Reflections on Current Societal and Social Context of Women’s Mental Health in Italy

Abstract

Introduction: The chapter deals with the current situation of women in Italy by examining the impact that Italian social and economic conditions have on women’s mental health. The framework adopted considers women’s mental health as a major public health issue; thus mental health is considered as the effect of sequels of distressing events experienced by women.

Main Body: The chapter focus is in particular on three following issues: (a) Italian socio-economic conditions and gender inequalities and their relevance for the prevalence of women’s mental disorders; (b) violence against women and (c) health and mental health of immigrant women in Italy. Data are presented in the main body of the paper as far as the prevalence of mental disorders in Italy and the consumptions of psychotropic drugs, the prevalence of crimes against women (homicide, stalking, sexual violence), and physical and psychological health conditions of immigrant women in Italy.

Discussion: The results presented in the body section are discussed considering the sociological and political changes that occurred in the Italian society along the last 30 years.

Implications: Recommendations are provided regarding: (a) the extension and the revision of the set of rights and duties that are attributed to the families; (b) the creation of stronger network of opportunities for sharing burdens and providing mutual support as well as supplying services designated and designed to help women; (c) removing loads from women’s shoulders and improving social policies for women.

The chapter is concluded with a response section devoted to the consumptions of those medicines that are indicative of a state of suffering, because they can be useful to cope with it or with the social and psychological demands that are causing this suffering. Particular focus is given in the response section on the new channels like Internet through which medicines can be made available.

Response

• Domenico Di Giorgio &
• Marta Gramazio 

1. Counterfeiting Prevention Unit, AIFA—Italian Medicines Agency, Via del Tritone, Rome, Italy

   Domenico Di Giorgio & Marta Gramazio

Consumption of Psychoactive and “Life Style Saving” Medicines Aimed at Improving Physical Appearance and Performance in Italian Women

There are different ways in which we can keep track of women’s mental health. One of these has to do with medicines consumption and especially consumptions of those medicines that are indicative of a state of suffering, because they can be useful to cope with it or with the social and psychological demands that are causing this suffering. While this topic has been partly addressed in Sect. 2 of this chapter, with this response section we want to deal especially with the new channels like Internet through which medicines can be made available.

The Demand for Medicines: Focus on Female Customers

Internet represents the easier alternative way of access to medicines with respect to pharmacies; in many countries customers use the Web for buying both life and life-style saving medicines. Most of this demand is related to male customers (e.g., medicines for sexual dysfunctions, and for improving performance in sporting activities). The demand from female customers is focused on different products, but with similar roots: life-style saving medicines in connection with some behavioral/social models requesting an effort for being in compliance with some specific conditions (e.g., age, physical appearance). The most requested products between Italian female customers are the following, ordered by decreasing relevance:

Slimming Products: The relevant incidence of slimming products from Italian female customers was confirmed by the results of three surveys conducted by AIFA and Sapienza University of Rome between 2010 and 2013, where slimming products were ranked as the most requested product, with a growing share of buyers between female customers (from 5.4 % in to 6.7 % in 2013). This result is in line with the available data related to the prevalence of eating disorders between Italian female population: according to the Ministries of Health and of the Equal Opportunities, about three million Italians suffer from eating disorders, 95 % of them being women. Since 2010, when sibutramine, the strongest slimming pharmaceutical ingredient, was withdrawn from the EU market due to its bad risk/benefit ratio, the market for this miracle medicine moved from the pharmacies to the Web. Even the packaging of the most common illegal sibutramine preparations (e.g., Slimex) evocate the reference physical model: the blister containing the sibutramine capsules is skinny top model-shaped. Slimming products are currently sold also under the appearance of natural tea/coffee/food preparation; the usual composition often includes also other ingredients aimed at granting a quick, slow term slimming action, as for instance phenoftaleine, a laxative ingredient forbidden in Europe for the same reasons explained for sibutramine.

Bleaching Creams: In Italy, the prevalence of the use of bleaching products between African immigrant females, being 43.9 % between women under 35 years, and 35.9 % between women over 35 years is in line with the one observed in many studies performed in Africa. The request for products changing the appearance and color of the skin is usually satisfied by the illegal offer on the field (bleaching creams, e.g.., steroid creams for dermatological diseases) and on the Web (melanotan, injectable tanning preparation). As for the slimming products, also in the case of bleaching creams the risk/benefit profile of the product for its cosmetic use is absolutely unacceptable; nevertheless, black women buy large quantities of the creams from ethnic shops on the field, starting long term treatments, considering the possible side effects as non relevant with respect to the expected positive results in terms of social desirability and performance.

“Surgery substitute” products: injectable botox and breast enlarging products: The request for surgery modification of the physical appearance is growing all around Europe; in parallel, also the miracle medicines aimed at avoiding the surgery (e.g., natural products promising breast enlargement), and/or to perform home surgery (e.g., injectable botulin toxin and similar medicinal products for rejuvenating skin) found a place on the market, both on the Web and on the field (in illegal beauty centers).

Female Sexual Activities Enhancers: Some female sexual activities enhancers were seized during our monitoring activities. There are not so many preparation granting a real effect, according to the available studies; the market for this kind of products should be looked at more in terms of fraud than in terms of illegal medicines distribution.

Psychoactive Drugs for Working Performance: The recent UK case of a young nurse who died because of the side effect of psychoactive medicines bought on the Web for improving her working performance, being under the pressure of a tight shift schedule, made a strong impression worldwide; even if there is no current evidence for similar behaviors in Italy, the frequent seizures of non approved psychoactive products (stimulants, antidepressants) during the post parcels inspections may be an indication of a growing trend we will keep under monitoring.

Conclusion

All the medicines discussed above are clearly related to behavioral/social models which are currently accepted and promoted between women. The fall of adherence to these models can have a significant impact on women’s mental health giving rise to the need of medicines to control diseases (e.g., anti-depressives), to modify the body to achieve the target “accepted” model (e.g., slimming products), or to help in sustaining the burden of activities (e.g., psychoactive drugs). It is then important that the activities of AIFA take into consideration not only the enforcement of existing regulation, but also the reduction of the demand. AIFA devoted many resources in this area: between 2010 and 2014, 3 market profiling surveys were delivered for having a clear picture of the psycho-social drivers of the demand for illegal medicines, and specific studies on risk communication were developed. In the view of the implementation of these new rules, AIFA started a broad cooperation with universities, with a specific focus on communication sciences and psychology, also in order to develop proper communication initiatives for counteracting the effects of the above mentioned female social models, in particular among children and adolescents.