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Sex and gender differences in mental health conditions: Addressing appropriate support.

Some mental health risk factors disproportionately affect people who are defined as female at birth. These include pressures created by women’s multiple roles, socially constructed differences related to status and power, gender discrimination, associated factors related to the pay gap, domestic violence and sexual abuse. In research terms, more is known about the differences between those assigned male or female at birth in some conditions (schizophrenia and depression) than others. There is limited research explaining the causes of these differences, and a demand for more research on sex and gender differences in illness behaviour, help seeking, treatment and compliance with treatment. Research on sex and gender specific differences in mental health conditions is mainly conducted in high income countries, with little known in low- and middle-income countries.

In regions which continue to endure conflicts, such as the Middle East and more recently Ukraine, trauma and associated social and political changes have a devastating impact on mental health. The WHO states one in five (22%) of people who have experienced war or other conflict in the previous 10 years will have depression, anxiety, post-traumatic stress disorder, bipolar disorder or schizophrenia. The war in Ukraine placed pressure on already stretched mental health services, and as such, emergency response work is ongoing to deliver a minimum service package, among other initiatives to provide mental health support in emergency settings.

In the Middle East, there are significant gender disparities related to culture (including polygamous marriage, intimate partner violence, female genital mutilation), layered on top of conflict related risk factors. As such, there are higher rates of mental health disorders in the Middle East than the rest of the world and women suffer disproportionately to men. The WHO Eastern Mediterranean Region, for example, reported the mental health burden in women to be higher than the global average.

Mental health research output in the Middle East is also lower than the global average and lacks the support of domestic funding. Mental health treatment guidelines often don’t exist, or are misused, resulting in patients receiving either no treatment, or treatment using outdated interventions. Mental health is not prioritised by decision makers, with only 2% of regional governments health budgets allocated to mental health in 2015.

People with mental health conditions in countries experiencing recent or ongoing conflict require urgent support. The lack of mental health research in the Middle East for example, further intensifies the need to understand service availability and accessibility, highlight resource gaps and generate a call to action.

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