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Received: 19 December 2021 / Revised: 20 January 2022 / Accepted: 24 January 2022 / Published: 28 January 2022
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Many studies have examined the influence of gender on mental health, but few have addressed gender differences in mental health risk and prevention. We conducted a narrative review to assess the current state of knowledge regarding gender-specific mental health preventive interventions, as well as an analysis of gender-related risk factors and available screening strategies. Of 1,598 articles screened through a comprehensive electronic search of the PubMed, Web-of-Science, Scopus, and Cochrane databases, 53 were included for review. Risk factors for mental health problems include individual, family, social and health factors. Individual factors include childhood adversity, which suggests gender differences in prevalence rates. However, current child abuse prevention programs are not gender specific. Maternal problems and intimate partner violence are known contributors to mental health problems, both of which have few gender-specific preventive measures available. Social risk factors for mental health problems include education, employment, discrimination and relationships. All of them show gender differences, but these differences are rarely taken into account in mental health prevention programs. Finally, despite well-known gender differences in the use of mental health services, mental health services appear to be slow to develop strategies that guarantee equal access to care for all individuals.
Gender; prevention; mental disorders; childhood abuse; pregnancy; intimate partner violence; education; employment; discrimination; relationship; gender of the health system; prevention; mental disorders; childhood abuse; pregnancy; intimate partner violence; education; employment; discrimination; relationship; health systems
Mental disorders are the fifth most common cause of disability in the world . Available treatment options for most psychiatric conditions do not promote restitutio ad integrum. Instead, investing efforts in mental health promotion, prevention and early intervention may achieve the best results . The World Health Organization (WHO) recommends that all neuropsychiatric interventions focus on promoting positive mental health at the population level to improve individuals’ ability to monitor their mental health and its determinants . On the other hand, prevention strategies aim to intervene in the pre-pathogenesis phase to prevent the occurrence of such conditions as much as possible (primary prevention), promote early disease detection, screening, rapid treatment and limitation of disability (secondary prevention) and maintain recovery , rehabilitation and restoration of functioning in the later stages of the disease (tertiary prevention) . Therefore, depending on the needs of individuals at different stages of the mental health and illness continuum , promotion and early intervention strategies aim to support the continuum of mental health care to achieve the best possible outcome in terms of well-being. Most of the previous prevention strategies have focused on psychosis, using the concept of at-risk mental state (ARMS), which implies the possibility of delaying the progression to a complete disorder . However, recent evidence is beginning to support the possibility of expanding the clinical scope of interventions beyond psychosis to include common psychiatric disorders such as depression, anxiety, substance abuse, and eating disorders . In this regard, an updated and more comprehensive clinical staging model, Clinically High-Risk Mental Status (CHARMS), has been proposed, which includes a transdiagnostic paradigm . A recent review of the literature suggests that it is important to refocus such interventions on youth populations [8, 9].
Oncology is one of the healthcare sectors where prevention, early detection, multidisciplinary and personalized strategies have made enormous progress in transforming cancer care . Evidence from oncology studies suggests that common cancer risk factors such as alcohol, smoking, excess weight, and physical inactivity have gender-specific cancer-promoting effects, as men and women are differently exposed to joint and multiplicative effects. risk factors . Thus, all things being equal, the health loss of men and women is not the same, which encourages the adoption of a gender perspective for more effective public health interventions.
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Mental health is no exception. When developing preventive strategies for mental health, an important aspect to consider is gender, defined as a socio-cultural construct that includes norms, rules, behaviors and attitudes associated with girl/woman or boy/man and sex. instead it refers to a set of biological and physiological characteristics . Gender interacts with gender differences, but represents a broader spectrum dimension and can combine with other social factors to potentially lead to differential exacerbations of biological vulnerability. Given their different and reciprocal effects on mental health, both sex and gender differences should always be taken into account, from promoting the adoption of screening strategies to identify people at risk of developing mental health problems, to preventing their occurrence or at least enabling action before rather they worsen . In addition, gender nonconforming people may face unique challenges, specific health problems and health disparities, and a recent literature review highlighted the importance of promoting gender diversity to avoid negative mental health effects .
Several risk factors have been identified that delineate the pluripotent pathological pathway of mental disorders . They have the greatest influence on mental health from the prenatal period to early adulthood, with less significant modulations until old age . In addition, pregnancy, parenting, childcare, relationship behavior and the socio-professional environment are privileged areas of intervention [ 14 , 15 , 16 , 17 , 18 ]. Research shows different reactions to life events depending on gender [19, 20].
The purpose of this narrative review is threefold: (i) to update the current evidence on the role of sex, gender, and gender diversity in the risk of mental health disorders; ii) analyze available screening tools designed to detect subjects at potential risk of mental health problems from a gender perspective; and iii) a review of recent advances in the implementation of gender-specific mental health prevention strategies.
The purpose of this literature review is to provide a comprehensive overview of the research evidence on gender-related mental health risk factors, the methodological applications of their identification, and the extent to which they have been targeted by mental health prevention and early intervention strategies. Specifically, the present paper aims to highlight the relationship between these components of gendered spiritual care and the need to integrate them as a guide for moving forward. Such application may offer new directions for clinical research to fully develop a gender-based model of mental health care focused on prevention.
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A literature search was performed using electronic databases (PubMed, Web of Science, Scopus, Cochrane) using a combination of terms: “prevention”, “mental disorders”, “gender”, “sex”, “childhood abuse”. , ‘pregnancy’, ‘intimate partner violence’, ’employment’, ‘relationships’ and ‘healthcare systems’, 15 Oct 2021. No predetermined time frame or age range was adopted for study searches to be as inclusive as possible. . Evidence from additional studies obtained outside the search or identified by hand searching the reference section of the included article was reported when considered appropriate by the authors. Screening and extraction of publication data followed a 2-stage selection process (conventional double checking) by 2 reviewers independently of each other (CC and GA). In rare cases of discordant screening, consensus was reached in consultation with a third senior clinical investigator (MC).
Studies were eligible for inclusion in this review if they assessed mental health risk factors or prevention strategies from a gender perspective. Only original articles published in peer-reviewed English-language journals were accepted for this review. Using a three-step screening approach,
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