de psicologia ! annals of psychology 2022 wot 58 xt Gansu), 16 cop 222 Eu. de Much) elieissaunelleos Gender roles and women’s mental health: their influence on the demand for psychological care Sansa Toxbio-Caballero, Violeta Cadena, Alejando Avie’, and Mercedes Ovejeo? 1 nai de Pines Reval Masi Spain) 2 Fait & Palin Unsesad Comper Mad Sie) "Taos Rates de ines 5 sd cara ens mujeres so moose cals demande de seneén porcogen Resumen: Le pevalcen de deterninados dagnéticos tasoene de In condctaabmctasa, depen, asked tastomo late es cope et rjeres queen homleer_Conseranc le sava mental en aes, sera {rpeescnsine poner el foeo en Ine pecan socales gue sateen en fons de ener Se rts ex una mutts de 365 mers I expand e dascacéa de lgueasvatabes cies ¥ areas socoeultzles( ‘emia con ls oars de gene®) pac eteariae eas mere ‘endo atstenca prcoligies 9 no, ax como I inpstanca decade feat veces le been de promostcns qué mujeres ovata sehen fee {it Los ceniadoe cosuavon qe coundo lar sees puaian ao ex a fons Tioables eunieae eam dessones Site + Raspes Lanes) > <0 figures ationndas con confermidad com las nas de gnere (Cua ‘aide Nikos, Aguadsle en lr elaine je Fiscal Seren) ee ma eobibe que esta aclaendo tctatseato picolsien. Poe Jo tno, cases que In sccoun dela perspeca de seser en programas de tchctvr, de sed yatencnpocologis ex fatmental pau on ined geneo pundas ser nde dvessry constan mene oe pence des dela pcioas fo que inden go tenga una rectal Palabras clave: Coufounidad cou lo eos de gener. Testers pice peor en meet Tromoe conduct almestana, Depiensn Ansel ‘Festomo line den personated “Rostact The presence 6f coma dagaoies, ch os eatnp oem, ddepoesion, asset and bonlesine personaly dsades i higher ‘Somme than evong men Wien comes to wacnefe mental ath, Fou ‘2g ou socal apecssafuensg he Gat Gemen fal becomes veal Ung ¢ sample of 368 women, ve studied the asifstion ably of ¢ senber of cca rales and socowaltual factors (conformity to gen (er mst) in andar fo ancetain vhather ce aot women were necting piieholozeal ease and detexnine the ipostaace ofeach ofthe Yasue ‘shen peesienas wach omen mec eceminethecepr One remit hoes {Gat women were mone Hin to be cisog perehologal tment hen, soung high on cesain cial rosie (och ar Seidl Leeson acd Decdedoe Festi!) and on a aunbec of vaables elated to confonting te sender noes (Cue foe Chee, Nice ss Relabonships, and SezoalF ‘eit. Therefore, bnecethat integrating the geeder perspec nt ‘duction helhseaed and prcslopes! case programmer is eens eo tat gender oe can become soe dese and es const of poo k's potecnal salting in peared beat Keywords: Gender ssl conformity. Peychologcal disasters in women Ening deocdors Deponesons Anse. Boderine personality cedar Introduction Women’s health is diffeseat fiom men's health, Womea lhave poorer overall healt: they have a higher number of chronic conditions, higher levels of cognitive impaimnent, and 2 higher prevalence of seveze pain and physical disability (Case & Paxson, 2005; Chiasson & Hirsch, 2005; Ceimmins etal, 2010; Ministerio de Sanidad, Consumo y Bienestar So- cial Spanish Ministry of Health, Consumer Affaxs, and So- cial Welfare], 20184; Oksuzyan etal, 2019; Sanchez-Lopez et al, 2012). However, if there is one asea of health where ges der-based differences in the prevalence of disorders is pre sieulady significant, that is mental health, whese the peewa- lence of mental health problems is twice as high in women as in men (Ministesio de Sanidad, Consumo y Bienestar So- cial [Spanish Ministy of Health, Consumer Affacs, and So- cial Welfise], 2018b; World Health Organisation (WHO), 20182: Velasco et all, 2007). Ta fact, even though women Ihave 4 longer life expectancy, engage in a greater ammber of preventive behaviouts, and have fewer addictions, they para Gosiclly have pooser healt, wellbeing, and quality of lite shan mea, They also wee mose health services and peyeho- Ses, 10, 1 Tague 2801: Ee seatonin@pcaterpaslciona sass Arie ied 12-10-2020, ned 69-2021, ab 11-4202 ‘wopic drugs and have a higher prevalence of aumerovs psy~ chiatie disorders (Hastung & Leder, 2019; Leal, 2006). This lnxe been texmed “tae mostalisy/ moubidity paradox”: women live Jonger than men but ase in poorer health (Case & Passou, 2005; Sanchez Lépez & Limiiana, 2017) Epidemiological dara show thac chete ate a number of di agnoses for which there aze no sex-based differences, eg the prevalence of sehizophcenia is very similar in men snd wom en (Jiménez & Vizquez, 2012; Sienz-Hersero, 2015). The prevalence of ather diagnoses, such as antisocial, nacissstic, obsessive-compulsive, paanoid, schizorypal, and schizoid personality disorders, is higher in men (Garniea de Cos, DOL). Mea alsa commit suicide ata higher cate than women (lackenzic eta, 2019) ancl tend to use more violent means to do s0 Balsamic et al, 2019; Kelien, 2010) However, thece are many other disceders that are each mote prevalent in women than in mea, The most sigaificant ceximple is esting dicosdess, with the highest female-to-male satio of all psychiatric disorders (Fetches Jeazen, 2009; Keel & Fomey, 2013): 90% of all people disguosed ate women. (Kohen, 2010; Ruiz et al, 2016). A similar situation applies to alfective disouders, Depression is two to tree times move common in women than in men (Fessadi et al, 2013; Pesez & Serza, 1997; Péxe2 & Gavia, 2015; Sienz-Herero, 2015 Salk et al. 2017); eates of bipolar disorder are similar in both sexes, but women’s cycles are faster and experience a greater number of depressive episodes and mixed phases. Ansiety8 Soni Toro Cb ca disorders (such as panie disorder, specific phobias, and gen~ ctalised ansicty disotder) and dysthymia affect women moze than men Bekker & van Mens-Verlulst, 2007; Leal, 2006; Pérez & Gavia, 2015; SinchezLépez & Cuéllar, 2013) With regatd to pessonality disorders, epidemiological data show that women have a higher prevalence sate of border line personality disorder thaa men (:l) Esesibano, 2006; Gasca et al, 2010; Kienast et al, 2014, Ostiz-Tallo et al, DOLL; Skodol & Bexnder, 2003; Tomko et al,, 2014; Teall al, 2010), Trak follows fiom the above that women have, in gene cual, a higher prevalence of intesnslising disorders (ansiety, depression) while men tend towaeds extesnalising disorders (antisocial personality disordes, addictions) (Eston et al, 2012). ‘The sex dlifeceatial in movhidiny may be explained by theo liypotheres. The fsst hypotiess lolds that coustitution- al, genetic, and/or endocrine factors are determinants of sex based differences in morbidity. However, it seems that most studies in this ares fall shost in explaining this phenomenon ine, 2018; Montero et al, 2004; Pérez & Serma, 1997). As pointed out by Siuchez-Léper and Cellar (2013) echoing Ellis et al. (2008), mental disoxdess in childhood-eg., con- uct disorders such as attention deficit hyperactivity disorder (Aanert et al, 2015), communicasion and language disorders such as stuttering, autism (Baron-Cohen et al, 2011), and Asperger synccome-are more commonly diagnosed in boys ‘vermt aide, The teend reverses in adolescence, where fe sales stct to have paoser health. Data suggest that these are ot (ealy) genetic disordecs but may also be influenced by enviconmental factors. ‘The second hypothesis is based on enviconmental thea- ties, which argue that sociocultisal vatiables seting through socially impaced goles aad pertesns of behavione ace what sl imately condition the way in which men aud women mani- fest their psychological disuess (Montero et al, 2004; Sinchez-Lépez et al, 2013). This is in line with Kohen (2010), who, quoting Dobreawend and Debreawend (1977), Gove (1984), and Nazroo (2001), point out that women’s meatal lealth being poorer than men’s may be selsted to swomien being affected digfecenty by social stuess: they wstal- ly ase poorer than men-which has been termed the feminisa- tioa of poveity (Belle & Doscet, 2003)-nad experience more abuse (Sexual abuse and sexist violence) than men dusing both childhood and adulthood (WHO, 20182), Gender based violence, the semtal division of labons, women's dax- ble o: tiple shifts (woxk, housework/casegiving, and affec- tive networks), and beauty ideals (Social pressose on theix bodies) ace other significant eouteibators to women's poses health (Sénchez, 2018). ‘As Wood and Esaly (2013) pointed out, it is true that acter biology ane culnice alone ean explain sex-based dif Fecences ot similarities. This ie whese the biopsychorocial ‘model (Engel, 1980) becomes particultly relevant as an ex: planatosy theon widely accepted and used ceptuslisiag aud testing a wide sauge of physical aad mental alo do psleslgi annals of psychology, 202, ol 352° ans) health problems (Meyer & Melchert, 2011) and is stil very popular today (Bott ef al, 2016: Yagehunaian & Miler Smedem, 2019). Sex and gender ace two complex and distinc ene, alt hough they may oveslip and selate to each othes to some es tent (Femiinde2, 2004): gender interacts with biological sex, bit i ea differ concept (WHO, 2019). However, ia the scieatifc Ltetise, the wo teams ate offen wed inter changeably and confusingly Sinchez-Lopez & Liminana 2017). The tec sex eefes t9 biologically deceemined chasse texistes (chromosomes, genes, gonads, hommones, mosphol ogy, ec), while the tum gender refers to the sacialy defined soles, chavscreseies, and oppostunities that ace considered approptiae for mea, women, boys, gil, and individuals ‘with nou-binstyidenties (WHO, 2019). Tese soles and chacacteitics are leasat theonch the process of diffevenial socialisation, which bepins at bith fd continues throughout life, whereby individwals, hotel interaction, eam and intemalise the values, attitudes, expee~ tations, and behaviours chasacteriste ofthe society to whieh they belong, enabling them to function in it (Giddens, 2014). ‘The World Health Organisation (2019) states that if people do not confoun to nouns or toes Gncluding masculinity and femininity), they axe often subject 10 stignatisation, social exclusion, and discrimination, which may eventually have a negative impact on ceit health ‘Based on the above, we set out to analyse to what extent gender (saciseulnsal aspects) comtatnes to women seeking psyehologieal axe. Our objective was to study the classifica Sioa ability of a number of clinical vaables taking a8 3 cof cxence the classification of the Diagnottic and Stoteical Manual of Mental Disoudess ox DSM-3 by the Amesican Payehiauie Association 2013)-and socioculeusl. factors (confozmsity to gendec aocms) in order to ascersia whethee or not womea were sectiving psychological case aud deter tine the importance of each of the vatiables when predict ing which women were seceiving thesspy Method Design This study used a retrospective, cross-sectional, ex post facto group compaticon design. In ex post facto desigus, « sample of pusticipants with already existing qualities associ sted with the study vatinbles is selected, The potential inde- pendent vasiables axe provided, and the dependent vasiable can be observed before, after, or at the same time as the in- dependent watiable (as itis the case of the present smady) This is a setvospective group compasison because the study compases a group of women selected for having a certain chacacteristic (Je. the clinical cases) with another group of ‘women lacking that characteristic (the non-clinical cases) The geoupe ase compaced on a anmber of poteatial inde- pendent variables (confacmity to feminiCee ese’ et eB aries ed rt ore 9 norms and clinieal vasinbles), which are cousidesed relevant {or thie occussence of that chasactesistic Participants ‘The total sample consisted of 368 women, but 10 of the asiessments wece discarded dhe to aniseing data, The Saal sample was made up of 358 women (M'= 3841, SD 12.96), 168 (AI = 35.75, SD = 11.49) of whom were recruit ced from private peycholagieal ence ceatses sacl were secei: ing psychological and/or psychiatse ease, and 190 (A 40.73, SD psyeliological/psychiatric care ‘The inclusion criteria were as follows: (@) being a cis gender woman, (b) being over 18 yeass old, (¢) being profi- ent and fluent in Spanish, and (€) not being institutional- ised. The exclusion csiteria were (a) being a man, (b) being a ‘wansgencler/tcanssemval woman, (¢) being under 18 years of age, (d) having language compzeliension problems for what- ever reason (difficulties in understanding questionnaires, in- telleersal disability, ete), ancl (¢) Being inetinstionalised. Table 1 shows the selevant sociodemogiaphic infox 3.73) were controls, as they were not receiving ont — Pe PF a Leet outage woo: om aos i 38 sete) one 28 SOR teens St ee 4 ana ES eke OF Boss $k Wihgese comics |S cal Sa Se ooAB vos $e as Se $48 Ou eee Seas ; 7D age oss Sa NizM Me 5D Stands devaton GE Degies of feedom V Ciamers V te vesiing te satel sneance of Levens eit ‘The main seasons for consultation in the clinical group ate related to anxiety problems (39.29%) couple sclationship problems (27.98%) and depression ( ‘Neue of the women ia the clinical gromp zeposted alechol oe drug problems asa reason for constitation, “Table 2 shows the seasons fos eontultatioa in the clinical rou, ‘The assessment instruments collected sociodemographic information and data on clinica vasiables and confosmity to gender nosms. ‘An ad hoc sociodemographic questionnaire was included to collect infoumation on age, sex, level of education, en ployment starus, and masital starus. The therapists of the ‘women who pasticipaced in the smdy completed a sexeening quettioanaise indicating the type of centce they wacked! ia (public practice, private practice, specialised centie), reasons foe cowsultstion up to thiee seasons for consultation eaazing from 1 (eajos) t0 3 (mines)-, and mype of diagnosis (clinical syudromes based oa the DSN-3) Fellec ee (Coles For the age vasable, WARE conection appied Tab 2 Reson re io ilo ‘Reasons for consulta Aisety problems (Couple selatonship problems Depression Tnseousity Esmlr pecblem= Dificltes in soil celations Loneliness Obsessions Work stress Treduess / Mness Others Semis disocders Disruptive / Antiscaal beaaione Emplopment / Study problems Alcohol abuse ‘Ne Sone mea have mise Ha one weasoa Tor consiaion “The validated Spaaish version of the Pessouality Assess ment Inventory (PAD wae sted (Macey, 2007). The Spanish adaptation of the sLostened scale (165 items) was validated anaes de psclois annals of peychoogy, 222 wh 36, 2°10 Soni Toro Cb ca bby Ontis Talo ¢ al (2015). Enc item had fous sxpomse op- tious: False, not tue at all), Sigly true (ST), Mainly txbe QM, and Very tue (VD). It compschensively assesses adule psychopathology using 22 scales (Ortia-Tallo et al, 2011): 4 ‘alidity scales (nconsistency, Iniiequeney, Negative Impres sion, and Positive Impression), 11 chniedl seales Somatic Concecns, Ansier, Aasies-Related Disoudess, Depcession, Manis, Pasanoia, Schizophtenia, Bordesinne Feanaes, At social Featuces, Alcohol Problems, and Daug Problems), 5 treatment coasidesstion seles (Aggression, Suicidal ideston, Suess, Noasuppast, and Treatment seection), and 2 in pessonal scales (Dominance and Warmth). Regarding the level of celisllity of the chose foam, ie mean iateraal con siseuey/ alpha coeficieut was 0.74 in somnal samples and OI in clinical samples, The meaa test-retest seliabiliy, wn decstood as temporal consistency, was 0.82. The mean cone Intioa value betweea the shost and fell forme was 0.90 in maples and 0.93 in elsical samples, suggesting that the short fom yields scores retsonably close to the scores individvals would obtain using the fll foun of the question. aie (Orz-Tallo etal, 2011) Since the PAI docs not meanute cating disordess, the Easing Attinades Test (EAT-26) was included. This 26-iem, version was developed by Gasner et al. (1982) from the full foun EAT-40 (Garner & Gasfinke, 1979), Bach item uses a Likect scale with 6 response options: aever (0), sarely @) sometimes (0), often (I), usually (2), and akways ()- Total scores sange om 0 to 78. The EAT-26 cousitte of thsee scales or factors (Gacaadilas etal, 2003): the Diet Seale (at tention t0 csloses ingested and bxsat doing physical nes cise, desce to be thin, seate of guilt afer esting), Bulimia Factor (scale of bulimia and coucesn about food), and Ox Consol (tems describing food intake mode aud ts conta) [As pointed out by Gazal et al. (2008), the EAT.26 and the EAT-40 ase highly concelated (¢ = .98), suggesting that the shortened version fetains adequate slaty sad validity properties for detecting eating disorders (Pike etal, 2008; Gaufkel & Newman, 2001), The level of zeabiity aad in remal consistency of the test as meastxed with Cronbach's slplia wns excellent (>,90) Rivas etal, 2010) ‘The Confoumity to Feminine Nouns laveatory (CEND) seas also inchaded (Mahalis et al, 2005). Ir assesses women's conformity to a set of dominant feminine noms in Ames can culnuse, Femininity is understood as the degice of con- fornity (emotional, cognitive, and/or behavioural t0 a set ‘gender sonine cat ase contidesed socially appcopeiate fox women ia terms of bebaviouss, attimdes, feelings, and thoughts tansmicred by each eultuce with which members of ach society cas identity to 3 (Ginches-Lépez & Limidans, 2017). The Spanish adapeation ff the teat wae candied out by Stnches-Loper et al. 2008), Reliailty dacs (an als coefficient af 7 foc the total ecale) contiumed the validity of the CENI for use ia the Spanish population. The CFNI consists of 54 items rsted on a 4 poiut scale (0 = Stougly dsaguee, 1 = Disagree, 2 = Agree, Strougly spies). It can be administexed both individally normal « alo do psleslgi annals of psychology, 202, ol 352° ans) nd collectively to individuals over 18 yeats of age. The dss tioa of the questionaaize enages between 15 and 20 minutes Total scores range fiom 0 10 252 points. Higher scoxes ind cate higher satisiaction with the traditional role of women. The factors that make up the CFNI axe the following: Nice in relationships (developing fiiendly and supportive relation- shipe with others), Care for Childcea (taking ease of and be- ing with childsen), Thinness (pussuing a thin body idea), Seswal Fidelity (Keeping sexual intimacy contained within fone committed selationship), Modesty (cefrsinine om call- lng attention to one’s talents or abilities), Romantic celation- ship Gnvesting self in romantic selstionship), Domestic (ontlatsiaing the home), and Tavest in appeacance (commit. ting rerowices to maintnining and improving physical ap- peasauce) (Mabalik etal, 2005). ‘The Coafosmity t2 Masculine Nocave Inventory (MNT) ‘was also included (Mabalik et al, 2003). It assesses confoumni- fy fo a set of dominant macculige aotme ia US culture. Its Spanish adaptation was conducted by CucllarFloses ot a (DLL). Reliability data (an alpha coet¥cient of 90 for the to- tal seale) confitmed the validity of the CMNI for use in the Spanish popslation, It consists of 94 items sated on a 4 point scale (0 = Strongly disagree, 1 = Disagree, 2 = Agree, 3 = Stwongly agxee). The factors making up the CMNT ase relared to attindes, beliefs, and behaviouss zeflecting con- foumity of non-confomty to eleven nosmative messages a5- sociated with masculine gender soles: Winning, Emotional Control, Risk-Tating, Violence, Dominance, Playboy, Self Reliance, Primacy of Wosk, Power Over Wome, Disdain for Homincemtale, Physical Toughaess, and Paes of Stans (Crséllae-Floses etal, 2011), Reliability data for the scoves of each seale obrained ia the present stidy are provided in the Results section. Procedure ‘Twenty-seven peychothesspiste fiom different provinces of Spain (Madtid, Valencia, and Bazcelona) and thiee psy chothecapy centres pasicipated in the cecrsitment of the sample. Paticipants in the control group (women who were snot seceiving psychological/psychiauic case at the time) ‘wcte reemited sing » snowball sampling proceduce. Pastci- pation ia the stady was voluntary, Informed consent was i cluded on the first page of the bookler where the different instements used were compiled. The booklets were hand Aelivesed and did not need to be filled in om the spot. In nost cases, the contact persons gave the questionaaixes to the women, who remmaned chem to the same contact person. Ta one of che collaborating centies, the questionnaires were filled in collectively. Data analysis Affes exchiding the participants who filled to sxeet the aforementioned inclusion citesia, all gender vatiables and EAT scores were standardised Using T-scores, the same scoting system used by the PAL T-scotes use a scale detived fiom Z-cores aud ate calculated by tuausfomning the ZGene sme met eb ore fe anf sti ae u score for each pasticipant on each scale, multiplying it by 10, and adding 50 points, This results ia vauiables whore mean, ‘would be equal to 50 and theic standacd deviation would be equal to 10. After standasdisation of the vasiables, a desexip- tive study of each independent vatiable for each study group ‘was cussed our, Statisties of centeal tendency, vasiability, and shape of the distdnution weve ineinded, “The aim of this study was to explose the classifieation ability of a mumber of clinical vasiables and vasiables zelated to conformity to gender aoams when detesmiaiag wheter or nat women were receiving psychological ease. Therefore, in order to make a classification model, two approaches were ‘ken: a binagy logistic cegsession model and a sandom forest model After constuvcting the binuy logistic regression ‘model, the collinearity analysis conchided that more than 20° of the vasiables had a high degcee of collinensty. The serults of the logistic zegression analysis aad the adjustment Of assumptions, inchiding the analysis of collinearity berween, predictor vasinbles, is available upon sequest from the Iead author In view of their collinearcy, a sandom forest classiica- tion model was considered (Breiman, 2001). This pe of ‘model makes it possible to wosk with vatiables exhibiting collineasity problems, among others. The 10-fold cxoss- validation proceduce was followed (Kuhn &€ Johnson, 2013) Irconsists of a resampling method based on cross-validation in which the total sample is divided into 10 pasts with ap- peosimately the came amber of pastcipante, A model is brit wing al bt the frst sample. The remaining sample is seed to estimate the penfoumanee measuses of the model Hypespatameters of tadom forest model inchide the numberof wees Gn this ese, this valve was set to 500) and the mumber of predictor vaiabes in cach tee (in this cae, the optimal model allowed this value to be set t0 18). The Gin indicator (ean Deceeate Gin) soe seed to asses the Significance ofthe vasinbes. The eurr sate was staied using out-of bag (OOB) procedises. Model aceusney and com owdance between tices wece also staid. As this isa clssi- fication problem, this algithm provides» confasion mati fom which the indicators of prevalence, sensitivity, speci Sei, dingortie sconcre, iagnomtie eddy stn, Von ia- dex, postive predictive whi, nd nepative peeictve valoe can be derived, All these indicators ae reposted with a 95% confidence interal Stave analyses wore petfoumed wing R softs OR Core Team, 2019), andthe cer (Kn, 2020), 2c Revell, 2019), glo (Wickham, 2016) and eR. Stevenson, 2020) packages Results ‘The descriptive statistics for each of the predictor vasinbles ln exch group, a8 well a# the iateenal consistency coefficiente fic each of the scales, are shown ia Table 3. The internal consistency of most of the scales is adequate, with the excep- sion of the Antisocial scale of the PAT. 1S seen femesmeceas poems ctpecennmie as Se 2 ee om Sy ae Rose Reid Daoces eG BEES — So cs = cut, ae ce a mt Stig, ee ‘Bordediine Features 9852 yo Ee casos we Cum 0a — Gils eso ce a a a sey a Some ey us ue a anaes de psclois annals of peychoogy, 222 vl 38 | jaca)12 Soni Toro Cb ca == Tas ss 5s a Daricuee 706787 are Sor sion ao0 i oe Sina ioe Nisin ect a yooaiaea joe ata Cuefciain 98 aoc bas inet Tuan ue ot eee oyna cme SemiFieiy 8 eee ee ode 7 Sevan! yeast aset Roman Reston me yin usr RN Done 72 Noe ee imetadgame Tn oz yaad "a9 ay = yal wae ae wuss Bening SSB wont oo Wet 708 yee 3 PecoaWons Sw yt 28 cant Daa ON yell ‘aii Pao = yee ue cure = yon oF mg of 7 yom By Didi rtimomus 6a ae monuretSans soe 709 ma ey ap a Random forest was the dssifer algorithm wsed, con: seructed gith 39 predictors and hypeeparametes desesibed inthe Doo Analyse section. The tease othe noel ob llnamnsg tried ws 990% and the agreement between the ees as Ein Boe Caan 220787, The confiion mats ie shows ia Table 4. The Cnical Non-clinical ss 136 2 cro OOB exior was 12.01%. Gove Nonelinial 216150 ‘The impostance of the vatiables is shown in Table 5. The a St smost imponant vasables belong co the PAI, with Snicidal Chsateaien Ene On as Tdestion being the most relevant scale, followed bry Border- line Featuzes, Somatic Concems, Anxiety, Stiess, Depres Sess Fidelis, Cate for Childeea, and Nice in Relation so, and Anxiety Related Disorders, Regarding gesdes,the ain ccales had the highest classification ability, although fe alo do psleslgi annals of psychology, 202, ol 352° ans)Gene sme met eb ore fe anf sti ae from the classification ability exhibited by the clinical scales, In the case of vasiables seated to Conformity to Masculine Noms, they have litle importance within the model, with B the Power over Women and Self Reliance scales attaining the highest valves, Tabs poe fh pcr ah (Chica vanes Tmparance CNT Trparance CENT Timporance Suicidal Tdeation 10490 Pasta of Satis 158) Sezual ety Bis Bordedline Features 12767 1672 Cate for Chien 44089 Suess 316 1639 Waemts 308 1637 Diceia celtoathige Somtie Coacesat 2at0 1367 Domenie ‘Ageresion Dass 1495 ‘Thunnese Aone 2688 1308 lavertin appearance Anet-Reated Disorder: 2500 Risk-Taking rs ‘Modesty Eats 1382 Emotional Contcol 10st Romantic relationship Schizopiasenia 1760 —Disdain for Homotemuale 0757 Noseupport 1699 Dominance oz Mania 1667 Depression 1385 Antisocial Featuces 1489 Dominance 1304 Paanoie 1.286 ‘Neu The EAT wove docs aot bleu wo the PAL Since the random forest algorithm has been used for classification, it was possible to obtain additional indicators of the quality of the model (see Table 6). The model has shown very good classification ability, as all diagnostic indi- ccators have very high valves Tables Aiton nie: of taftion abil Indicator Estimation eel 7 Seaacmity 90 Speatiaty Acourscy in diagnosis Diagaoene Oa Ratio ‘Yous lade ostve predictive value Negative peedicve vale 92 795 Discussion ‘The aim of this study was to explose the classification ability of a number of clinical vasiables and sociocultural Exctors ze- lated t0 confounity to gender notms in order to ascertain ‘whether of not women were receiving peychological care and detcimine the importance of each of the vasiables when pre Ts this sample, the main ceasone fae consultation ia the clinieal group wese selated to anxiety problems (39.29%) aad epcession (27.3896), which ase among the moet prevalent diagnoses in women (Bekker & van Mens-Verhulst, 2007; Fessasi et al, 2013; Leal, 2006; Péxe2 & Sera, 1997; Pérez & Gavia, 2015; Séenz-Herreco, 2015; Salk et al, 2017; Shacher Leper & Crsllas, 2013), a¢ well ae couple zelition 27.98%), The second most prevalent reason in the sample was couple relationship prob- Jems, which is not a clinical diagnosis in itself, but sathes 2 concer frequently voiced by women in the clinical sample (women who were receiving psychotherapy), This is com sistent with Velasco (2008), who seports chat couple's con Bets were the psychosocial process most frequently associ sted swith common mental disordess, somatestion, aad pain among men and young women up to 44 yeass of age (p. 181) ‘The data obtained indicate that women scosing higher oa the clinical variables Suicidal Ideation (the variable with the highest weighting) and Bordesline Featises ate more likely 10 be ceceiving psychological ease. The peesent sample ciel not sepott significantly sevese symptoms (women in the clinical sample were seen in private practices and not in hospitals), 20 s high seose on this scale was indicative of severity, which Ste with secking therapy. Something similar could be ssid with respect to the Borderline Fearues variable, which is re Inted to severe symptoms and an indicator of a higher likeli hood of receiving psychological case. This is cousistent with the fact that borderline pessonality disosder has a higher prevalence rate in women than ia men Gil) Escibano, 2006; Garcia et al, 2010; Kienast etal, 2014; Oxtiz-Tallo et a, 2011: Skodol & Besnder, 2003: Tomko et al, 2014; Trull eral, 2010) ‘The vasiables with the highest classification ability in de- ‘eamining whether a woman is seceiving psychological care ace typically associated with conformity to feminine gender soles: Care for Childsen, Nice in Relationships, and Sexual Fidelity. This is consistent with a amaiber of sniies sugges lng that having feminine but also masculine taits (andeney- say) wns associated with less eevete eating disorders and with anaes de psclois annals of peychoogy, 222 vl 38 | jaca)“4 Soni Toro Cb ca the fact that femininity and anxiety axe positively comclated, while masculinity and ansety are aegatively comelnted (Harung & Lele, 2019). In fat, one of she possible rea- sons why women have a higher prevalence of mental disor ddess than men is that social roles axe different fox each sex moving away fiom gender ideals ean be stressful for both women and men lec ideals ace not met, ies moce dif. ficult to have a good exteinal sepresentation of selfavorth) However, this has moxe negative consequences for women thas foe men (Mand & Agniless, 2009), a8 secial noeme and standads are known co guide and constrain behaviouss (Gialdini 8 Trost, 1999) ‘The clinical vasiables Steess, Wasmth, Agarestion, Annie ty, Atuniety-Related Disorders, aud Somatic Concenns have the highest classification ability. These vatiables ate selated to the fict that wremen have a hisher psevalence of iatesnal- ising disorders (Eaton et al, 2012) and higher levels of social sess: they have a lower economic stamus and experience more abuse (sexual abuse and sexist violence) than men dir- ing both childhood and adulthood (WHO, 20180). This is ako consistent with some of the results found: women with higher femininity scoces also had higher levels of anxiety and, overall, feminine taaits hindes women’s psychological wellbeing, as chey axe zelated to passivity, dependence, lack. fof assertiveness, and low self-esteem, which in um ase linked to ansious and depressive symptoms (Pérez & Sera, 1997). In seems of conosmity to auasculine gender aceme, the variable Pucsuit of Stans is canked fest, fllowed closely by the clinical vasable Eating Disordess, Being female and coor ling high on a “rpieally masculine” (gendes) variable males that woman almost as Ukely to seek psychological help as swhen scoring high on the clinical variable Eating Disorders. Eating disorders ase the most commonly diagaased disor- dess among the young population (Séenz-Henexo et al, 2013). However, in this study the Eating Disorders vatiable does not seem to be the most important vasiable when clas- sifjing the clinical population, which may be due to the fact thar the mean age of she participants was 40 years old Therefore, it may be augued that gender determinnts ase at the soot of attudes aud lifestyles related to vuluesabilty and the tendency to become ill. For instance, the ideal of femi- ninity based on s thin, inevt body (she contemposnuy gender mode!) inexeases the vulnerability of young women whose identity is developing, leading 10 exting disorders (Velasco, 2009, p. 148), As Sinches-Léper and Dsescls (2012) state, “conformity to some feminine nouns could be selated 10 gxcater reporting of elxonic illnesses, which isa health cost" (p. 192) aad so “identifying the association berween peaple's constaictions of femininity and masculinity and theis health may contre to changing peablemat gender noame using cognitive techaiques” (p. 193) alo do psleslgi annals of psychology, 202, ol 352° ans) Conclusions We can conchice that gender watiables have been fond to be relevant in determining whether women are receiving paychological care, ie, greater conformity to gender soles leads women to seek moze psychological cate. When soady- ing health, itis erential to inchade not only sex as a variable, but also gender as a sociocultusal dimension mediating ill ness. Ove results show the impoztance of futher explosing sex and gender a8 nro different dimensions that aeed to be considexed in research; otherwise, these is a xisk of intvodue- ing bias into the study of healt. The inchision of a geader pecepective ia sesensels will help to achieve a broader understanding of the aetiology af disosdess, ie. the suadeslying censone why mea and semen become ill differeatiy, a phenomeaca that is nat sufficiency explained by biology. Being able to analyse the weight of so- ciseulmsal variables in the development of a given mental llnese becomes enicial in osdes to identity the celevaat fae- tous of au illness, Integssting the geudes pevepective into ed uucational and health-related programmes, clinieal treatments Gocluding individval peychothesspy), aad prevention pro- (genmmes may thus inccease their effectiveness and elficien- Moving away from gender ideals can be stressfl for both women and men (Mand S Aguera, 2009). However rnot fitting into these ideals might not be so problematic if women ‘were more mene of thom and if they were to change. Taking a gender perspective approach and pointing to socioculnural factors as determinants, with the implica- tlons that this entails, cna help to ‘depsychiopathalagise'die- orders experienced by women and to design interventions promoting henlthies bebavionss Tels ont belief chat ous facings provide an avenue wosth explosing, However, our snady has a aumber of limitations that should be considered. This smly is the fiest part of lager srady that is projected to include men ia the sample. A compaiison of the scales between the sample of men aud ‘women could thus be made to explore models such as this one and study the health of women, men, and non-binary people, It would also lve been interesting to inchide in the sample women with severe mental disorders, in institutional cate, of with a non-waiversity level of education ia order to make the results moze geuetslisable Iris essential thar fanace lines of xeseauch futher explore the different forms of illness that men aud women (a8 well as tuansgender people) experience by taking a feminist, biopsy chosocial pesspeetive and by defining more cleasly the sex/gender constsuets. This will zesut ia better psychalog’- cal caze and better mental and overall health for women, ‘men, and non-binasy peopleGene sme met eb ore fe anf sti ae 15 References Amescan Pechitic Associaton. 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