women (not just cancer) is influenced by biological and hormonal factors, as well as by the life roles we assume, our lifestyle, and environmental and work conditions. In turn, all these factors are influenced by gender (Castañeda, 2007).
For example, heart disease is more common in men than in women, as is Parkinson's disease (1.5 times more common) and kidney and liver diseases. Women, on the other hand, have a higher risk of stroke and osteoporosis compared to men. Likewise, women with mental health conditions are generally at higher risk of developing certain physical disorders such as acne, irregular menstrual cycles, and decreased bone density (González-Rodríguez et al., 2021b), as well as high cholesterol and diabetes mellitus .
Medical complications and the risk of late diagnosis increase in postmenopause.
As we have already mentioned, women with severe mental illness already experience more medical complications and a higher risk of late diagnosis, and when they reach the postmenopausal phase, all of this intensifies even further. Menopause is a universal process that all women go through and is characterized by a progressive decrease in the levels of female sex hormones, which translates into a loss of the protection enjoyed against certain diseases during reproductive years (Brzezinski-Sinai and Brzezinski, 2020).
Although the risk of cardiovascular disease increases with age in both sexes, it is after menopause that there is an increase in the occurrence of these disorders in women. A similar pattern is observed in women with severe mental disorders regarding brain or neurological conditions. During menopause, the onset of cognitive disorders and movement disorders such as Parkinson's disease is more frequent in women than in men, unlike in other stages of a woman's life. Thus, we can deduce that women with mental disorders are more vulnerable during menopause to certain medical conditions from which they were protected during their reproductive years (González-Rodríguez et al., 2021b).
Furthermore, women in general are more prone than men to developing autoimmune diseases. In addition, some autoimmune diseases are more common in individuals with schizophrenia or other related disorders (Ngo et al., 2014). Therefore, it seems reasonable to think that people with schizophrenia (and especially women) deserve more specialized and precise attention to their overall health within our devices, beyond just their mental health.
To offer a differentiated care proposal to women with severe mental disorders
To improve the physical health of women with severe mental illness , several intervention proposals are presented. The creation of specialized teams, comprised of professionals in medicine, nursing, psychology, and social work, and coordinated with primary healthcare, can contribute to improved coordination between these two levels. Cooperation between community healthcare and specialized mental health care must be strengthened. For example, returning to the topic of cancer screening, it is important to offer support and guidance to women so they can undergo the necessary tests for early detection.
It is essential to ensure that women attend primary care appointments and participate in breast cancer screening programs, among other things. Nurses can be active agents of change in this area (González-Rodríguez et al., 2021), working in outpatient settings or in partial hospitalization programs such as those offered by Day Hospitals. These programs, staffed by psychiatrists, nurses, psychologists, and other healthcare professionals, can improve the relationship between two teams that must be coordinated and collaborate with each other. This requires time and training, as well as an effort on our part to earn the trust of our patients.
Change is possible and necessary: we must improve care for women with mental disorders. Partial hospitalization programs can focus the coordination of mental and physical health care in cases where intensive intervention is needed for our mental health users (Brown et al., 2015).
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