Psychology

It was widely assumed that there were no gender differences in mental disorders and any evidences that suggested that women experienced more psychological distress than men.  The assumption lies on the fact that women are being more willing to admit to psychological distress, being more willing to seek treatment andor sex bias on the part of clinicians (Gove 2002). Furthermore, although it was widely recognized that on most indicators of physical illness women appeared to have higher rates of morbidity, it was generally assumed that the apparent higher rates of women did not reflect real differences in morbidity, but gender differences in mental disorder. A survey of the recent literature, however, shows that women experience more psychological distress than men mainly because of the aspects of their societal roles.   
    
Additionally, in the last few years the cumulative evidence indicates that women do in fact have higher rates of morbidity than men and that this probably is also largely a consequence of their social roles. The current paper concentrates on the roles normally assumed by men and women.  The roles of men are inclined to be more structured than the roles of women.  Women, on the other hand, are more likely to occupy nurturing roles than men. It is argued that highly structured roles, in the case of men, tend to be causally related to good mental health and low rates of morbidity. On the contrary, nurturing roles of women tend to enforce a strain that possibly can impair ones ability to effectively adopt a sick role.   As consequences, the nurturing roles are linked to poor mental health and the higher rates of morbidity. In short, the hypothesis of the structured role versus nurturing role complement each other and can be combined to explain their effects on higher rates of psychological distress and mental disorder among women.

Statement of the Problem
Gender affects various aspects of life including methods of coping with stress, social interaction, self-evaluation, spirituality, access to resources, and expectations of others.  These factors influences mental health of both men and women in a negative or positive way.  The current paper seek to develop understanding between the relationship between gender and mental health so as to lessen risk factors predisposing men and women to develop mental disorders, as well as to improve treatment methods.

Research Questions
The study aims to answer the research question of whether there is a relationship between gender specific stressors and the development of mental disorders.

Research Hypothesis
The research hypothesis is that there is a relationship between gender specific stressors and the development of mental disorders.

Relevance to social work
The current study can be utilized as a guide on planning therapies to individuals, both men and women.  The focus of therapy differs based on issues of role stressors of patients and their gender.  Thus, the social workers can recognize causative factors that led to the development of mental disorders and plan interventions that best fit the client along with his or her past experiences. 

Furthermore, social workers can reduce the incidence of anxiety among toddlers and young children by first identifying high-risk conditions that produce greater than average number of children having unmet needs not given by their caregivers.  Social workers can intervene to reduce the number of risk conditions among young children.  Before interventions are instituted, the need for a strong association in the connection between risk factors and their effects on young children.  Frequently, evidences of childhood issues such as unmet needs are limited, thus it seriously weakens the rationale for intervention efforts. 

III. Background and significance

Womens typical stressors
During the time of post-independence, it has been realized that women were granted an active participation and cooperation to the progress of a nation.  They were provided with equal opportunities whether in the field of education or occupation.  These efforts increasingly resulted to a great change in life of women that influences their attitudes, values and roles.  While women participates in the labor workforce, much of their feminine or nurturing roles remains unchanged.  Research on womens roles has revolved around two competing theories.  The role of enhancement theory argues that employment provides psychological and social benefits to women due to increased contact, social interaction and increased sense of esteem.  In contrast, the role overload theory implies that the pressures and demands of juggling multiple roles including career, parenting, spouse roles, may exhaust womens personal resources and impair womens physical and mental health (Singh  Shyam 2007).  Rosenfield (1999) reported that women perform 66 percent more of the domestic work compared to men.  The study showed that women sleep one half hour less per night and perform an extra month of work each year.  Some of the obstacles to womens psychological health are the emerging demands and challenges linked to work and non-work responsibilities of women.  Thus, it is assumed that most patients in psychiatric facilities experienced stress from multiple roles at home and work. 

Besides the multiple roles of women, personality variables could also affect reactivity to the demands of multiple role-playing.  In relation to, Type-A individuals are more motivated to control stressful situations compared to Type-B individuals (Glass 1977).    Houston and Kelly (1987) studied Type-A behavior among housewives when it comes to work, marital adjustment, stress, tension, health, fear of failure and self-esteem.  Ninety-five housewives were administered the Framingham Type-A Scale and the Jenkins Activity Survey.  The data gathered were from personal interview and questionnaire concerning different aspects of their daily lives, various psychological and psychosocial variables.  Type-A was found out to be in contrast from Type-B concerning more stressful, work-related experiences.  Type-A reported lower covert self-esteem and report more fear of failure than Type-B. 

Mens typical stressors
The traditional role of men is marked with expectations for superior physical strength, intellect, or sexual performance.  Some situations typically produces stress for men that challenges their self-identity hence makes them feel inadequate.  Research indicates that men who strictly adhere to extreme gender roles are at higher risk for mental disorders.

Traditional male gender roles are adhered in particular cultures. An exaggerated form of masculinity is characterized by qualities such as concerns for personal honor, virility, physical strength, heavy drinking, toughness, aggression, risk-taking, authoritarianism, and self-centeredness.  In a study by Jose Abreu and colleagues, an exaggerated form of masculinity is adopted by Latino men, coming close are European Americans, and then African Americans.

Mental Health
Well-being is defined as a subjective, positive emotional state with general life satisfaction (Diener 1984).  The most common and comprehensive indicator of the sense of well-being including life satisfaction which refers to a persons global judgment of his or her quality of life, feeling of contentment and happiness. 

Mental health is best achieved by maintaining a balance between masculine and feminine qualities. When either set of qualities is taken to the extreme and to the exclusion of the other is detrimental to health and self-esteem. A non-traditional gender role orientation would combine the best of both genders a social focus (reciprocally supportive relationships and a balance between interests of self and others) and active coping strategies.

It is also necessary to know the educational attainment, family environments, emotional health and marital status of patients.  Educational attainment influence socio-economic status or level of prosperity and welfare of people consequently contribute to wellbeing.  Higher educational attainment are typically associated with higher income, higher standards of living and above average health (Federal Interagency Forum on Aging Related Statistics 2004).
 
Vulnerability to depression presumably began in early family environments in which the childrens needs for security, comfort, and acceptance are not met.  In fact, a study found out that two-year-old children with secure attachments to his or her primary care givers were more cooperative, persistent, and enthusiastic, show more positive affect, and function and better overall than those with insecure attachments (Matas, Arend,  Sroufe 1978).  Moreover, adolescents undergoing stressful life events are more likely to become depressed if they had insecure attachments to their parents than adolescents with more secure attachments (Kobak, Cole, Ferenz-Gillies, Fleming  Gamble 1993).   A persons emotional and economic wellbeing can be greatly affected by marital status.   The marital status can influence living arrangements and life satisfaction.  Cross sectional studies have shown that married people have significantly higher levels of subjective well-being than people in de facto relationships, newer married people, or divorced people (Singh  Shyam 2007). 

A study indicated that, overall, neither women nor men are at greater risk to develop mental disorders.  Certain types of disorders, however, may indicate susceptibility to males or females.  Gender identification possesses advantages and disadvantages.  Findings of the study showed that women are protective against antisocial behaviors and substance abuse, but is linked to develop increased levels of avoidant coping strategies and low levels of achievement.  On the other hand, men are protected against depression, but have a high tendency in antisocial behavior and substance abuse (Rosenfield 1999).

The current study attempts to determine whether men and women who has and had mental disorders experienced stress from assuming gender roles.  Women participants will be assessed based on their age, emotional health, personality type, and the nature of their lifestyle including their roles at home andor work prior to admission and discharge from psychiatric care. 

Participants who are men will be also assessed based on their age, emotional health, employment, marital status, and nature of lifestyle upon assuming roles at work and home. 

IV.  Research Methodology
Research Design
The current study utilizes an approach of retrospective and explanatory to demonstrate the hypothesized relationship between gender specific role stressors and the development of mental disorders.
 
Sampling Plan
The study uses stratified sampling method, as it is advantageous to sample each group of participants namely men and women who have a history of mental disorders and has been treated in a psychiatric facility.  Each group is divided into two based on the

C.  Procedures
The sampling frame included every eligible patient who had completed psychiatric rehabilitation as a treatment for mental disorders.  Psychiatric nursing staff based on the given criteria initially recruited potential participants.  The potential participants are those who have successfully completed psychiatric therapy and adhere on his or her medication management.  As the recruitment of patients progresses gradually, the researcher seeks participants through weekly discussions with staff nurses to identify patients meeting study-screening criteria.  After initial screening administered by RN staff, the researcher explains the study to the potential participants and obtained patient consent.  The staff nurses are not asked to secure patient consent since patients might be compelled to participate in order to please their caregivers.  The researcher is not the direct patient caregiver thus it is less likely that patients would be compelled to participate in the study when they are not initially willing to do so.  Patients are asked to sign an authorization to use protected health information before the conduct of the study, as medical records will be utilized.  Initial data are collected through open-ended questions asking about the participants history on family and relationship to parents, marital or single status, educational attainment, occupation, experiences and understanding on current medical condition. 

D.  Operationalization of Concepts and Measurement

Variables
The current study investigates the hypothesized relationship between gender specific role stressors and the development of mental disorders.  The two concepts of gender specific role stressors, as the independent variable, and the development of mental disorders, as dependent variable, are involved in the study.  The main concept that needs to be operationalized and measured is mental disorders. 
Gender specific role stressors will be measured through retrospective means via structured questionnaire and interviews.  A correlation of other variables such as gender, age, emotional health, marital status, educational attainment, occupation history, type of personality (Type A or Type B) will be taken into consideration upon administering the structured questionnaire and interviews towards determining the hypothesis.

Mental disorders can be measured through past and current information of the patient including family history and relationship, DSM-IV results, and medical history relating to length and frequency of psychiatric admission and current and past medications given. 


Level of Measurement
The independent variable of gender specific role stressors such as gender, age, emotional health, marital status, educational attainment, occupation history, type of personality is measured at a nominal level and ordinal level or referred to as categorical variables.  The attribute of the categorical variables will have a central tendency measured as mode and chi square.  The same level of measurement will be applied to the dependent variable.

Instrumentation
The structured questionnaire will ask participants both basic information and other pertinent information including but not limited to age, gender, family background, family relationships, occupation, marital status, Several psychiatric tests will be employed to determine gender specific role stressors and its relationship to mental disorders.  DSM-IV-TR will also be utilized to know the history of the client but not necessarily to know the underlying cause of the mental disorder.  Personality tests in mental health will be determined with the use of the Minnesota Multiphasic Personality Inventory (MMPI) 2.  Trained professionals to assist in identifying personality structure and psychopathology use the MMPI 2 test.  It is appropriate for use with adults 18 and over.  The current MMPI-2 has 567 items, all true or false formats, and typically lasts between 1 and 2 hours to complete depending on reading level.  The raw scores on the different scales of the MMPI-2 are transformed into a standardized metric known as T-scores that renders an easier interpretation.  Clinical scales will measure different descriptions of personalities, shown below

NumberAbbreviationDescriptionWhat is measuredNo. of items1HsHypochondriasisConcern with bodily symptoms322DDepressionDepressive Symptoms573HyHysteriaAwareness of problems and vulnerabilities604PdPsychopathic DeviateConflict, struggle, anger, respect for societys rules505MFMasculinityFeminityStereotypical masculine or feminine interestsbehaviors566PaParanoiaLevel of trust, suspiciousness, sensitivity407PtPsychastheniaWorry, Anxiety, tension, doubts, obsessiveness488ScSchizphreniaOdd thinking and social alienation789MaHypomaniaLevel of Excitability460SiSocial IntroversionPeople orientation69ValidityReliability

The validity of the study signifies the strength of the inferences and hypothesis made.  The conclusion validity of the study inquires if there is a relationship between gender role stressors and development of mental disorders.  The external validity is the study can be strengthen when future researchers attempt to investigate the effect of other variables such as occupational history, marital status, emotional health and their respective effects to the development of particular mental disorders.  A mortality threat exists when subjects decided to drop out of the study due to confidentiality concerns. 

Reliability measures the consistency of the measurement of the instrument used when used under the same conditions with the same subjects.  The current study does not involve test and retest given that the nature of data collection is of retrospective in nature.  It means that the researcher will link the current mental disorder of participants with their history on various variables. 

Preliminary Data Analysis Plan
The descriptive and retrospective study utilizes history of the participants including their age, gender, occupation history, marital status, family history, family relationships, and emotional health.  The dependent variable of mental disorders will be correlated to the independent variables mentioned above.  The quantitative data collected will be measured as categorized variables as nominal and ordinal forms of data.  The researchers will link the independent variables on whether they contributed to the development of the mental disorders of both men ad women participants.


Human Subjects Protocol
The current study anticipates a sample size of 150 subjects, divided into two groups of male and female, or 75 men and 75 women.  Participants of the study are further divided into unemployed and employed group given that stressors can vary based on employment and unemployment.  The age range of the sample population is 30-65 years of age.  There is no specific race chosen for the study provided that the participants have a history or current medical condition of mental disorder.  Participants should be alert and not under any sedative effect of medications that might render him or her unable to communicate her answers.  Furthermore, participants are expected to converse in English and have completed the rehabilitation program of a particular psychiatric facility.
The mental disorders included in the scope of the study are mood and anxiety disorders (depression, phobias, obsessive-compulsive disorders, bipolar-affective disorder, PTSD, panic disorders), personality disorder (paranoid personality, schizoid personality, antisocial personality, borderline personality, histrionic personality, narcissistic personality, avoidant personality, dependent personality) and psychotic disorders (schizophrenia, schizophreniform, schizoaffective disorder, substance-abuse psychotic disorder).  The study mainly investigates the relationship of gender specific stressors to mental disorders thus the criteria for inclusion of participants should be clients who have history of mental disorders based on admission records of psychiatric facilities.

The research data will be derived from participants from second hand data from records as well first-hand data from structure questionnaire and interviews.  The variables such as occupation, emotional health, marital status, gender, age, and family relationships and structure will be based on second data from records of the participants and their DSM-IV TR results from Axis I t o Axis IV including their Global Assessment Functioning (GAF) deemed vital to rate the social, occupational and psychological functioning of adults. 

Several local psychiatric facilities will be contacted and proposed to participate on the study.  The nature and background of the study will be discussed to these facilities as well as an affirmation of the confidentiality of the data and names of participants will be stated under false names or aliases to protect their identity.  A written consent will be secured from participants following full disclosure of all details of the current study. 

Several steps will be undertaken to further protect the identity and sensitive information of the participants information.  No real first or last names, addresses and name of psychiatric facilities will be mentioned in the complete 

A consent form will be handed out to participants to ensure their willingness to be involved in the study.  In addition to, the consent form signifies their full understanding on the background of the study as well as their role as subjects.

Information and Consent for Participants (sample)
The purpose of this form is to provide information regarding the purpose of the study on the hypothesized relationship of gender specific role stressors and the development of mental disorders.  Please read the information carefully, discuss your concerns with the researcher or clinical psychiatric staff.  Indicate your choice, and sign this form in the area indicated below.

I have read and have had read to me the above information and I understand it.  I have discussed the potential risks and confidentiality issues with the researcher team or clinical psychiatric staff.  I have received all the information I need to know.

____ I want to be a participant ____ I dont want to be a participant

______________________ _______________________
Patients signature Print Patients name

________________ ____________________
Date Witnessed by

Administration and Timetable
The administration of the structured questionnaires and interviews will be conducted when participants are able to communicate and think well without any sedative or cognitive affecting side effects of medication.

There are three phases of the administration of the current study pre-working phase, working phase, and termination phase.  The pre-working phase involves orientation of the study and allows the staff nurse to narrow down the potential participants.  The working phase involves building trust and rapport with participants.  The researcher entails consistency and clarity on the details of the study.  The researcher will se a contract on the duration of the study as well as the necessary steps involved such as the background of the tests and enabling participants to have a sense of trust in relation to privacy and confidentiality of data.  When participants commit on the study, the administration of the structured questionnaires and face-to-face interviews will be conducted.   It allows the researcher to further confirm whether participants decided to be subjects of the study.  The termination phase involves the researcher and participant to terminate their working relationship as researcher-subject.

Limitations of the Study
Recruitment issues
During the course of the study, some issues were known in patient recruitment that may have resulted in selection bias.  The participants selected were based on an outpatient arrangement and not those patients who are currently experiencing cognitive dysfunctions.  Future studies can explore selection of participants such as those who finished the psychiatric rehabilitation program and are employed versus participants who were admitted in psychiatric rehabilitation program but unemployed.  Thus, future researchers can determine whether the aspect of employment and the nature of the job contribute to a depressive state of emotional health.

Variables concerned
Future researchers should consider breaking down the variables stated to be under investigation in the current study.  Studies on the effect of occupational history towards the development of mental disorders should be looked into.  The link between marital status as a stressors to the development of mental disorders should also be investigated.

Precise and accurate history of participants
Another limitation of the study is the question whether the history and records of the participants documented are accurate and truthful.  Patients who have cognitive disorders such as delusions, hallucinations, and illusions among others may have contributed to inaccurate statement of facts.  Even if the researcher was able to gather all pertinent data and was secured from official medical records, some important facts relating to the current mental disorder of the patient may be lacking or were presented in different implications.  Thus, researchers should gather data from the family, community of the participants.