Gender Wage Gap and Depression/Anxiety

Philip Hickey, PhD
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In their January 2016 issue, the journal Social Science and Medicine published Unequal depression for equal work? How the wage gap explains gendered disparities in mood disorders, by Jonathan Platt, MPH, Seth Prins, PhD candidate, Lisa Bates, PhD, and Katherine Keyes, PhD, MPH.  All the authors work at Columbia’s Department of Public Health.

Here’s the abstract:

“Mood disorders, such as depression and anxiety, are more prevalent among women than men. This disparity may be partially due to the effects of structural gender discrimination in the work force, which acts to perpetuate gender differences in opportunities and resources and may manifest as the gender wage gap. We sought to quantify and operationalize the wage gap in order to explain the gender disparity in depression and anxiety disorders, using data from a 2001-2002 US nationally representative survey of 22,581 working adults ages 30-65. Using established Oaxaca-Blinder decomposition methods to account for gender differences in individual-level productivity, our models reduced the wage gap in our sample by 13.5%, from 54% of men’s pay to 67.5% of men’s pay. We created a propensity-score matched sample of productivity indicators to test if the direction of the wage gap moderated the effects of gender on depression or anxiety. Where female income was less than the matched male counterpart, odds of both disorders were significantly higher among women versus men (major depressive disorder OR: 2.43, 95% CI: 1.95-3.04; generalized anxiety disorder OR: 4.11, 95% CI: 2.80-6.02). Where female income was greater than the matched male, the higher odds ratios for women for both disorders were significantly attenuated (Major Depressive Disorder OR: 1.20; 95% CI: 0.96-1.52) (Generalized Anxiety Disorder OR: 1.5; 95% CI: 1.04-2.29). The test for effect modification by sex and wage gap direction was statistically significant for both disorders. Structural forms of discrimination may explain mental health disparities at the population level. Beyond prohibiting overt gender discrimination, policies must be created to address embedded inequalities in procedures surrounding labor markets and compensation in the workplace.”

In other words, when women were receiving less pay than men for the same work, they were about two and a half times more likely to “have major depressive disorder,” and about four times more likely to “have generalized anxiety disorder” than their male counterparts.  But when women were earning more than men, the odds were 1.2 and 1.5 respectively.

The use of psychiatric terminology (“major depressive disorder” and “generalized anxiety disorder”) constitutes something of a barrier to communication here, but the general message is clear: people (in this case women) who are routinely treated unfairly and discriminately are more likely to be depressed and anxious, than those not so treated.

This is hardly surprising. Depression and anxiety are not illnesses. They are adaptive mechanisms – messages from our bodies alerting us to the need to make changes.  So, for instance, a person living in a high crime neighborhood might experience depression and anxiety. These feelings are not symptoms of an illness. Rather, they are the normal and appropriate emotional concomitants to the knowledge that one’s living arrangements are not safe, wholesome, or comforting.

The feelings of depression and anxiety are, in effect, a “nudge” from the body to move to safer surroundings, analogous to the urges that animals feel to move to higher ground in time of flooding, or to move to warmer latitudes as winter approaches.

But in a great many cases, the individual is unable to move, either because of family ties, lack of means, or other reasons.  So the urge to move lies unrequited, where it grows stronger, and saps the person’s energy and will.  The feelings of hopelessness, anhedonia, worthlessness, and guilt, codified in the DSM as “symptoms” of the “illness, major depressive disorder” are in fact the eminently appropriate response to being trapped in an untenable but inescapable situation.

And in this regard, gender wage discrimination is an extremely fast-holding trap.  Even if the victim can manage to find another job, there is every likelihood that the wage discrimination will be as strong as it was in her previous position.

Platt et al found that women in a large US nationally representative sample were earning only 54% of men’s pay.  This figure, when adjusted for productivity, was increased to 67.5%.  But even by the latter reckoning, this is an enormous difference.  For every man earning $30,000 per year, his matched female counterpart was earning about $20,000.  Over a forty-year working career, this amounts to a $400,000 disparity.

Quoting again from Platt et al:

“In sum, there are robust and long-standing gender disparities in depression and anxiety disorders, in addition to persistent gender disparities in wages. Although the latter are somewhat reflective of differential individual-level attainment of characteristics conducive to productivity, a large proportion of this gap remains after accounting for these factors and is likely the result of discriminatory processes operating at structural, institutional, and individual levels. This ‘unexplained’ portion appears to be increasing.”

So what we’re seeing here is one more piece of evidence that depression is not an illness to which women just happen to be “prone.”  Rather, it is an entirely appropriate and realistic response to an intolerable situation.  And when the situation can’t be escaped, the depression becomes, understandably, an abiding and persistent sense of joylessness and unfulfillment.  And when this kind of discrimination is combined with the fact that many employed women come home to another five or six hours of housework and childcare, the joyless treadmill factor increases enormously.

Psychiatry then enters the picture, proclaiming with its customary unsupported assurance, that episodes of depression and anxiety that cross arbitrary and vaguely-defined thresholds of severity, frequency, and duration, regardless of their source, are illnesses – just like diabetes.  These illnesses are caused by deficits of neurochemicals for which, by great good fortune, psychiatry has “very effective” remedies in the form of pills and high voltage electric shocks to the brain.

Psychiatry also has an “explanation” for the gender gap disparity in depression.  On the NIMH website you will find a page called Depression in Women.  There’s a section headed “What causes depression in women?”  Here’s the section quoted in full:

“Several factors may contribute to depression in women.

Genes—women with a family history of depression may be more likely to develop it than those whose families do not have the illness.

Brain chemistry and hormones—people with depression have different brain chemistry than those of people without the illness. Also, the hormones that control emotions and mood can affect brain chemistry.

During certain times of a woman’s life, her hormones may be changing, which may affect her brain chemistry. For example, after having a baby (postpartum period), hormones and physical changes may be overwhelming. Some women experience postpartum depression, a serious form of depression that needs treatment. Other times of hormonal change, such as transition into menopause, may increase a woman’s risk for depression.

Stress—loss of a loved one, a difficult relationship, or any stressful situation may trigger depression in some women.”

So there it is:  genes, brain chemicals, hormones, and stress.  Stress, of course, is a valid consideration here, but note how the NIMH has worded it:  “Stress…may trigger depression…”  Trigger is a firearms analogy and denotes a relatively minor event that initiates a major event in a system that is already prepared and primed.  So, the loss of a loved one – to use the NIMH’s own example – doesn’t cause feelings of despondency and depression; rather, it triggers these feelings in “some women,” presumably those already primed with “different brain chemistry” and depression-prone genes.

The Platt et al study is thorough and meticulous and was picked up by several mainstream media, including the Wall Street Journal, the New York Times, and the Guardian.  But I have not been able to find a single mention of it on any psychiatry-promoting site.  This is the same psychiatry that consistently asserts its commitment to a biopsychosocial perspective.

24 COMMENTS

  1. Philip,

    You clearly sum up an example of what should be obvious to all of us and is now backed by numerous medical studies. Our environment affects our biology. Stressful and traumatizing experiences cause harm and contribute to mental suffering and distress. This is not about “blaming” parents, but realizing that human beings are both nurtured and/or damaged by their environment and relationships. Racism, poverty, sexism and personal experiences of abuse all leave their mark on our psyche.

    You rightly point out that the word ‘trigger’ is misleading. Environmental harm can ’cause’ the problem. In addition to behavioral experiences, I would include environmental toxins such as the iatrogenic harm caused by prescribed meds to adults, children and developing babies in pregnancy (related to skyrocketing rates of autism).

    Thank you for your work.

  2. Phil,

    This is a good study; but bizarre in the use of medical terminology to describe what are natural human responses to stress and adversity.

    As for psychiatric journals and websites not highlighting this study… it’s just more of the same from the pseudoscientist antidoctors that run these sites. The underlying unconscious narrative must go something like,

    “We are making an average of $180,000 a year by telling people that their behavioral and thinking problems are medical illnesses for which they have to take pills. We can make this kind of money by seeing them for 15 minutes at a time, prescribing a pill, and rarely having to wrestle with the real life stresses that are the primary cause of their problems. Also, we get looked up to as prestigious doctors despite having no scientific basis for our categories and treatments. What a deal! Why would we want to go back to being therapists making $40,000 a year and having to absorb all the difficult emotions of our clients in long 45 minute sessions? Why would we want to acknowledge information that might interfere with such a profitable scam? Let’s delude ourselves that we are really doing good and our research is real science!”

    These processes are mostly unconscious, but this economic analysis is a large part of the reason why psychiatrists use denial and avoidance almost habitually when faced with the overwhelming evidence that groups of behaviors labeled as DSM disorders are not valid and do not represent brain diseases.

    Furthermore, corporations are applying massive pressure to psychiatrists to maintain these lies. The recent responses by Carlat and Pies to Leo/Lacasse were a good example of this symbiotic relationship. The message from the corporations is something like:

    “Our goal is profit (we made $18 billion last year from antipsychotics alone!). We need you as the thought leaders to tell the public that problems of behavior are medical diseases, and to trick people into believing that a pill that damps down distress 10% better than placebo over a few week period with horrible side effects is worth buying. So we are going to massively fund your university programs, hospitals, and research. You’ll never overtly acknowledge it, but by your actions and words you are going to promote our products and the disease model of human distress. No, it doesn’t benefit the patients much at all, but that’s not what we’re interested in. Our executives and shareholders want profit and power, and you, our minion psychiatrists, will provide this by raking in the cash through prescriptions, while profiting handsomely yourselves.”

    This is what is happening today in American psychiatry. The American public are mostly ignorant cattle 20% of whom let themselves be drugged for life problems that usually neither require nor significantly benefit in any way from drugs. It’s pathetic and more people need to start educating themselves so they can exit the zombification cycle.

    I am continually stunned by how much of the public falls hook, line, and sinker for the medical model of behavioral distress. Yesterday I was on a date with a young woman when I unwisely ventured into discussing her psychology studies at university. It turned out that she believes that bipolar and schizophrenia are illnesses requiring drugs (how did I get to this topic on a first date, don’t ask…). I felt horrified and wanted to respond with all the data that I know. Readers of my earlier comments can imagine how I could have responded to that. However, because we were having a good conversation up to that point, I just steered the conversation away into more benign areas without refuting what she said. Maybe later if we meet again I will bring it up. It was just another example of how very nice, well-meaning people, like this smart young university student, can be completely deceived by the medical model.

  3. Economic suppression is related to emotional depression, surely. Chronic social injustice leads to maladjustment and extreme mood swings, no doubt. Sociologists have the concept of anomie to explain the rise in suicide rates during economic downturns. This while some segments of the population are denied the possibility of an economic upturn. Pathologization represents a way to hide from people the political nature of their situations. If you’ve got every reason to support a change in the existing order, working for the status quo is bound to create inner turmoil and conflict. Typically, psychiatry is about trying to impose the values of the ruling order on people who are not served, or who are served inadequately, by those values. Sacrificial lambs, of course, serve the bosses, the politicians, the rich, and the entire basically patriarchal existing social structure. What it doesn’t serve is the interests of all the lambs sacrificed on the altar of gluttony, stability, and custom, or, in a word, business as usual.

  4. “So what we’re seeing here is one more piece of evidence that depression is not an illness to which women just happen to be ‘prone.’ Rather, it is an entirely appropriate and realistic response to an intolerable situation.”

    I was shocked, when I picked up my medical records, to find the psychiatrist who misdiagnosed adverse drug reactions, then massively drugged me, to cover up child abuse for his therapist friend and her pastor. Did so based upon his belief that a woman contemplating going back to school for her masters degree, had “delusions of grandeur” for such contemplations. I’m not quite certain what century that psychiatrist thinks it is, but definitely such a psychiatric belief system is discrimination against women.

    Definitely, our current disrespectful, to the point of misogynistic, paternalism run amok society, needs to change it’s ways. And I find it amazing that the doctors think all problems in the world are caused by “chemical imbalances” in individual’s brains. I used to believe doctors were intelligent.

    I do so hope we may help bring about a more just society, by pointing out society’s flaws, and the stupidity of the “chemical imbalance” theory of “mental illnesses.” And the fact that injustice is a societal problem that has run amok, due to the greed of today’s “too big to fail” banks, and the corporations and industries that have grown up around them.

    Thanks, as always, for pointing out the reality, Philip.

      • Thank you for your compliment, Philip. And, I will just mention the psychiatrist who initially misdiagnosed me, in part, based upon his belief a woman wanting to return to school for her masters degree, had “delusion of grandeur.” Did finally, after numerous attempts at my life with drug cocktails known to create anticholinergic toxidrome, take the time to look at my work, and listen, just a tiny bit, to what I was actually saying.

        And he finally weaned me off the toxic drug cocktails because he realized my, what he initially assumed to be, “w/o work, content, and talent” work, was actually “work of smart female.” And he, too, finally concluded I was “insightful,” according to his medical records.

        Perhaps it’d be wise if the psychiatrists stop judging people based upon lies and gossip from child molesters and their friends. And started actually holding off judgement of a person, until after they get to actually know the person? And since this psychiatrist was a forth opinion, he was paid outside my insurance, so he did NOT have the excuse he had to come up with a DSM diagnosis for payment.

  5. Philip

    Another great blog.

    Of course here you are only referencing a study focusing on economic inequality along with your added point about additional unpaid labor performed in the home.

    None of this addresses all the other aspects of gender inequality and forms of sexism in our society that represent additional stressors to the female sex, This easily accounts for the still higher adjusted figures you listed when only examining economic factors.

    Biological Psychiatry clearly serves a social and political role to obscure the class and gender disparities in society and shift the focus to “genetic theories of original sin” as an explanation for human frailties and shortcomings.

    Their disease/drug model also serves to anesthetize potential activists and rebels with mind numbing substances. All of this only reinforces the power and control of the status quo and the ruling classes who hold the reins and reap the benefits of this class and profit based system. What a racket!

    Richard.

  6. “So what we’re seeing here is one more piece of evidence that depression is not an illness to which women just happen to be “prone.” Rather, it is an entirely appropriate and realistic response to an intolerable situation. And when the situation can’t be escaped, the depression becomes, understandably, an abiding and persistent sense of joylessness and unfulfillment.”

    I agree that depression is a reasonable response to discrimination and stigma leading to feeling less valued in society than others. After all, getting angry about it and fighting for equality tends to lead to more discrimination and even marginalization, it can get a person labeled and ostracized. So on top of being marginalized, one is shamed for being powerful in the face of it. Indeed, that would be intolerable, completely and toxically double-binding.

    Not being able to change it would cause feelings of powerless, I would imagine. Not having the power to change a bad situation can lead to despondence and very low self-esteem.

    I believe it would be beneficial to focus on how best and most effectively to change an intolerable situation. I believe there is always a way, but it can be a bit tricky in complex situation and delicate balance, one step at a time. Still, it is empowering and freeing to find the way out of toxic situations and environments, and in the long run, healing to society.

    • Alex,

      Thanks for coming in.

      I think these various battles are being identified and fought. And progress is being made.

      But for truly millions of people there is no end in sight for the misery, exploitation, and discrimination. Psychiatry’s practice of pushing pills on these people adds insult to injury.

      • I agree about the pills being insult to injury–and injury to injury–been there. I’m doing everything in my power to educate others about how to get out of that toxic medical and social quagmire; but it does take a huge shift in perspective and new habits of thought and beliefs, which not all are willing to take on, so it does become double-binding for them.

        I hope with all my heart that people wake up to their personal power. That’s up to each individual, and it can happen regardless of their situation, as it is a very personal internal shift.

  7. Hey.
    I think its true that situation that you are currently in is affecting your mood, not chemical imbalances that psychiatrists suggests.

    What I find misleading in this article are numbers. I dont know, maybe I have wrong ones. But I was thinking that wage gap was largely a myth. So this article was challanging for me to read. So I looked up the numbers and I still think I was right and article is misleading in presenting the numbers.

    So I felt it would be useful to present other nubers and facts.
    First, the number 54% of mens earnings for women I find only in one study, that was done on Hispanic and Latina females. This does not discount it, but it does not shows big picture.
    The number that I often found is 78 % of mens earnings for women. But here is the problem. It takes all full time earnings of men, and all full time earnings for women, and derives its number from that gap. It does not account for education, job choices, hours working, fields, differences in salary negotiations, work experience, and breaks in employment. These factors resolve 60% to 75% of the pay gap, depending on the source.
    The numbers are also different for older women, and women entering the market in recent years. You can argue that older women tend to focus more on family and children, as these days women focus more on education and job performance. So gap for second group is a lot smaller that for first.
    Also, you can argue that the number 54 % for Latino and Hispanic women(I dont know if you derives it from the same source), can be due to less education amongs these groups, that usually came to USA as immigrant population, from countries that are less familiar with free market ideas, education, more prone to dependency on government. But I am not sure.

    Other studies(OECD, AAUW, US Department of Labor) shows that gap is about 5-6.6 %. So your article Philip can account only for that number, which still need to be addressed, but it is not 32,5 % as you wrote.

    It still resonates with me that you environment is crucial, and thanks for that.
    Cheers.

    • Michal,

      Thanks for coming in. You are correct in pointing out that estimates of the gender wage gap vary. The authors of the study cite the US Department of Labor 2013 figure of 82 cents on the dollar (BLS 2014: http://www.bls.gov/opub/reports/cps/womenlaborforce_2013.pdf ) I wrote to Jonathan Platt, the correspondence author, concerning this discrepancy, and he replied that the figure they quoted was what they found in their sample, which was not precisely representative. But the main point was that within their sample (22,581), depression and wage gap for matched individuals were significantly correlated. Also, they adjusted their figures to reflect a wide range of likely confounders:

      “These included age, age entered the workforce, 7 categories of educational attainment, whether the respondent was US-born, 14 occupation categories (e.g., executive, administrative, and managerial), 14 industry categories (e.g., manufacturing), 8 employer types (e.g., private forprofit company, business, or individual), a binary indicator of fulltime and part-time employment, marital status, and number of children in the home.”

      And even with all these adjustments, the link to depression was still very strong. I’m sure there will be ongoing debate on these numbers, and I’m grateful to you for addressing the issue.

      Best wishes.

      • Thanks for answer! It suprised me, but that may be due to my own history of disrespect that I was predicting some outburst. Respect for that!

        Yes. The studies results vary. But I think the newer study you pick, the gap is smaller and smaller. Some of the newest studies show that the gap may be almost all disapear. But I need to take a better look at the studies you cited.

        You can also argue that quality of parenthood in childhood have much to do with your future effectiveness, your negotiation sklls, standing up for yourself, and being productive.

        The thing is, I dont buy the term structural gender discrimination, and I dont buy the proposal of some kind of policies from government. If you raise minimum wage, businesses hire people on part time jobs, or need to fire someone else. That never worked. Any intervention or subsidy tilt the scale in the other directon and is ineffective in the long run. Studies show that most of the gap is due to women individual choices, and remaining 5-7 precent is unknown.

        Women need to emancipate themselfes. If you think job you are doing is worth more, you should ask for raise. If you dont get it, you should start your own business and hire women on better salary and outcompete business that you left.