514 Women’s Health Psychology
perspective that involves biological, psychological, and soci-
ological aspects of women•s lives. Such a biopsychosocial
framework involves the complex interaction of biological,
physiological, economic, political, environmental, psycho-
logical, cultural, and familial components (American Psy-
chological Association, 1996).
This chapter provides a brief but comprehensive introduc-
tion to pertinent issues in women•s health to increase aware-
ness of the needs of women among researchers and health
practitioners and suggests areas in need of further attention.
In general, we suggest that further exploration of gender dif-
ferences in symptom presentation, diagnosis, prognosis, risk
factors, treatment effectiveness, and psychosocial factors for
various disease entities is needed to enhance appropriate
prevention and intervention strategies for women and their
families.
We begin with an overview of the top “ve causes of death
among women (i.e., coronary heart disease, cancer [lung and
breast], stroke, chronic obstructive pulmonary disease,
and HIV/AIDS); the leading cause of injury to women (i.e.,
domestic violence); and chronic diseases common in women
(i.e., arthritis, “bromyalgia, and osteoporosis). We next dis-
cuss certain mental health conditions prevalent among
women (i.e., depressive disorders, anxiety disorders, eating
disorders) and substance use in women. As comprehensive
de“nitions of women•s health recognize the importance of
the association between mental and physical health in
that many physical illnesses can be risk factors for certain
mental illnesses and vice versa, we include information on
this relationship when available. After a brief discussion of
issues relevant to women in mental health treatment, other is-
sues related to health care are discussed (i.e., health insurance
and relationships with health care providers). A section high-
lighting stressful conditions related to pregnancy (i.e., mis-
carriage, infertility, postpartum reactions, and peripartum
cardiomyopathy) is then presented. Later in the chapter, we
discuss social and cultural in”uences on women•s health
focusing on the relationship between socioeconomic status,
multiple roles, sex roles, and socialization as they relate to
the incidence of psychological and physiological illness in
women. We conclude with a discussion of the current status
of women in health care and psychology, and future direc-
tions in the “eld of women•s health.
PHYSICAL HEALTH ISSUES
There are numerous physical health issues women confront
throughout their life span. Mortality statistics indicate that
women live longer than men, while morbidity statistics
suggest women are less healthy. Therefore, although women
are living longer than men, women often experience a dra-
matic decline in health during these additional years. Present-
ing issues related to prevalence, gender and ethnic-racial
group differences, risk factors, and treatment, this section fo-
cuses on the “ve leading causes of death and the leading cause
of injury among women, as well as chronic physical health
conditions that are more prevalent among women. With the
exception of breast cancer research, comprehensive investi-
gation of gender differences in the diagnosis, treatment, and
prevention of the top “ve causes of death among women has
been sparse. Additional research in the area of physical health
that includes gender as a variable is sorely needed.Coronary Heart DiseaseCoronary heart disease (CHD) is the leading cause of death
for both men and women in the United States (Centers for
Disease Control and Prevention [CDC], 1999). CHD is char-
acterized by a narrowing of the coronary arteries usually due
to atherosclerosis (thickening of the arteries), which can pre-
vent oxygen and nutrients from entering the heart. Myocar-
dial infarction (heart attack) occurs when oxygen and/or
blood cannot enter the heart. It has been estimated that in the
United States approximately 7.1 million men and 6.8 million
women have a history of myocardial infarction and/or angina
pectoris (chest pain due to lack of blood and oxygen entering
the heart; Bittner, 2000). Although prevalence rates are
similar for men and women, more women actually die from
CHD each year than men. Study of mortality rates indicates
that 42% of women who have a myocardial infarction die
within one year compared to 24% of men (American Heart
Association [AHA], 1999). Mortality rates among women
with CHD increase as women get older, and CHD is
most common among postmenopausal women over the age
of 60 years (Stoney, 1998). Regardless of age, however,
African American women have a higher risk of developing
CHD than European American women, and those African
American women younger than age 75 are more likely to
die from CHD than their European American counterparts
(see Newton, Lacroix, & Buist, 2000, for a review). Possible
reasons for this health disparity are limited access to medical
resources and a higher prevalence of risk factors among
African American women (Holm & Scherubel, 1997).
CHD risk factors for men and women include cigarette
smoking, family history of CHD, high blood pressure, high
cholesterol, diabetes, physical inactivity, poor diet, and obe-
sity (Bittner, 2000; Newton et al., 2000). These risks factors
often are interrelated. For example, diabetes often is associ-
ated with high blood pressure, high cholesterol, and obesity