Priority issues in women's mental health

As mental health professionals update their training and practices to accommodate the new paradigms (integration of mental health in primary care, mainstreaming of gender perspective, increasing attention to evidence-based interventions), they will encounter several challenges in the field of women's mental health, as outlined previously in the International Consensus Statement on Women's Mental Health (1).

Violence against women and children and its consequences for mental health is probably the most pressing issue. We have now a solid body of knowledge about this scourge: data on the magnitude and the geographic variations in prevalence (2,3); the recognition of the dire consequences of exposure to violence, which damages the capacity of the individual to deal with stress and predisposes to mental and physical ailments (4,5); both qualitative and quantitative research to support the ecological model of multiple levels of causality (6), as well as evidence that the perpetuation of traditional submissive roles of women is a very important factor, particularly in settings were patriarchal attitudes have not been challenged. The pressing task now is to design interventions and subject them to good quality research to determine their effectiveness. The conversion of successful pilot interventions into region- or state-wide programs cannot be delayed further.

The impact of social determinants on women's mental health is progressively better understood (7). Stress at work, inequity in access to health care, the multiple roles and burdens of women (as professionals, spouses or partners, mothers, caregivers, role models) and the demands of globalization all may have an impact in determining how much a woman realizes her right to health.

The evaluation and management of mental disorders in women across the life cycle extends beyond perinatal care, to include the need to advance in our knowledge of dementias and other conditions that affect older women (8). The management of affective disorders during pregnancy and puerperium is an exciting area of interest mostly for medical professionals, while women's mental health encompasses the whole array of concerns of women along the entire life cycle and across the different areas of development.

In the field of perinatal mental health, the wide recognition of the impact of functional impairment in women affected by common mental disorders on children's health and survival has determined advances in research and clinical practice. Remarkably, the role and place of medication is better understood, with recommendations to use drugs only in moderate to severe depression (9). The role of primary health care has been studied in several sites and the results are promising, with an emphasis on the usefulness of community support and non-pharmacological interventions (10,11). More research is needed in this promising area.

The demands of professional careers and the unrealistic expectations of beauty, success and perfection placed on women by the media may pose special dangers to young women, unless societies can collectively build environments where the distribution of opportunities and rewards is not determined by criteria such as conforming to a bodily stereotype or belonging to a certain class or gender.

The normative developments that have been adopted by most countries as a result of international covenants and some international pressure have not been accompanied by changes in attitudes and cultural mores. The result is the lack of implementation of laws about gender based violence and the persistence of discrimination in political, economic and academic advancement of women.

During the recent 5th World Congress on Women's Mental Health (Lima, March 4-7, 2013), it was recommended that:

• educational and attitudinal changes have to catch up with what we know and what international and national laws say about equality and protection of women from violence and exclusion;

• academics must advance the conceptualization and expansion of our understanding of the mechanisms that turn experience into changes in the way women – and men – feel, think and behave;

• states need to enforce and monitor the law and policies to advance equality and autonomy of women;

• civil society and professional advocates must use the globalized flow and intercultural exchange of information to shape the global agenda in order to advance gender equity and the right to live free of violence for all women.