Director: dr. Elvira Reale




Report to the European Commission

on Women’s Mental Health

Luxembourg, 5.7.1994




" Update on health care in Italy, specially concerning women’s status, and actions perspective "




In Italy, as much as in other european countries, women are the largest portion of health care services users.

Women, indeed, are, in most cases, the ones asking for assistance whether the request concerns themselves or their family members. It’s their chore, by social expectations, to take concern of the family’s health care needs.

Focusing on disease and mental health, women think of themselves to be more espoused than men to mental disorders, e they undergo treatments and pharmacological therapies  more frequently.

In Italy, like in other European countries, women request, more than men,  the general practitioner help, for theirs or their relatives health problems; following the general practitioner suggestions, then, they  accept to contact a specialist, in particular a mental health specialist, and they ask, more than men, hospital treatments for mental, and  specially depressive, disorders.

Based on several epidemiological studies, carried on both men and women users of mental health care services, in different geographical areas,  as reported in our “1° International Seminar upon Mental Disorders in Women”, CNR, Roma 1998, we can assume that there is a prevalence in women, compared to men, in approaching general practitioners or specialists for psychiatric or psychological help.  

We, also, find that women, more than men, are prevalent in 9 kinds of disorders typology, with a rate of 5 to 1.

The prevalence of women is evident in disorders like: psychosomatic, affective and relational,  depressive, but, also, and this is a new data, in the major psychiatric diseases.

The presence of this particular risk factor, in women, very clear in the italian researches, seems to be relievable, at the same extends, in other international studies.

Just as it appeared in that International Seminar, which updated conditions of women’s mental health care in Europe and, in certain studies, in U.S.A., Canada and some Latino American countries, there is the necessity to compare the most advanced experiences in female psychological disorders care systems, but, most of all, to lead our researches towards a shared network system of studies upon actions and events, that we consider important to individuate the causes of female disorders.

These are the conclusions of international studies and data.

1.        women are the most users of general and mental health or psychiatric health care services; those, on the other hand, do not respond to women’s needs and do not take in consideration women’s daily life;

2.       women, all over the world, live in worse economical, material and psychological conditions; they die later than men, but, voiceovers, they experience worse health conditions, either on an objective (they get ill more and longer) or subjective (they precept sufferance more, they complain about it and declare it more) perception;

3.       Women suffer in most cases with depression, which is the new rising pathology in our industrial society;

4.       Because of their central role in the family contest, women in their problems the other members, and,  particularly in their psychological problems, they involve their children too.

5.       Women working take seek leave frequently for psychological problems. This causes damage to their career besides influencing the costs of work productivity.


These assignments configure a situation of more sufferance for women and a lack of correspondent adequate actions aiming to the organization of health care and prevention specific services.

In Italy, in particular, the organization of public services for mental health care is still in process since the law which reformed the psychiatric assistance has not yet been applied to the whole national territory.

We, besides, find a shortage in updated data, given by Ministry of Health, about psychiatric assistance and psychic pathologies development conditions.


At an international level is clear that the main attention in researches is focused on the care of disorders as much as pharmacological and diagnostic survey. This way leads up to an interpretation of psychological disorders according to a typical medical point of view by which, diseases are classified merely by their symptom  description and their cure is mainly pharmacological.

The diagnostic/pharmacological research is the one  which has been developed the most, at an international level, also because related to the big business of the pharmacological industry.

Those, in particular, are the ones which have sponsored most of the researches upon certain problems such as depression.

Also clinical and epidemiological researches upon genesis and causes of psychic pathologies, (specially depression and psychosis) have focused on biological factors.

Because of the prevalence of the medical and treatment approach, and the amount of funds devolved to this section, other kind of researches, like the ones focusing on prevention, have been left a part or assigned to single people or small group researchers, with shortage of budgets.

Prevention should be, instead, the main objective of institutions promoting health through actions aiming to reduce causes of illness; therefore, it should take vantage of public funds for researches since the final result, improving quality of life, is not a single person but the whole community vantage.

Researches for prevention need a large study contest because they concern the whole population, the ill and the healthy part, and various factors related among themselves.

We can achieve such a purpose only if we built a kind of research that relate researchers together  in comparing: hypotheses, methods and samples; and tends to a network kind of study, able to individuate those factors which mostly lead to genesis of psychiatric illness, through the largest work experiences of researchers themselves. 

The lack of exchanges among researchers, till now, has produced repetitive researches, n one side, and contradicting results, on the other.

In researches upon mental health, for instance, there have been disagreements on the following topics:

a.       age and sex classes mostly espoused to pathology risks;

b.       life conditions particularly risky : some considered marriage as a protective factor, others as a risk factor. The same has happened regarding the presence of children and/or a job;


The imprecision on these and other topics, shows the lack of large and deep studies upon relationships between daily life and psychic disorders.


A differently orientated research plan will have to take in consideration this relationship and find out specific risk factors besides people classes more espoused to psychological disease risks.

According to our experience,  as confirmed by results of our survey for the C.N.R. “Stress conditions in daily life and  pathological answers”, the risk factors to be checked the most are the following: over or under load of work and responsibilities in familiar and extrafamiliar contests; absence of social relationships and supports;   lack or failure of individual projects related to a personal perception of being without resources or alternatives; physical conditions of tiredness not related to  effective condition of stress.

Besides, categories more espoused to psychological disorders, are, in most cases: women, adolescents, and all those categories of people experiencing violence and conditions of outsiders.

The guidelines we believe should be given today for an appropriate prevention planning are:

1.        a national and international institutional effort to acknowledge the growing relevance of mental health, in particular the women’s one;

2.       a kind of researching which aims to put in evidence connections between personal psychological experiences and environmental contest, while studying risk factors;

3.       research planning for prevention which considers as social groups, espoused to risk, women, adolescents of both sexes and all those categories of people with special life conditions (such as experiences of violence) or living in specially “destructurated” environments.

4.       Training courses to those working with people suffering with mental disorders;

5.       Sanitary educational programs for “under-risk population” those who take care of adolescents (parents and teachers);

6.       Differentiated planning in psychiatric assistance : one aiming to prevention and the other to treatments, along with developing different actions and services.