The University Record, July 30, 1997

'Barn-raising' approach needed for research on women's health issues, speaker says

By Deborah Gilbert
News and Information Services

Women's health and the female psyche are endlessly fascinating to pop psychologists and the public at large, but there is a dearth of insightful empirical research on women's health issues, said speakers from across the nation earlier this month at a workshop on "Methods and Measures: Emerging Strategies for Women's Health Research." The workshop was sponsored by the Michigan Initiative on Women's Health (MIWH).

For instance, "women have higher rates of depression than men and theories abound as to the reasons," but the fact is that no one knows why for sure, according to Susan Nolen-Hoeksema, associate professor of psychology.

Scientists speculate that premenstrual, postpartum, pubertal and menopausal shifts in hormones are the cause, while psychologists postulate that women, who are more likely than men to define themselves in terms of relationships, are more vulnerable to the needs and problems of others, Nolen-Hoeksema said. Meanwhile, sociologists wonder if women are more prone to depression because they are up against uncontrollable negative events such as sexual assault or sexual discrimination.

"It is a paradox that there are so many theories about women and depression but there is so little empirical research on the issues, and what is out there is controversial," said Nolen-Hoeksema, who who took part in a panel discussion on "Future Challenges in Women's Health."

Why so many theories but so few solid answers? Nolen-Hoeksema argued that historically, women's health researchers tended to focus on one variable when the issues are multivariable.

"We've used a horse-race approach," she said, meaning that researchers seek the primary or "winning" factor, "when we should be using a barn-raising approach that teams researchers from biology, psychology, sociology and so on."

Panelist Jennifer Kelsey, professor of health research and policy in epidemiology at the Stanford University School of Medicine, echoed Nolen-Hoeksema's sentiments, adding: "We must document gender differences in health and develop better, more specific exposure measurements. For instance, researchers must define 'regular' when they ask women if they had regular menstrual cycles in regard to breast cancer research."

Kelsey also stressed that researchers need to examine the hidden topics--premenstrual syndrome, domestic violence, incontinence--that women have not discussed much in the past.

Panelist Cynthia Myntti, consultant in international health and former co-director of the Center on Women and Policy of the Hubert Humphrey Institute at the University of Minnesota, asserted that there are a host of factors in women's lives that are never measured because the right questions are not asked or because the factors are elusive and difficult to measure.

"For instance, researchers in international health don't consider the consequences for women of carrying heavy loads or working in sweat shops or in unventilated kitchens," she said. "They also don't consider the impact of satisfying or unsatisfying sexual and marital relationships on fertility patterns, in part because those factors are hard to measure.

"We need to resist the urge to focus on and measure data before we have conceptualized the questions that need to be asked," Myntii added. "I'd like to bring together demographers, social scientists, epidemiologists, feminists, gender theorists, anthropologists and men's sexuality researchers, among others, to open up the questions," she said.

"MIWH convened the workshop because we need new paradigms, new methodologies and new measurement tools that integrate qualitative and quantitative approaches before real gains can be made in our understanding of the diseases and in the design of effective interventions and national women's health policies," said Sioban Harlow, assistant professor of epidemiology and workshop coordinator.

The workshop, which concluded with recommendations for advancing research and improving interdisciplinary communication, was attended by 50 clinicians, researchers and graduate students from a range of disciplines.