Women’s Mental Health: The Struggles Nobody Talks About at Home

Depression is about 1.5 times more common in women than in men. In 2023, WHO estimated that 6.2% of adult women worldwide were living with depression, compared with 4.1% of men (WHO). Anxiety disorders follow the same pattern: WHO notes that women and girls are more likely to have one than men and boys (WHO).

Numbers like these are easy to read and forget. In desi and Gulf homes they usually look much quieter. A daughter-in-law smiles at every guest and cries in the bathroom. A new mother tells everyone she is “just tired”. A working woman finishes office work, then starts the second shift at home. An expat wife in Riyadh or Dubai waits all day for her husband to come home because she has no one else to talk to.

This article goes through the pressures that shape women’s mental health at different stages of life, the signs worth taking seriously, and what women and their families can do. It is written for women, and just as much for the husbands, mothers, mothers-in-law and brothers who love them.

Need help right now?

If you or anyone else is in danger, or you are having thoughts of harming yourself, please contact someone today.

• Pakistan: Umang mental health helpline 0311 7786264; in an emergency, police 15 or Rescue 1122
• Saudi Arabia: emergency 911; counselling line 920033360 (8am–8pm, Saturday 1pm–8pm; not 24 hours)
• India: Tele-MANAS 14416 or 1-800-891-4416 (emergency 112)
• Bangladesh: Kaan Pete Roi +880 9612-119911 (3pm to 3am daily)
• United States: 988 Suicide & Crisis Lifeline, call or text 988 (24/7)
• UK and Ireland: Samaritans 116 123 (free, 24/7)
• European Union: emergency number 112
• Anywhere else: call your local emergency number, or find a free helpline at findahelpline.com.

Why women carry a heavier load

Biology plays a part, especially around pregnancy, childbirth and menopause. But much of the extra risk is social. A systematic review of studies from Pakistan found that being female, being a housewife, financial difficulty and relationship problems were linked with anxiety and depression. Arguments with husbands and problems with in-laws were linked in three of the eleven studies that examined risk factors. Women who had a close, confiding relationship were less likely to have anxiety or depression (Mirza & Jenkins, 2004). The authors were careful to say the evidence had methodological limits. Still, their main conclusion was that anxiety and depression in Pakistan appear to have a major social cause.

That is the hopeful part. If much of the problem is social, then much of the solution is social too: how a family listens, shares work and treats the women in it.

The pressures, stage by stage

Not every woman will face all of these. Read the ones that fit your life.

The new bahu

Moving into a joint family often means a new home, new rules and a new hierarchy overnight. Many young wives are expected to adjust fast, stay polite, and keep their unhappiness to themselves so that no one says “she’s difficult”.

What it can look like: constant tension in the body, loss of appetite, feeling like a guest in your own home, crying when alone, losing the confident person you were before marriage.

One thing to try today: pick one small, specific need, such as an hour alone in your room after lunch or a weekly call with your own family, and ask your husband privately for help protecting it. Small, clear requests are easier to agree to than general complaints. My guide on setting boundaries with family without guilt has respectful scripts, including a section on in-laws.

The new mother

WHO estimates that more than 10% of pregnant women and women who have just given birth worldwide experience depression (WHO). In low- and lower-middle-income countries, a systematic review found that common mental disorders such as depression and anxiety affected an average of about 19.8% of women after birth. Risk factors included lack of empathy and support from the partner, hostile in-laws, intimate partner violence, insufficient emotional and practical support and, in some settings, giving birth to a girl (Fisher et al., 2012). Having a kind, trustworthy partner was protective.

In desi families, a new mother is often surrounded by people and still alone. Everyone is watching the baby, and no one asks how she is.

What it can look like: feeling low or numb most of the day, anxiety that won’t switch off, feeling disconnected from the baby, guilt, irritability, or feeling that the family would be better without you.

One thing to try today: take the free postpartum depression test, which uses the PHQ-9 and can be taken during pregnancy or in the first year after birth. It is a screening tool, not a diagnosis. Show the result to your doctor or lady health worker. If you ever have thoughts of harming yourself or your baby, get urgent help today using the numbers above. These thoughts are a symptom of an illness that can be treated. They don’t make you a bad mother.

There is strong local evidence that help works. In rural Rawalpindi, a trial trained lady health workers to deliver a simple CBT-based programme to depressed mothers during their routine visits. When the babies were six months old, 23% of mothers in the programme still met criteria for major depression, compared with 53% in the comparison group (Rahman et al., 2008).

The working woman

Earning your own money can be good for mental health. WHO describes decent work as a source of livelihood, confidence, purpose, positive relationships and routine (WHO). The strain often comes from what surrounds the job: the second shift of cooking, children and guests at home, the guilt of “neglecting” the family, long commutes, and in some workplaces unwanted comments or harassment.

What it can look like: exhaustion that sleep doesn’t fix, snapping at children, feeling guilty at work and at home at the same time, and dread on Sunday nights.

One thing to try today: write down every task you do at home in a normal week, then sit down with your husband or family and divide that list on paper. Saying “I’m tired” is easy to wave away. A written list is much harder to ignore. If you are being harassed at work, keep a dated record of each incident and speak to someone you trust.

The expat wife

Moving to the Gulf, or with a husband to any new country, can mean losing your parents, friends, language, work and independence in one move. Some women are home alone for most of the day in an apartment, without a car or a job, while the husband works long hours and the family back home assumes life abroad is easy.

What it can look like: sleeping a lot or very little, endless scrolling, feeling invisible, homesickness that gets worse over time instead of better, and saying “I’m fine” on every video call home.

One thing to try today: build one weekly anchor outside the home, such as a class, a volunteer role, a mosque or community group, a walking partner, or an online course with live sessions. The aim is regular contact with the same people, which is how a sense of belonging slowly comes back.

The woman in midlife

Menopause is still barely discussed in many desi homes. WHO lists difficulty sleeping, changes in mood, depression and anxiety among the possible symptoms around menopause, alongside hot flushes and other physical changes (WHO). Midlife is also often when children leave, parents fall ill, and a woman who has spent decades caring for others suddenly asks, “What about me?”

What it can look like: irritability, broken sleep, low mood, anxiety, forgetfulness and a loss of confidence that seems to come from nowhere.

One thing to try today: book a visit with a doctor and name the symptoms directly, including mood and sleep. You don’t have to accept “yeh umar ka masla hai” as the end of the conversation.

When home isn’t safe

Violence against women is common. WHO estimates that nearly 1 in 3 women worldwide have experienced physical and/or sexual violence from an intimate partner or sexual violence from a non-partner. WHO also lists depression, post-traumatic stress, anxiety disorders, sleep difficulties and suicide attempts among its consequences (WHO).

If you are being hurt, threatened or controlled at home, it is not your fault, and you don’t have to fix it by “adjusting” more. Your safety comes first. When it is safe, talk to someone you trust, or contact one of these official services:

If someone at home is hurting or threatening you

If you are in danger right now, get help immediately.

• Pakistan: In an emergency, call police on 15 or Rescue 1122.

For emotional support, a trusted family member, friend or qualified professional can help too.

A composite of common situations (not a real client). Hira is 31. She was a schoolteacher in Karachi before marrying and moving to Jeddah, where her husband works long shifts. She doesn’t drive and doesn’t know anyone nearby. After her second baby, she stops dressing up, sleeps through the afternoons and feels a constant knot in her chest. On calls home she says everything is fine, because her mother’s advice is always “sabr karo”. One evening she takes a free depression screening on her phone and scores in the moderately severe range. It is the first time she has seen her feelings described as something real and treatable rather than ungrateful. She shows the result to her husband, and they book a doctor’s appointment together.

What helps: for women

1. Check your symptoms. The PHQ-9 depression test and the GAD-7 anxiety test are free, private and take a few minutes. Both were validated in research as brief measures of depression severity and generalised anxiety (Kroenke et al., 2001; Spitzer et al., 2006). They are screening tools, not a diagnosis, but a result in black and white can make it easier to ask for help.
2. Find one confiding relationship. The Pakistan review found that women with a close, confiding relationship were less likely to have anxiety or depression (Mirza & Jenkins, 2004). That person could be a sister, a friend, a cousin abroad or a counsellor.
3. Calm the body first. Slow breathing, a daily walk and a regular bedtime won’t fix a difficult marriage, but they can lower the anxiety enough for you to think clearly. My guide on how to handle anxiety has step-by-step techniques for home and night-time.
4. Ask for help in specifics. “Please take the children from 6 to 7 every evening” works better than “nobody helps me”.
5. Remember that treatment works. WHO lists behavioural activation, cognitive behavioural therapy, interpersonal psychotherapy and problem-solving therapy among effective psychological treatments for depression (WHO).

What helps: for husbands and families

• Ask, and then listen without fixing. “Tum theek ho? Sach mein?” Then let her talk without defending your mother or explaining why she is wrong.
• Share the work, visibly. In joint families, a husband who openly picks up tasks changes what others think is normal.
• Protect her links to her own people. Calls home, visits and friendships are protective, not a sign of disloyalty.
• After a birth, look after the mother as well as the baby. Partner support and kind in-laws are among the clearest protective factors in the research (Fisher et al., 2012).
• Treat a mental-health appointment like any other doctor’s visit. Drive her there, look after the children, and don’t make it a family announcement.

When to get professional help

Please see a psychologist, psychiatrist or doctor if:

• low mood, numbness or worry has lasted two weeks or more
• you can’t sleep, eat or function the way you normally do
• your PHQ-9 or GAD-7 score is in the moderate range or above
• you feel unsafe at home
• you have any thoughts of harming yourself or your baby (use the helplines above today)

Choose a qualified, registered professional. Many offer online sessions, which can help if you live far from a city, can’t travel alone, or are living abroad.

For more, explore the Mind section of this site.

Quick FAQ

Is it ungrateful to feel depressed when I have a good husband and a comfortable home?
No. Depression is a health condition, not a measure of gratitude. It can affect anyone, including women whose lives look fine from outside.

My mother-in-law says therapy is for “pagal” people. What should I say?
You don’t have to win that argument. You can simply say you are seeing a doctor for stress and sleep, which is true. Your health is your decision.

Can men use the PHQ-9 and GAD-7 too?
Yes. These questionnaires work for adults of any gender. New fathers can also take the postpartum test.

References

1. World Health Organization. Depressive disorder (depression) (fact sheet). https://www.who.int/news-room/fact-sheets/detail/depression
2. World Health Organization. Anxiety disorders (fact sheet). https://www.who.int/news-room/fact-sheets/detail/anxiety-disorders
3. Mirza I, Jenkins R. Risk factors, prevalence, and treatment of anxiety and depressive disorders in Pakistan: systematic review. BMJ. 2004;328(7443):794. https://doi.org/10.1136/bmj.328.7443.794 (PubMed 15070634)
4. Fisher J, Cabral de Mello M, Patel V, et al. Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review. Bulletin of the World Health Organization. 2012;90(2):139G-149G. https://doi.org/10.2471/BLT.11.091850 (PubMed 22423165)
5. Rahman A, Malik A, Sikander S, Roberts C, Creed F. Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. The Lancet. 2008;372(9642):902-909. https://doi.org/10.1016/S0140-6736(08)61400-2 (PubMed 18790313)
6. World Health Organization. Mental health at work (fact sheet). https://www.who.int/news-room/fact-sheets/detail/mental-health-at-work
7. World Health Organization. Menopause (fact sheet). https://www.who.int/news-room/fact-sheets/detail/menopause
8. World Health Organization. Violence against women (fact sheet). https://www.who.int/news-room/fact-sheets/detail/violence-against-women
9. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine. 2001;16(9):606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
10. Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine. 2006;166(10):1092-1097. https://doi.org/10.1001/archinte.166.10.1092

This article is for education only and is not a diagnosis or a substitute for professional care.

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Dr. Malik Sherjeel Awan

Dr. Malik Sherjeel Awan is a clinical psychologist based in Makkah. PsyD (Clinical Psychology), University of Karachi.
He writes practical, evidence-based psychology for everyday life.

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