Autoimmune diseases

Autoimmune diseases arise when, for unknown reasons, a person's body declares war on itself, producing antibodies that attack healthy tissue. About 75 percent of autoimmune diseases occur in women, including systemic lupus erythematosus (SLE), rheumatoid arthritis, scleroderma, diabetes Type I, multiple sclerosis, and autoimmune thyroid disease [22],. Individually, autoimmune diseases are not very common; however, taken together, they represent the fourth largest cause of disability among women in the United States. These diseases remain misunderstood and misdiagnosed.

Mental illness

One in ten Americans experiences an episode of depression each year [23]. Major depression and dysthymia (a less severe, more chronic form of depression) affect approximately twice as many women as men [24]. An estimated 12 percent of women in the United States experience a major depression during their lifetimes, compared with 7 percent of men; and 4.2 percent of women have dysthymia [24]. Women are 2 to 3 times more likely to have certain types of anxiety disorders, including anxiety, panic, and phobic disorders [24]. At least 90 percent of all cases of eating disorders occur in women and a high correlation appears to exist between eating disorders and depression, and eating disorders and substance abuse [25].

Untreated mental illness can be fatal. Suicide was the fifth leading cause of death among women ages 25 to 44 in 1994, and the fourth leading cause for those ages 15 to 24 [26]. Women are more likely than men to attempt suicide, but are far less likely to die as a result, largely because men are more likely to use a firearm.

Substance abuse

The abuse of alcohol and other legal and illicit drugs is a serious and continuing problem among American women. Approximately 120,000 deaths annually are attributed to alcohol and drug use [27]. In 1998, the health and societal costs of alcohol and substance abuse were estimated at $238 billion [27].

Nearly 4.1 million women in this country currently use illicit drugs, and over 1.2 million misuse prescription drugs for non-medical reasons [28]. In 1997 and 1998, 4.5 million women ages 15 to 44 were current illicit drug users, including 1.6 million who had children living with them [28]. Only 3.2 percent of pregnant women were current drug users, but the rate increased to 6.2 percent among women who had a child under age 2 and were not pregnant [28]. Altogether, women account for an estimated 37 percent of illicit drug users in this country.

Women are less likely than men to use or abuse of alcohol, however death rates among female alcoholics are 50 to 100 percent higher than those of their male counterparts [29]. In 1998, 2.1 percent of American women were heavy drinkers, 8.6 percent were binge drinkers (more than 5 drinks at one time), and 45.1 percent of women had at least 1 alcoholic drink in the past month1. Among teenage girls in 1997, 40 percent reported some alcohol consumption in the past month and 29 percent reported binge drinking [1].

Heavy drinking during pregnancy has been clearly associated with severe birth defects, including mental retardation, nervous system disorders, abnormal features of the face and head, and retarded growth [30]. The effects of moderate drinking (1-2 drinks per day) are not well established, so the only known safe level of drinking in pregnancy is total abstinence. In 1996, 16.1 percent of pregnant women reported any alcohol use; 1.3 percent reported binge drinking; and 0.5 percent reported heavy drinking (5 or more drinks per day) in the past month [28].

Many women who abuse drugs or alcohol have histories of mental illness. Seventy percent report having been sexually abused before the age of 16, and more than 80 percent say they have a family member addicted to drugs or alcohol [31]. These factors complicate the course of their illness and treatment planning. Women who abuse alcohol or drugs are also at higher risk for HIV/AIDS, tuberculosis, oral and pharyngeal cancer, injury, and sexually transmitted diseases (STDs).