Adult women

As women emerge from adolescence into adulthood,
issues of relationship persist, but the complexities of
attaining a livelihood, sustaining oneself, and possible
partnering come more directly to the fore.
Many young adult women will be continuing to
traverse tasks of adolescence, while many others will
have long since been pushed prematurely into assuming
sets of responsibilities normally thought of as
adult. The developmental tasks faced in adulthood
are numerous (Table 5.4). These broadly apply to
most women in a western culture but will be affected
powerfully by ethnicity, culture and circumstance.
Few women, if any, follow a smooth developmental
trajectory. Economic forces will shape this
trajectory tremendously and poverty is consistently
identified as a major source of psychosocial stress.
Sexual orientation may have significant influence
on the accessibility of social supports upon which one
might depend. Changing social mores may affect how
openly a woman remains single, is lesbian, adopts children of color, and lives her life. Job and legal
changes may allow closeted women to live more
openly than previously, or the reverse may occur.
Threats of violence, harassment, and intimidation
are daily facts of life for millions of women. Constructing
a model for “normalcy” in women’s lives is
not reasonable. There are simply as many variations
as there are women. Table 5.5 presents some suggestions
for psychosocial screening questions that may
facilitate a deeper discussion of these issues.
Constructing a model for “normalcy” in women’s lives
is not reasonable.
Research that explores psychosocial correlates of
health has highlighted attributes that may be relevant
for the provider. One large study examined psychosocial
factors and their relationship to coronary heart
disease in 750 women between the age 45 and 64.
Women who developed angina and coronary heart
disease were 2–3 times more likely to score higher on
scales measuring type A behavior (emotional lability,
ambitiousness, and “non-easygoing”), suppressed
hostility and anger, tension and anxiety.10 A followup
study examining this same group 20 years later
revealed similar findings but added low educational
level, lack of vacations, and perceived financial status
among employed women as risk factors.11 Measurable
associations exist between divorce, lower socioeconomic
class, lower educational attainment, and
limited social supports, on the one hand, and cardiovascular
disease, cardiac arrhythmias, sleep disturbance,
depression, and anxiety, on the other.12,13
Conversely, overall health has been shown to have
strong correlations with role satisfaction (particularly
work related),14 higher socioeconomic class, caring
for a family, strong social supports, high self esteem,
and larger social netw orks. 15,16,17
Clear differences exist in mortality between lowest
and highest income women and educational attainment
level. Many argue that the higher rates of morbidity
and mortality found in low income groups are
solely explained by differences in health related
behaviors such as alcohol and tobacco consumption.
While no doubt a factor, other studies refute these as
the major etiology and find that education level, social
stresses, and social roles at work and home are independent
risk factors.18,19
Women are the caretakers in the culture; this role
can be a source of great satisfaction, identity and
fulfillment, but can also be the source of enormous
stress and frustration.
How caretaking affects women will be highly
dependent on a host of associated factors: support
systems, relief from the role, degree of caretaking, presence of more than one generation requiring
caretaking, and the nature of the caretaking relationships,
among many others.
The full time working woman (some 65% of
women) who is responsible not only for young children
but also aging parents or relatives is at high risk
of being overwhelmed by these responsibilities.
Relationships with those being cared for may be
warm and loving or may be fraught with anger, unresolved
issues, and confusion.
The provider should be aware of the caretaking
responsibilities of their patients and how these will
affect psychosocial and overall health. Providers can
serve not only as a source of this needed caretaking
but also assist women in realistic assessment of the
demands upon them, and assist with finding alternatives
where needed.

Posted in: Health,Psychosocial health of well women through the life-cycle