Rethinking gender and mental health: a critical analysis of three propositions

In this paper, we critically examine three propositions that are widely (but not universally) accepted in the gender and mental health literature. First, women and men have similar or equal rates of overall psychopathology. Second, affective disorders like anxiety and depression, which are more common among women, and behavioral disorders like substance abuse and antisocial personality, which are more common among men, are functionally equivalent indicators of misery. Finally, women are more likely to respond to stressful conditions with affective disorders while men are more likely to respond to stressful conditions with behavioral disorders. Our review of previous research shows little to no consistent empirical support for any of these propositions. Results from national studies of overall psychopathology or "any disorder" are, at best, mixed and limited to a narrow range of mental health conditions. A comprehensive test of gender differences in overall psychopathology would require a systematic and exhaustive examination of gender differences across the known universe of mental health conditions, but this may be impossible to achieve due to a lack of consensus on the universe, the proliferation of diagnostic categories, and the tendency to pathologize the mental health of women. There is no empirical evidence to suggest that women substitute affective disorders for behavioral disorders or that men substitute behavioral disorders for affective disorders. There is no theory to suggest that affective and behavioral disorders should be treated as comparable indicators of misery. Some studies support the idea that women and men respond to stress in different ways, but most do not. Numerous studies show that women and men respond to stressors with higher levels of emotional distress, substance abuse, and antisocial behavior. We conclude with seven recommendations to advance theory and research and several general reflections on the sociological study of gender and mental health.