On Friday, October 21, 290 researchers and practitioners from the medical, social and health fields gathered in Ottawa’s new Convention Centre for the first-ever “Women in Mind Conference,” a one-day event hosted by The Royal.
“Women’s mental health is a new frontier to conquer,” said George Weber, President and CEO of The Royal, “and The Royal is making it one of our key priorities.”
“When we talk about women’s health, it’s not to be exclusionary of men,” said Dr. Alison Freeland, Associate Chief of Psychiatry at The Royal and the Conference Chair. “Although men also have specific needs and issues with respect to mental health, women have some catch up to do. Most of the research in the field of mental health has been conducted generically and the subjects recruited have primarily been men. Only in recent years have we started to highlight the unique needs of women.”
The day-long Conference – which started and ended with remarks from Margaret Trudeau, the former wife of the late Prime Minister Pierre Elliott Trudeau and one of the country’s greatest mental health advocates – featured a diverse mix of subject-matter experts who shed light on the ways in which women experience mental illness differently than men as a result of their biology, social determinants, and the role they play in society as caregivers for children and aging parents.
“More than anything, what this day has shown me,” said Mrs. Trudeau during her closing remarks, “is the extraordinary hope we can all feel, that we are beginning to make great breakthroughs in understanding the workings of the brain.”
A copy of the presentations can be found below.
Presentations from the event
Effects of Estrogen on Cognition and Dementia
Presenter: Dr. Pauline M. Maki
What is dementia and how is it related to Alzheimer’s disease? Why do we care about the dementia risk in women? Is hormone therapy a risk factor for Alzheimer’s disease or can it protect against the disease? How does exercise affect the onset of dementia?
Dr. Pauline Maki tackled these and many other questions in her keynote address, which laid out reasons why women seem to be at greater risk than men for developing Alzheimer’s disease (the most common form of dementia) and also shed light on the effects of estrogen on cognition and dementia.
Studies suggest that if hormone therapy is started early in the menopausal transition (i.e., during the peri-menopause or early post-menopausal period), it can protect women from Alzheimer’s disease; some studies, in fact, have shown up to a 39% reduced risk. If introduced later, however, it appears to have a neutral or potentially detrimental effect. As well, estrogen has been shown to offer protection for healthy cells (which are more prevalent among women earlier in the menopausal transition), but to be potentially harmful to unhealthy cells.
Dr. Maki stressed that although there is exciting and ongoing research in the area of hormone therapy and dementia, at this stage she does not advocate that physicians recommend hormone therapy to their patients as a primary prevention against dementia. Rather, she encouraged them to use the information as a way of encouraging dialogue with their patients who might be considering hormone therapy to ensure they understand both the “critical window” hypothesis and the “healthy cell bias” hypothesis she describes in her presentation.
Dr. Maki’s complete presentation is available here: The effects of estrogen on cognition and dementia
Dr. Dennis Raphael
Social Determinants of Women’s Mental Health
Dr. Dennis Raphael’s presentation looked at the relationships between women’s living conditions and their mental health, as well as at how the provision of good living conditions is dependent on public policy.
Dr. Raphael focused on three important social determinants for women’s mental health and compared Canada against other countries in these areas: employment/working conditions; gender/family; and income/income distribution. He shared the results from a number of studies, including one that indicated that there is a 35% greater incidence of depression among low-income women compared to high-income women and an 80% greater incidence of hospitalization related to depression among women living in the lowest income neighbourhoods.
A key point he made is that by improving the material living conditions of woman we can improve their mental health and perhaps even prevent some mental illnesses.
In his closing remarks, he advocated for the need to educate, lobby and convince policy makers of the need to develop public policy to ensure health equity for all Canadians.
Dr. Raphael’s complete presentations can be found here:
- How Differing Concepts of the Determinants of Health Lead to Differing Approaches to Promoting Mental Health
- Social Determinants of Women’s Mental Health
Mental illness and Medical Comorbidity in Women: One More Thing to Worry About
Presenter: Dr. Valerie Taylor
Dr. Valerie Taylor’s presentation focused on the links between physical illness (specifically illnesses related to weight gain) and mental illness, and how distinct periods within a woman’s life can exacerbate this relationship.
One area she is researching – and which she describes as the chicken and egg question – is whether people first have a vulnerability towards obesity and then develop mental illness or whether depression, bipolar disorder and other mental illnesses lead to weight gain, which in turn leads to such physical illnesses as diabetes, cardiovascular disease, and hypertension.
Dr. Taylor also talked about the early predictors of adult obesity, which include a high BMI during pregnancy, excessive weight gain during pregnancy (an adverse uterine environment can predispose a child to adult diseases), and possibly the use of psychiatric medication during pregnancy. Among other recommendations, she urged practitioners to treat both the physical and psychological parts of a mental illness, to counsel patients with mental illness about the risks of excessive weight gain, and to educate those same patients on the importance of leading a healthy lifestyle.
Dr. Taylor’s complete presentation can be found here: Mental Illness and Medical Comorbidity in Women: One More Thing to Worry About
When the Bough breaks: Mental Illness in the Pregnant and Postpartum Woman
Presenter: Dr. Jasmine Gandhi
Dr. Jasmine Gandhi’s presentation explored how mental disorders in pregnant and postpartum women represent significant risks to both the mothers and their children, as well as significant economic and health care burdens on society.
She looked at a number of mental illness – including depression, anxiety disorders, bipolar disease and psychosis – and shed light on the psychiatric, obstetric, and pediatric implications during and after pregancy if these disorders are left untreated.
She also discussed a biopsychosocial (biological, psychological, and social) approach to the management of these disorders, which includes screening for postpartum depression, self help (in terms of nutrition, exercise, rest and support) and treatment (including therapy and medication).
Dr. Gandhi’s complete presentation can be found here: When the Bough Breaks: Mental Illness in the Pregnant and Postpartum Woman
Dr. Alison Freeland
Developing a Women’s Mental Health Program for Champlain: Results of the Royal’s Needs Assessment Survey
Dr. Alison Freeland – The Royal’s Associate Chief of Psychiatry and Conference Chair – shared the preliminary results from The Royal’s recently completed Women’s Mental Health Needs Assessment Survey, conducted for the Champlain LHIN (Local Health Integration Network).
As part of the needs assessment process, The Royal’s project team interviewed 9 internal stakeholders and 19 external stakeholders, sent out 100 email questionnaires (receiving a response rate of 55%), and held a focus group with 17 current clients.
The results were divided into four pillars: clinical, advocacy, research, and education (CARE). Among the many areas recommended for attention were: trauma-based care; women-centred care for those experiencing concurrent disorders (e.g. substance abuse with mental illness); increased outreach services; more French language and cultural services; and tools to help people navigate the clinical and social services available in the region.
Dr. Freeland’s complete presentation is available here: Developing a Women’s Mental Health Program for Champlain: Results of The Royal’s Needs Assessment Survey
Dr. Cláudio Soares
Depression in Women: Understanding the Windows of Risk Across the Life Cycle
Dr. Claudio Soares’ presentation looked at depression in three specific windows of risk during a woman’s reproductive life cycle: premenstrual (PMS), perinatal/post-partum, and menopause.
In terms of PMS, Dr. Soares cited research that suggests PMS is related more to a woman’s sensitivity to hormonal changes than to how much estrogen or progestin are in her body, potentially explaining why some women are more affected than others by mood swings and other symptoms.
During the prenatal/post-partum window, he noted that women with mental illnesses are also at risk of worsening their symptoms or having them re-emerge. In fact, in one study, 200 women who were using anti-depressants for unipolar depression were offered the option to stop taking the medication during their pregnancy. Half of the group chose to stay on their medication; the other half chose to stop taking it. The research showed that the risk for relapse was much higher for those who went off the medication – a staggering 76% relapsed into depression within nine months versus 26% for those who continued on medication.
Studies also show that women face an increased risk for depression during menopause and that the risk is even higher for women experiencing hot flashes and night sweat or women who have had a history of depression.
Dr. Soares encouraged physicians treating female patients with mental illness to also pay attention to the reproductive history of these patients. By understanding the risk women face at various times in their reproductive life cycles, he indicated, practitioners can design strategies to better treat depression in women or prevent the emergence of depression during these periods.
Dr. Soares’ complete presentation is available here: Depression in Women: Understanding the Windows of Risk Across the Life Cycle
Women’s Caring: Psychological and Social Issues
Presenter: Dr. Charmaine C. Williams
Dr. Charmaine Williams’ presentation focused on the key role that women play in “caregiving”, both paid and unpaid. She asserted that the current arrangements of care are overwhelmingly unfair to women, a reality that has direct consequences on the quality of their life and health.
Unpaid caregivers, for example, suffer from increased stress, decreased psychological well-being, and increased levels of depression. Paid caregivers – who as a group are underpaid, overloaded and unprotected – are prone to workplace anxiety and depression, as well as chronic and cumulative ill health and stress.
Dr. Williams argued that caregiving is work (and, indeed, hard work that requires skill) and, as such, should be treated as a social concern. She advocated for paying caregivers a living wage and ensuring benefits, safety on the job, and job security. She also suggested that unpaid caregivers could be financially compensated.
Dr. Williams’ complete presentation can be found here: Women’s Caring: Psychological and Social Issues
Women, Aging, and Mental Health
Presenter: Cathy Shea
For the first time in history, the number of Canadians over the age of 65 (13%) has surpassed those in childhood, and that number – thanks to the baby boomers – will double in the next 30 years. Of that population, most are women (147 for every 100 men) and 52% are widowed (suggesting that as they age they are less likely to have familiar caregivers).
The Royal’s Dr. Cathy Shea, a specialist in geriatric psychiatry, highlighted the many changes that take place as part of “normal” aging and focused on the additional challenges, problems, and stigmas faced by older women with mental illness.
The three most common mental illnesses found in the elderly are what Dr. Shea called the “3 Ds of Geriatric Psychiatry”: dementia, delirium, and depression. She discussed each in detail and offered insights into what physicians can expect from aging patients with mental illness.
She emphasized that although confusion is a common condition in the elderly, it is not normal and no matter what the history of the patient, it needs to be investigated, diagnosed, and dealt with. She also stressed that treatments and recovery are possible, to varying degrees, for all late onset mental disorders in the elderly.
Dr. Shea’s complete presentation is available here: Women, Ageing and Mental Illness
Women in Mind brought together leading researchers and practitioners for Ottawa’s first academic conference devoted to women’s mental health. Issues in women’s mental health were explored from both the medical and social perspectives. The Conference was attended by a diversity of health care providers, including physicians, social workers, health care professionals and community workers.
The Women’s Mental Health program of the Royal Ottawa Mental Health Centre was proud to present this groundbreaking conference in Ottawa.