Female Patients in Mental Health: Symptoms Patterns and Severity
Each March we recognize International Women’s Day, a time at which many organizations reflect on sex and gender disparities. Mental Illness impacts females differently than males, in terms of diagnosis and prevalence, risk factors, symptom patterns, ages of presentations, and outcomes 1,2. Additionally, most mental health research has not systematically included analysis for sex-specific differences 3.
A good starting point for examining sex differences in MHO’s dataset is to review just how much of our data are comprised of females. Recent U.S. Census Data indicate 50.7% of persons aged 18-55 are female 4. When considering all unique adult inpatient admissions to MHO programs for 18-55 year olds during 2023, we see fewer females (44.3%) than would be expected if the inpatient psychiatric population was representative of the overall population.
MHO’s diagnostic data are again consistent with research, where female admissions are more often related to mood or anxiety disorders while male admissions are related to schizophrenia and substance use disorders.
Figure 1. Primary Diagnosis Distributions for Adult Inpatient Programs (graph is NOT interactive)
Next, we explored patterns of severity on the patient self-report BASIS-32™. Patterns were explored for both admission and discharge by item, domain, and overall score. At admission, female patients report higher severity than males in most items, domains, and overall, with exceptions in the Impulsive/Addictive and Psychosis scales and items. Encouragingly, females and males discharge with similar severity in all areas where females admit with a higher severity.
Figure 2. Symptom Patterns and Severity by Sex (interactive graph: choose parameters and hover over data points for more information)
Though we see sex differences in admitting symptom severity, this could be attributed to differences in primary diagnosis. To examine that possibility, BASIS-32™ scores for each sex were examined by primary diagnosis. Females continued to report higher admitting symptom severity across almost all diagnostic groups, though again, by discharge this gap begins to disappear.
For the primary diagnoses in the mood and anxiety disorders categories (bipolar episodes, depressive disorders and episodes, and reaction to stress), female admission severity is lower than males in a cluster of items related to sexual activity or preoccupation, alcoholic beverages, drugs, controlling temper and anger, and impulsivity.
Mental health research in general 3, and even analysis at MHO, often looks at aggregate groups of patients without focusing on differences unique to female patients. When research does look for these differences, it consistently supports that there are differences in prevalence, risk factors, and presentation. MHO data confirms females report higher severity at inpatient admission across diagnostic groups and across most items of the BASIS-32™. MHO’s data also show females do not have less favorable outcomes, as they can and do obtain reduction in symptoms during inpatient stays. MHO’s online reporting allows for viewing data by sex, and facilities should be using this information particularly in light of recent calls for attention to disparities in behavioral health by The Joint Commission and CMS. Acknowledging and monitoring these differences are a meaningful first step to providing better care and outcomes for all patients, both male and female.
References
1. Riecher-Rössler A. Sex and gender differences in mental disorders. Lancet Psychiatry. 2017;4(1):8-9. doi:10.1016/S2215-0366(16)30348-0
2. Seedat S, Scott KM, Angermeyer MC, et al. Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys. Arch Gen Psychiatry. 2009;66(7):785-795. doi:10.1001/archgenpsychiatry.2009.36
3. Howard LM, Ehrlich AM, Gamlen F, Oram S. Gender-neutral mental health research is sex and gender biased. Lancet Psychiatry. 2017;4(1):9-11. doi:10.1016/S2215-0366(16)30209-7
4. https://www.census.gov/data/tables/2022/demo/age-and-sex/2022-age-sex-composition.html
5. https://www.nimh.nih.gov/health/topics/women-and-mental-health
