Covid and Gender Part 2: Mental health

Related content; Part 1: The widening of the gender divide and Part 3: The catch 22 of flexible working

Women’s mental health – why we have to act now

Reading about the challenges during the Covid crisis has highlighted a plethora of inequalities. Across sectors of society the fallout from living with a pandemic is widening equality gaps in gender, racial and social groups which ought not to exist at all. And this sadly holds true when it comes to mental health and wellbeing.

Mental health should always be high on our agenda. One in four people will suffer from mental ill health in the next 12 months – and that statistic is for the general population and pre-Covid¹. The figures are likely to be even more concerning both within our high-risk profession and due to the additional stresses of the pandemic, especially for women. So where do the risk factors lie and how can we all help to mitigate them?

Veterinary women’s mental health – the existing gap

It has been well documented that the veterinary profession is high risk for poor mental health and suicide. In a feminising profession, the mental health of our demographic should always be forefront of our thoughts. The Merck Animal Health Veterinary Wellbeing Study showed wellbeing scores for male vets was above that of men in other areas of work, whereas the converse was true for female vets.² Women are also more prone to stress, compounded by the fact they are exposed to additional stressors such as gender inequality and bias in the workplace. Alarmingly, research showed risk of suicide is 3.5 times higher among female vets than the general population, elevated to a greater extent than for male vets who are at a 2.1 times increased risk.^2,3 I’m raising this to highlight how important it is that we delve into the reasons why women are more at risk of mental ill health. That knowledge is key to both prevention and providing effective support.

Gender differences in mental health

In the general population, the World Health Organisation (WHO) reports that overall rates of psychiatric disorder are almost identical for men and women, but striking gender differences are found in the patterns of mental illness.

Unipolar depression, predicted to be the second leading cause of global disability burden by 2020, is diagnosed twice as frequently in women than men. It may also be more persistent in women.⁴ Conversely, the prevalence for alcohol addiction is twice as high in men than in women, and personality disorders are three times more likely to affect men.

Gender specific risk factors for diagnosis of common mental disorders that disproportionately affect women include gender-based violence, socioeconomic disadvantage, low income and income inequality, low or subordinate social status and rank, and unremitting responsibility for the care of others. Many of these factors have been exacerbated by the coronavirus pandemic. Cases of domestic violence have risen, with approximately 80% of victims being female⁷. As we saw in the first article in this series, it is women whose incomes have suffered the most. Women are more likely to be furloughed or lose their jobs altogether, contributing to feelings of frustration and inadequacy at further subordination of social status. And of course, women are bearing the brunt of the addition childcare responsibilities, and indeed are more likely to be involved in the care professions.

Widening of the gender mental health gap during Covid

While we may not be surprised to hear lockdown is having a negative impact on mental health, it is concerning this effect is far greater for women. A new study by the Universities of Cambridge, Oxford and Zurich revealed men experienced small and statistically insignificant alterations, whereas women reported significant declines in mental health.⁸ The May index from Total Brain found working women’s level of depressed mood increased 83% since February, versus 36% for working men. Meanwhile, anxiety levels for working women have increased 52% since February, versus 29% for their male counterparts¹⁴.

Similarly, a study by Kings College London showed 57% of women say they are feeling more anxious and depressed, compared with 40% of men. More women than men report they are sleeping less and eating less healthily than usual.⁹ I can relate to this – may sleep patterns have been all over the place as I shoehorn work into the early and late hours. Also, my jelly sweet consumption has never been higher.

Gender stereotyping in mental health

Here’s the rub; gender stereotyping regarding proneness to emotional problems in women appear to reinforce stigma and constrain help-seeking. This is particularly true when there is a hormonal element, which can be significant and severe.¹⁰ Such stereotypes are a barrier to the accurate identification and treatment of psychological disorders. Doctors are more likely to diagnose depression in women compared with men, even when they present with identical symptoms. Being female is, in itself, a significant predictor for being dispensed mood altering or psychotropic medication⁴.

Veterinary mental health and Covid

Vet teams worldwide have experienced the additional challenges of being caregivers and essential workers during this crisis. Yes, unlike NHS who are experiencing outpourings of public support, many frontline veterinary staff are experiencing negativity from clients. Social media groups are full of stories from vets and nurses on the receiving end of anger, frustration and verbal abuse at a time when they’re under unprecedented strain.

In an article for the American Animal Hospital Association, Erin Allen, LSW, a social worker with the Argus Institute at Colorado State University’s (CSU) veterinary teaching hospital, says, “Veterinary professionals have the same fears as their human medical counterparts. This dedication level of those in the veterinary field is not often celebrated on the broad social spectrum though, seemingly more likely to go unrecognized within the media outlets. This can lead to a perceived lack of appreciation from the general public, a lack of recognition of their dedication and personal risks to stay available to their patients and clients.”

And yet, veterinary teams are finding ways to stay motivated and united, as Allen continues, “We’ve seen this perspective in the CSU – a strong, positive ‘can do’ attitude in the face of fear.” However, to decompress the inevitable build-up of emotion it’s important to actively debrief about cases or personal challenges throughout the workday. Sometimes people need to vent or express frustration or anger. In these situations, Allen recommends a three-step process:

1. Express the emotion.
2. Evaluate it for what can and cannot be controlled.
3. Let it go.

For this to happen effectively, you must give yourself and others permission to feel and express emotion. Now is the time for practices to embrace a culture free from stigma about mental health.

Supporting women’s mental health in the veterinary profession

So, what can we do to reverse this and improve the wellbeing of women? As practices and individuals, the first action to support anyone is always to ask; ask if they’re okay with time and space to answer. Ask again, and regularly. Cultivate a culture of openness where mental health is not stigmatised – and call it out when it is. Champion wellbeing and put in place measures to support your team. These do not have to be complex or costly; plenty of practical examples to suit all sizes and shape of practice can be found through the SPVS/Mindmatters practice wellbeing award booklets and articles. Above all, make it a priority. After all, people are the greatest practice asset, with value beyond compare. If any of the issues raised above strike a chord with you personally, please contact Vetlife for confidential advice and support.

Self-care for mental health during Covid

Getting help early is the key to quick recovery. Having spoken with Vetlife managers, I know they want to encourage people to phone early, rather than waiting until they feel they’re really suffering or at crisis point. They are there for all of us.

Dr. Jessi Gold, a psychiatrist and assistant professor for the Department of Psychiatry at Washington University in St. Louis, “There’s no wrong time to get help. We’re in a culture that very much thinks you have to be in a crisis to seek care. That’s not the right mentality. That’s a dangerous mentality, actually, because by the time you’re in a crisis a lot of the treatments we provide aren’t as effective. For example, medications can take months or weeks at least to work. It would be a lot better if you get help earlier. So if you start to feel that maybe talking to someone outside your family will be helpful, reaching out will be worthwhile.”¹³

Dr. Gold also gives the following advice:

• Prioritize yourself: It’s hard to prioritize when you have competing interests. “Even something as small as taking a bath, or something. Just try to find something that’s just for you and try to do that.” Gold says
• Create boundaries: “Just because everybody is at home doesn’t mean they get a say in your every second of every day,” Gold says. “Just because you’re the caregiver doesn’t mean you have to be care-giving all the time.”
• Prioritize sleep: This is essential to function day to day.
• Move your body: Simply going for a walk with the kids is a good way to get out pent-up anxiety.
• Remember coping skills aren’t one-size-fits-all: “Just because one person says something is helpful doesn’t mean it’s going to work for you,” Gold explains. “And just because something worked one time doesn’t mean it’ll work all the time.” Find what works for you and be prepared to flex it over time.
• Learn how to be comfortable with uncertainty: Living one day at a time at the moment is how I’ve got through this far. As Gold says, “If we look too far into the future and hope we can plan everything out we’ll just be disappointed.”

Caring for veterinary teams during the pandemic

Many businesses across the spectrum have been lagging in terms of acting on the growing concerns of poor mental health. While not specifically veterinary, much of what is written in an article by the HR Executive rings true for our profession.¹⁴

“In many ways, it’s shining a light on flaws that existed before we knew about COVID-19,” says Anne Richter, a health management consultant at Willis Towers Watson. While wellbeing has been embraced by some employers, many fell short when it came to helping employees with such issues as anxiety, depression and stress. Those shortcomings included: a lack of resources offered; poor communication about existing offerings; and a near-unanimous view that the subject was too taboo for the workplace.

No more can such shortcomings be acceptable. Mental health and our fundamental human needs are not aspects of work that can be viewed as nice-to-have extras. For our workforce to survive the pandemic and beyond in a state of positive mental and physical health, we must stop deprioritising breaks, debriefs and support for all team members. Mechanisms which focus on stress-reduction are thought to be especially important for helping employees get through the pandemic.¹⁴ As an empathetic and caring profession, we have to start prioritising and practicing systemic self-care.

Simple measures such as providing employee access to the Headspace app is increasingly common – they reported a 400% increase in business membership after the pandemic struck. SPVS, Vetlife and the RCVS Mindmatters websites all have guides and resources freely accessible. The AAHA has also put out a self-care guide for vet teams.

Be part of the solution

Awareness is the first step to addressing problems – so thank you for reading! Beyond this, helping one another by fostering an open, supportive culture is vital. We would be interested to hear your experiences and ideas how we can better facilitate women in the workplace through and beyond Covid. To be representative we need diverse representation, and would like to invite women from across the industry to take part. Follow our facebook page for upcoming polls to feed into this work, and please contact us if you would like to share your story or contribute in any way.

1.  https://www.mentalhealth.org.uk/publications/fundamental-facts-about-mental-health-2015
2. https://avmajournals.avma.org/doi/full/10.2460/javma.252.10.1231
3. https://www.sciencedirect.com/science/article/pii/S2352250X17301884?via%3Dihub
4. https://www.who.int/mental_health/prevention/genderwomen/en/
5. Better Or Worse: A Longitudinal Study Of The Mental Health Of Adults In Great Britain, National Statistics, 2003
6. https://www.innerbody.com/womens-mental-health-facts-and-statistics
7.  https://www.womensaid.org.uk/information-support/what-is-domestic-abuse/domestic-abuse-is-a-gendered-crime
8. https://www.inet.econ.cam.ac.uk/working-paper-pdfs/wp2018.pdf
9. https://www.theguardian.com/world/2020/may/03/i-feel-like-a-1950s-housewife-how-lockdown-has-exposed-the-gender-divide
10.  https://www.veterinarywoman.co.uk/2020/03/menopause-and-the-veterinary-profession-should-we-be-talking-about-it/
11. https://www.aaha.org/publications/newstat/articles/2020-03/mental-health-risks-and-strategies-for-veterinary-teams-during-the-pandemic/
12. https://www.womansday.com/health-fitness/womens-health/a33237867/mental-health-covid/
13. https://hrexecutive.com/hres-number-of-the-day-depression-among-working-women/
14. https://hrexecutive.com/will-covid-finally-make-employers-fix-their-mental-health-problem