Women in Pakistan generally have high rates of reported anxiety than men. The higher level of anxiety reported in women can be due to many socioeconomic pressures faced by women in the society.
There is evidence that the pressure of managing multiple roles in women is greatest, and the psychological benefits of unemployment are the least, under condition of heavy family responsibilities.
This research is helpful in knowing the presence of anxiety among workers and nonworking women of Peshawar with reference to their socioeconomic status, family status, and the number of children.
Sampling and methods used
In this cross sectional study, subjects were selected by convenient sampling of the population and a sample of 100 women (50 working and 50 non working) was taken from Peshawar. Taylor manifest anxiety scale (TMA scale) was administered in each respondent to find different levels of anxiety.
It was found that anxiety was observed in 52 out of 100 women. Among them 46.30% were workingwomen and 53.70% were nonworking.
Thus, it was concluded that anxiety was dominant among nonworking women. Results also revealed that living in nuclear family system had a great impact as women living in this type of family system were suffering from anxiety. The age range of the respondents was from 15 to 65 years with a mean age of 36 years. Results also showed association between high number of children and anxiety apart from three variables namely low income/socioeconomic status, age and job description of the respondents.
There is a need to support all nonworking women in order to increase women’s chances to learn, to develop self efficacy and self assistance, to built social network and open access to informational, instrumental and emotional support to avoid the risk of developing anxiety.
The term “working women” refers to women who get paid to work outside the home. Working outside the home is a big boost for women psychological and even physical health. Being gainfully employed is good for one’s role fulfillment, self-confidence and self-esteem.
Women in Pakistan have been assigned the monotonous role of housework and child-rearing and putting up with in laws. They can take more responsibilities outside the house but they need to shed off some of other roles that our traditionalistic society has closeted them in.
According to Dr. Khan (2007) Pakistani women have high rates of anxiety. An unhappy, anxious mother is a bad news for the family as it is not just her mental health but that of her children that is affected as well (Khan, 2007).
There is anecdotal evidence that housewives frequently complain about the monotony of their lives. They feel that they have to look after children and do that housework and they do not have time for themselves. Compared to the working women their social environment is limited. Their husbands are the only ones to appreciate their intense efforts they make for their homes. A woman, for instance, with six children and a husband, and with no help from others and no money for the most costly labor-saving devices, simply cannot organize her necessary duties so that she will have leisure for pleasure and activities outside the daily routine. In such a house the most modest requirements for food, shelter and clothing become a driving force that pushes aside relentlessly any irrelevant longing. The working women, however, have the chance of being ‘appreciated by the society and behave independently and earn money. On the other hand, many working women find that children provide a common focus of interest for them and their husbands and many of them feel that the time devoted to children resulted in less sharing and companionship and less spontaneity in marital relationship. The problems and difficulties of working women are multidimensional and may be broadly classified into three types environmental, social and psychological.
Joining the business life outside home is an extra burden for women who have already been responsible for baby, sitting (child rearing) and other household chores. From this aspect, working, women are expected to have more psychological symptoms.
However, the studies carried out in various countries show that it is not the case. Working has the positive psychological influence on women especially those from lower socioeconomic class.
In a comparison of working and non working women, Mukhopadhay showed a positive statistically significant relationship between the health score and anxiety score. Traditional role theories suggest that women who are trying to maintain several roles would be expected to experience negative stressful feelings (Mukhopadhay & Susmita, 1996). In contrast, more recent theories suggest that individuals may profit from enacting multiple roles. Performing several roles may increase individual’s privileges and resources in their social environment, assist in establishing social and economic status and security, act as buffer for problems or families in any single life domain, and enhance feelings of self-wealth. Recent studies of risk and benefits of having multiple roles indicate that people who had more social roles experience less psychological distress and mental illness. Considering recent studies of risk and benefits of having multiple roles, the emotional problems, and complaints of housewives arc understandable. Then anxiety and other emotional problems could be related to their monotonous life, lack of independence and social support, a sense of insecurity regarding marital life etc. The most common contributory factors which may lead to mental distress in non-working women are low family income, dispute among spouses, verbal abuse by in-laws and too many children.
Non working women are more likely to suffer from anxiety than working women.
Non educated women are more prone to develop anxiety than educated ones.
Women with low income jobs will suffer more from anxiety than the women with high income jobs.
Married women have more anxiety than unmarried.
Women living in nuclear family have high level of anxiety than women in joint family system.
Women having greater number of children have more anxiety than women having less number of children.
Aged women are liable to be more anxious than young ladies.
Women with poor socioeconomic status have more anxiety than women living under better conditions.
WHO has defined health in terms of complete physical, mental and social well-being and not the mere absence of disease or disability. The health status of women remains precarious, especially in the developing nation we are still far from an equal status to both men and women on every social indicator. In a fortunate turn, women get enter into various professions, mostly at the lower level, with a proportionately less no at the middle level and handful at the higher level.
Though the economic and professional status has contributed to their sense of, security and the ability to face otherwise challenging situation, various other factors have contributed to their sense of insecurity. The dual task of handling home and job mixed with a real or perceived threat against women may make them feel rejected, isolated and tense. A patriarchal society where males dominate the domestic as well as the work front, a growing sense of anxiety is imperative. The social situations that make them uncertain and hesitant also make them socially anxious.
Women have not only excelled in teaching, medicine, nursing and social services but they have also proved their worth in commercial fields.
As a society becomes more and more complex and technologically advanced, women depend increasingly for their further development on their individual talent and initiative (Lerita & Tonicc, 1981).
It has been concluded by various studies that women (whether working or non-working) cope with anxiety in a physiologically more economic way but at a higher psychological cost. This feeling creates a number of physical and psychological problems for them.
The entity of general anxiety was originally conceptualized by Freud, who coined the term “Anxiety Neurosis”.
Word anxiety means “Mental uneasiness” or “Distress arising from fear of what may happen”.
2.1 Definition of Anxiety
“Anxiety is a physiological state characterized by cognitive, somatic emotional and behavioral components”.
“Bodily response to a perceived threat or danger which is triggered by a combination of bio-chemical changes in the body of the patients personal history memory and social situation” (Schwarzar, 1990).
It is a physiological state not pathological or maladaptive. A person may feel anxious without having an anxiety disorder. A person facing a clear and present danger or a realistic fear is not usually considered to be in a state of anxiety. In addition, anxiety frequently occurs as a symptom in other categories of psychiatric disturbance. Anxiety may occur without a case or it may occur based on a real situation but may be out of proportion to what would normally be expected. Sever anxiety can have a serious impact on daily life.
Anxiety is often related to fear but it not the same thing fear is a direct, focused response to a specific event or object of which an individual is consciously aware. Most people feel fear if someone points a loaded gun at them or if they see a tornado forming on the horizon. They also will recognize that they are afraid.
Anxiety, on the other hand is often unfocused vague and hard to pin down to a specific cause.
Anxiety has an aspect of remoteness that makes it hard for people to compare their experiences. It is often triggered by objects of events that are unique and specific to an individual (Taylor, 1953)
There are some theories which tells us that anxiety is a learned behaviour which can be unlearned with the help of therapy and life style changes (Bloom & Harold, 1998).
2.3 Causes of Anxiety
Anxiety may be caused by:
Combination of above three
The doctors’ initial task is to see if your anxiety is caused by medical condition.
2.3.1 Mental Condition
Some types of anxiety include in mental condition:
Generalized anxiety disorder. These are worst form of anxiety and lead to various mental disorders.
The cause of anxiety cannot be linked to a single situation or event, rather many psychoanalysts believe that there are both physical and environmental triggers that combine to create a particular anxiety disorder.
For example; some psychoanalysts feel anxiety stems from unconscious conflicts that arise from past fearful experiences. These experiences can prime the person to react anxiously to situations where most people would experiences no fear other scientist link anxiety disorders to a biochemical imbalance in the brain that can be alleviated through the use of medication or natural food supplements.
2.3.2 Physical Triggers
The Autonomic Nervous System
The nervous system of human beings is hard wired to respond to dangers or threats. These responses are not subject to conscious control and are the same in humans as in lower animals. They represent an evolutionary adaptation to animal predators and other dangers that all animals including primitive humans had to cope with.
The most familiar reaction of this type is the fight or flight reaction to a life threatening situation when people have fight or flight reactions, the level of stress hormones in their blood rises. They become more alert and attentive, their eyes dilate, their heartbeats increases, their breathing rates increases, and their digestion slows down, making more energy available to the muscles (Spielberger, 1972).
This emergency reaction is regulated by a part of the nervous system called the autonomic nervous system or ANS.
The ANS is controlled by the hypothalamus, a specialized part of the brainstem that is among a group of structures called the limbic system. The limbic system controls human emotions through its connections to glands and muscles. Its also connects to the ANS and higher brain centers, such as parts of the cerebral cortex.
One problem with this arrangement is that the limbic system can not tell the difference between a real physical threat and an anxiety-producing thought or idea. The hypothalamus may trigger the release of stress-hormones from the pituitary gland even when there is no external danger.
Anxiety and Coronary Heart Disease
The idea that a link may exist between anxiety and the heart has been around for as long as the history of medicine has documented. However despite a wide spread public perception that stress and anxiety are significant risk factors for coronary heart disease (CHD), numerous conceptual and methodological difficulties in studying whether a relationship between anxiety and CHD exists have scared away many researchers from even attempting such studies (Akhtar, 1998). It is only very recently with advances in methodobgy, that possible associations between certain types of anxiety and CHD have been uncovered. Medical conditions which leads to anxiety are
Mitral valve prolapse
ARDS (Adult Respiratory Distress Syndrome)
Endocrine Diseases and Disorders Lead to Anxiety
Anxiety is a symptom of certain endocrine disorders that are characterized by:
Over activity or under activity of the thyroid gland.
Gushing’s syndrome in which cortisol overproduction’s.
2.3.3 Biochemical Basis of Anxiety
A second problem is caused by the biochemical side effects of too many false alarms in the ANS. When a person responds to a real danger, his/her body relieves itself of the stress hormones by facing up to the danger or fleeing from it. In modern life, however, people often have fight or flight reactions in situations where they can neither run away nor lash out physically (Schwarzar, 1990). As a result, their bodies have to absorb all the biochemical charges of hyper arousal rather than release them. These biochemical changes can produce anxious feelings as well as muscle tension and other physical symptoms of anxiety.
There are various endocrinological diseases that often include anxiety states as part of their initial presentation or as a characteristic symptom seen during their course understanding the mechanism by which anxiety develops as a routine part of these neuro endocrinological disorders may help us understand the organic basis of anxiety disorders.
Recent work suggests that some patients may be biochemically more sensitive to the development of anxiety symptoms in the presence of particular diseases.
Mathew et al have reported that patients with generalized anxiety disorders have high plasma catecholamine levels than normal controls (Mathew). These patients may down regulate catechol receptors as a result of these higher plasma concentrations and thus experience reduced receptor sensitivity in their adrenergic nervous system. Other investigators, however, have failed to confirm these finding. Abelson et al have noted that patients with generalized anxiety have a blunted growth hormone response to clonidine (an alpha2 partial agonist) stimulation, suggesting a decreased sensitivity of alpha2 adrenergic receptors. It may be that higher levels of catecholamines lead to down-regulation of selective patients post-synaptic alpha2 adrenoceptors.
Why Serotonin Cause Depression and Anxiety
Serotonin appears to be one of the major players in mood and a variety of other disorders. But exactly how remain an open question. Imagine walking past a dark alleyway in a dangerous part of some city; although it might be a shortcut most people wouldn’t consider taking it. In healthy subjects, Serotonin appears important of this automatic avoidance (PLOS Computational Biology, 2008).
It has long been suggested that over activity of the Serotonin system may relate to mood disorders such as depression and anxiety, as these seem characterized by too much withdrawal and avoidance. However, the new modeling study simply suggests that we think about what happens when these reflexes fail suddenly you have to think hard to avoid things that used to be avoided reflexively you might for example consider walking down the dangerous alley, be robbed and thus be reminded and taught by additional experience that dark alleys are to be avoided. Serotonin enhancing drugs, such as prozac, are then suggested to reinstate the reflexive avoidance and thus to redress the balance (PLOS Computational Biology, 2008).
2.3.4 Social and Environmental Stressors
Because humans are social creatures, anxiety often has a social dimension. People frequently report feelings of high anxiety when they anticipate fear the loss of social approval or love. Social phobia is a specific anxiety disorder that is marked by high levels of anxiety or fear of embarrassment in social situations (Sheikh & Bhushan, 2002).
Another social stressor is prejudice people who belong to groups that are targets of bias have a higher risk of developing anxiety disorders. Some experts think, e.g. that the higher rates of phobias and panic disorder among women reflects their greater social and economic vulnerability.
Several controversial studies indicate that the increase in violent or upsetting pictures and stories in news reports and entertainment may raise people’s anxiety levels. Stress and anxiety management programs often recommend that patients cut down their exposure to upsetting stimuli.
Environmental or occupational factors can also cause anxiety people who must live or work around sudden or loud noises, bright or flashing lights, chemical vapors, or similar nuisances that they cannot avoid or control may develop heightened anxiety levels. In Sweden, according to information published by the National Board of Health and welfare, every third working person suffers from fatigues, dejection and anxiety and every seventh working person is mentally exhausted at the end of the working day.
2.3.5 Personality of the Person
There are certain hypothesis which shows that life experiences alone do not determine whether a person will or will not develop anxiety (Taylor, 1953). The researchers believe personality may play a major role in how well a person deals with whatever life throws their way. This is based on the idea that people who have low self esteem and good coping skills seems to be more prone to developing anxiety than do people with higher self esteem and good coping skills. People who have low self esteem or bad coping skills tend to look at the situation as more of a challenge, which results in greater amount of self inflicted stress. These stressors if left unchecked results in the development of anxiety.
Stills other scientists believe and look to faulty brain chemistry as the underlying cause of anxiety. This is probably the most widely accepted theory of why people develop anxiety, but it is also the one theory highly debated. This theory has become widely accepted since the symptoms of anxiety can be treated with medications.
People suffering from anxiety and depression are thought to have altered levels of neurotransmitters. The two chief chemicals involved are nor adrenaline and Serotonin when given medications, the levels of neurotransmitters are regulated therefore relieving the symptoms of anxiety. The debate over the brain chemistry theory centers on the issue of whether the person would have improved even without the medications.
Each of these theories, heredity, life experiences, brain chemistry and personality, are plausible causes of anxiety.
2.3.6 Medication and Substance Use
Numerous medications may cause anxiety like symptoms as a side effect. They include:
Birth Control Pills
Thyroid and asthma control
Some psychotropic agents
NSAIDS (Such as Flurbiprofen)
Caffeine can also cause anxiety-like symptoms when consumed in sufficient quantity.
Withdrawal from certain prescription drugs primarily (3-blockers and corticosterods
Withdrawal from drugs of abuse, including LSD, > Cocaine > Alcohol > Opiates
2.3.6 Childhood Development and Anxiety
Researchers in early childhood development regard anxiety in adult life as a residue of childhood memories of dependency. Humans learn during the first year of life that they are not self sufficient and that their basic survival depends on others. It is thought that this early experience of helplessness underlies the most common anxieties of adult life, including fear of powerlessness and fear of not being loved.
Thus, adults can be made anxious by symbolic threats to their sense of competence or significant relationships, even though they are no longer helpless children.
The psychoanalytic model gives a lot of weight to the symbolic as aspect of human anxiety e.g. includes phobic disorders obsessions, compulsions and other forms of anxiety that are highly individualized. Because human mature slowly, children and adolescents have many opportunities to connect their negative experiences to specific objects or events that can trigger anxious feelings in later life e.g. a person who was frightened as a child by a tall man wearing glasses may feel panicky years later, without consciously knowing why by something that reminds him of that person or experience.
According to Freud hypothesis, people feel anxious when they feel torn between moral restrictions and desires or urges toward certain actions. In sonic cases, the persons anxiety may attach itself to an object that represents the inner conflict e.g. some one who feel anxious around money may be pulled between desire to steal and the belief that stealing is wrong. Money becomes a symbol for the inner conflict between doing what is considered right and doing what one wants.
Phobias are a special type of anxiety reaction in which the person concentrates his or her anxiety on a special object or situation and then tries to avoid.
It is estimated that 10-11% of the population will develop a phobia in their life time. Some phobias are agoraphobia, claustrophobia and social phobia.
2.3.9 Alcohol Researchers Relate a Genetic Factor to Anxiety in Women
Researchers have identified a genetic factor that appears to influence anxiety in women. Combining DNA analysis, recordings of brain activity and psychological test, investigator at the NATIONAL INSTITUTION ON ALCOHOL ABUSE AND ALCOHOLISM (NIAAA) found that Caucasian and American Indian women with the same gene variant had similarly high scores on tests that measure anxiety (Sinha, 1997).
These women also had similar EEG recording of brain electrical activity as unique as an individual’s fingerprints that showed characteristics of anxious temperament.
The team investigated a gene that encodes Catechol-o-Methyltransferase, or COMT, a major enzyme responsible for the metabolism of certain neurotransmitter the nervous system chemical messenger including norepinephrine, which effects anxiety. People can inherit various possible forms, or polymarphisms, of the COMT gene, which in turn can affect the metabolism of their neurotransmitters.
Other studies from NIAAA and elsewhere indicate a role for COMT in cognition. The COMT polymorphism is a common genetic valiant, which lead to differences in both anxiety and cognition, both domains of normal behaviour. The COMT variant’s different effects also implicate it as a risk factor in diverse and clinically very distinct psychiatric diseases, including alcoholism, schizophrenia and anxiety disorders.
2.4 Sign and Symptoms
Anxiety is characterized by the following symptoms produced by the hormonal.
Difficulty in breathing
Sensations of tightness in chest neck, shoulders or hands.
Feelings of doom
Confusion or inability to concentrate
Feelings of tension/nervousness
Feeling “hyper” or “Keyed up”
Feeling of unreality
Feeling of Panic”
Feeling of Terror
2.5 Measurement of Anxiety
2.5.1 Different Rating Scales to Measure Anxiety
Hamilton Anxiety rating scale (HARS-1959)
Spielberger’s stat trait anxiety inventory
Taylor Manifest Anxiety scale
Cattell’s trait and stats anxiety measures the affect adjective check list.
The SCL-90 symptom check list the profile of mood states crown-crisp experientel index.
Among many instruments to assess anxiety, one stands out: the state trait anxiety inventory. It is more frequently used scale in research world-wide and no other measure has received as many foreign language adaptations and citations in the last three decades. It consist of 20 items to assess state anxiety and another 20 items to assess trait anxiety.
An alternative to STAI is the Endler Multidimensional Anxiety Scales, (Sheikh & Bhushan, 2002)based on Endlers theory of person situation interactionism.
Diagnosing anxiety is difficult and complex because of the variety of possible causes and because each person’s symptoms arise from highly personalized and individualized experience.
When a doctor examines an anxious patient he or she will first rule out physical conditions and diseases that have anxiety as a symptom.
No specific laboratory test to diagnose anxiety disorder.
The doctor bases his/her diagnosis of GAD on reports of the intensity and duration of symptoms.
The doctors will take detail history to sec if prescription drugs, alcohol or drug abuse, caffeine work environment or other external stressors could be triggering the anxiety.
Doctor may administer several brief psychological tests, including the Hamilton anxiety scale and the anxiety disorders interview schedule (ADIS).
Self-care at home
IN certain cases, treat anxiety at home without the involvement of a doctor. These are limited to anxiety attacks of short duration in which you know the cause e.g. anxious over an upcoming public performance, a final exam, or a pending .job interview. In such circumstances, stress may be relieved by such actions as these.
Picturing yourself successfully facing and conquering the specific fear.
Taking with a supportive person.
Taking a long, warm bath
Resting in a dark room
Treatment depends on the cause of the anxiety is a physical ailment, treatment is directed toward eliminating that ailment e.g. if your thyroid gland were overactive and causing anxiety, the treatment might involve surgery and various thyroid regulating medications.
If underlying cause is psychological, treat the underlying cause.
If cause is difficulty in a marriage, the doctor may suggest marital counseling.
Withdrawal from a substance of abuse is often addressed with drug abuse , treatment.
May drugs are used in the treatment of anxiety, which can be classified as:
Include benzodiazepines or barbiturates:
Used in the treatment of Anxiety but it is not benzodiazepines.
Anti-seizure medications used to treat anxiety in some people.
SSRI (Selective Serotonin Reuptake Inhibiters)
Include the following drugs:
Most patients with anxiety will be given some form of psychotherapy along with medication. Many patients benefit from insight-oriented therapies, which are designed to help them uncover unconscious conflicts and defense mechanisms in order to understand how their symptoms developed.
Cognitive-behavioral therapy (CBT) also works well with anxious patients. In CBT, the patient is taught to identify thoughts and situations that stimulate his or her anxiety, and to view them more realistically. In the behavioral part of the, program, the patient is exposed to the anxiety-provoking object, situation, or internal stimulus (like a rapid heart beat) in gradual stages until he or she is desensitized to it.
Unfortunately, a 2002 report stated that about half of the patients with an anxiety disorder who see their primary care physician go untreated (Sheikh & Bhushan, 2002). The prognosis for resolving anxiety depends on the specific disorder and a wide variety of factors, including the patient’s age, general health, living situation, belief system, social support network, and responses to different medications and forms of therapy.
2.8 Anxiety level and its temporal change among working mothers in Calcutta
Non-working mothers studied in 1992, exhibited higher anxiety levels than non-working mother in 1987. On the other hand, working mothers in the 1992 study had lower anxiety level than working mothers studied in 1987. Working women in 1992 had lower anxiety scores probably because role conflict no longer existed. Furthermore, their wages enabled them to buy time saving devices or hire domestic help to reduce their household chores (Mukhopadhay & Susmita, 1996).
Numerous Indian women simultaneously perform demanding roles at home and in the work place.
2.9 Anxiety in non-working women
In a study conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore found statistically significant association between anxiety in women and education and number of their children (Iqbal, Nadeem, & Fatima, Anxiety in nonworking women, 2004). No significant association was observed between women anxiety and their family system. It was observed that 74% of non-working women and 36% of working women had anxiety.
2.10 Marital adjustment, stress and anxiety among working and non working married women
In a study conducted at Quaid-e-Azam University Islamabad, Pakistan in 2007, researchers found that non-working married women are better adjusted than working married women. The results further show that highly educated working and non-working married women con perform well in their married life and they are free from depression and Anxiety (H