Mental illnesses affect one in ten people globally, but some groups are at higher risk than others.
Writer and Artist: Lia Bote
Editor: Pauline Münchenberg
In the UK, 9% more Black women suffer from a mental disorder than White women. Common mental disorders, which encompass conditions like anxiety, eating disorders, and postpartum depression (PPD) in new mothers, are also higher in Indian and Pakistani women compared to their White British counterparts. Interestingly, while there are no significant differences in the prevalence of mental disorders amongst men of different racial groups, White British people are twice as likely to consult a mental health professional than people of colour. And it isn’t just the UK: in America, for instance, Black and Hispanic women are twice as likely to suffer from PPD than White women.
One common explanation for this is the socioeconomic disparities between ethnic and gender groups. In the UK, women of colour are more likely to be unemployed than White women. This is echoed by Dr. Rochelle Burgess from the UCL Institute for Global Health, who stresses that the mental health recommendations that have come out of the pandemic fail to address the socioeconomic roots of the issue. For the nearly one billion people living in slums around the world, mostly people of colour, and the 1.3 billion women who have experienced violence in their lifetime, Dr. Burgess emphasises that recommendations like the World Health Organisation’s (WHO) for mindfulness and meditation are superficial and inadequate.
Still, the roots of the issue may be more nuanced. According to Dr. Tiffany Green from the Department of Population Health Sciences at the University of Wisconsin-Madison, even controlling for socioeconomic parameters such as income, educational attainment, and marital status, Black and Asian women have higher rates of suicidal ideation than White women. Three main factors are thought to influence this: racial discrimination, cultural stigmatisation, and a mismatch between professional services and the patients’ needs.
In a study based on anecdotal evidence, the Black Women’s Health Imperative found that Black women are often hesitant to talk about their PPD because of their fear of racial discrimination. Even though PPD is a uniquely female condition affecting about 15% of mothers, ethnic minorities are still more heavily affected. In fact, those who felt that their health providers discriminated against them exhibited higher rates of PPD. This discrimination applies in various settings: another study found that women of colour who experienced both sexism and racism at the workplace, whether in the form of direct harassment or microaggressions, had poorer mental health outcomes and lower productivity than women who experienced only one or neither. On the other hand, workplace cultures that had stronger anti-racist and anti-sexist attitudes resulted in lower burnout rates and higher employee satisfaction.
Cultural stigmatisation of mental health at the family and community level also plays a role. More than 60% of Asian American women with high-risk mental disorders have never availed of mental health care at all, and over 80% are receiving minimal to no care, as strong cultural prejudices prevent them from being willing to speak about their mental health. For Black women, the pressure to conform to the ‘superwoman’ stereotype ‒ breadwinner, caregiver, community leader ‒ has often led to emotional suppression. In regions of South Asia, the treatment of women as second-class citizens aggravates this cultural aversion, with high rates of domestic violence, marital conflict, and forced prostitution, coupled with practices like sex selection, where female fetuses are aborted. As a result, women in Bangladesh are thrice as likely to have a history of suicidal attempts and ideation than men.
Finally, the mismatch between cultural needs and available services can lead to the misdiagnosis of certain conditions. Given the limited studies on mental health and people of colour, healthcare providers in countries like the UK are not often fully equipped to understand the cultural backgrounds of women from ethnic minorities, and thus the different ways that they may present symptoms. Cross-cultural barriers may often be cognitive, where some Asian cultures conceptualise the body and the mind as one, and psychological conditions manifest as somatic symptoms. They may also be value-oriented, where collectivist cultures are averse to sharing emotional struggles with an outsider, or structural, with challenges like English language proficiency and health insurance coverage.
Ultimately, the disproportionate effects of mental illness on women of colour are testament to the inextricable linkage of racial and gender discrimination with every facet of society. Rectifying this involves addressing the structural failures that put women of colour in difficult social conditions, and a better consideration of diverse cultural backgrounds in the treatment and diagnosis of mental disorders. After all, protecting women of colour is protecting the communities that they nurture and uphold, and we cannot do this without first equipping our health systems to understand the nuances of our cultural diversity.