Psychiatric emergencies confirm bias
2022/04/07 Galarraga Aiestaran, Ana - Elhuyar Zientzia Iturria: Elhuyar aldizkaria
An Emakunde report shows that women received more inadequate care than men in the mental health emergencies of the Cruces Hospital (Barakaldo, Bizkaia) during the years 2017-2019. The study involved the psychiatrist of Cruces, Marga Saenz Herrero, and the researchers of Neuropsychiatry of Biocruces, María Recio Barbero, as well as the emergency physician, Ana Medicalcuato Bilbao, the research team of the OPIK, Amaia Bacigalupe De La Hera, and the psychiatrist, Rafael Etgarria.
The main objective of the research was to verify whether there were differences in the assessment of psychiatric emergencies because they were female or male, in the complementary tests used and in the established treatment.
For a better interpretation of the results, patients were divided into four groups according to the reason why they went to the emergency room: usual alterations; severe alterations (schizophrenia, delusions…); mental problems derived from substance use; and personality and behavior disorders.
In total, 9,789 cases older than 15 years were treated in this three-year period. These cases corresponded to 6,879 people, some of whom sought emergency care more than once. Of the total number of people, 53.9% were women. The average age of women increased by two years (47 and a half). Taking into account the location of Cruces, the researchers hoped that most of the people who came to the emergency room would come from low socioeconomic areas, and so on. In this sense, there were no differences between women and men.
In total, the most common disorder was anxiety (almost half), followed by schizophrenia and substance use (14.8% and 13.8%, respectively). But if we look at sex separately, some types of disorders are much more common in women. For example, neurotic and personality disorders account for more than 65% of women and 82.5% of women related to feeding and other physiological dysfunctions. Those related to toxic consumption are, however, much more frequent in men: 70% are men.
Researchers emphasize that most cases of women were concentrated in the age range between 45 and 55 years. In this interval, for the first time, some problems appear, such as psychosis or disorders of depression. They stress that these psychiatric pathologies are closely related to a wide variety of risk factors in interaction, both at biological level (genetic and epigenetic, neurostructural, hormonal) and at social and such level (poverty, violence, poor social and emotional support network…).
Complementary tests and drugs
On the other hand, in complementary tests of two types (imaginary and analytical), differences were observed between men and women. In general, men are more probative. It is possible that severe alterations are associated with aggressive behaviors and present a higher risk of trauma, so it is intended to observe blows or fractures in men. Alterations related to toxic consumption are also more frequent in men and laboratory tests would be useful to detect possible organ damage. However, in other alterations there are no differences in risk, although there are differences in the tests performed.
Among the medications, anxiolytics and antidepressants stand out. The two are mainly directed at women, and the issue of antidepressants is particularly striking, since in principle its application is not appropriate in emergency situations, but in situations of longer duration. They also warn that depression in men may be under-diagnosed.
Finally, they highlight the growing presence of women among professionals, who consider it essential to incorporate the gender perspective in the work, in order to reduce bias and improve care. It was also mentioned that it would be convenient to perform this work at the Cruces Hospital in other places in order to compare the results and complete the vision with a psychosocial model.
To further elaborate on the theme: