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Mental Health Essay

Introduction

Mental health, often overshadowed by its physical counterpart, is an intricate and essential aspect of human existence. It envelops our emotions, psychological state, and social well-being, shaping our thoughts, behaviors, and interactions. With the complexities of modern life—constant connectivity, societal pressures, personal expectations, and the frenzied pace of technological advancements—mental well-being has become increasingly paramount. Historically, conversations around this topic have been hushed, shrouded in stigma and misunderstanding. However, as the curtains of misconception slowly lift, we find ourselves in an era where discussions about mental health are not only welcomed but are also seen as vital. Recognizing and addressing the nuances of our mental state is not merely about managing disorders; it's about understanding the essence of who we are, how we process the world around us, and how we navigate the myriad challenges thrown our way. This essay aims to delve deep into the realm of mental health, shedding light on its importance, the potential consequences of neglect, and the spectrum of mental disorders that many face in silence.

Importance of Mental Health

Mental health plays a pivotal role in determining how individuals think, feel, and act. It influences our decision-making processes, stress management techniques, interpersonal relationships, and even our physical health. A well-tuned mental state boosts productivity, creativity, and the intrinsic sense of self-worth, laying the groundwork for a fulfilling life.

Negative Impact of Mental Health

Neglecting mental health, on the other hand, can lead to severe consequences. Reduced productivity, strained relationships, substance abuse, physical health issues like heart diseases, and even reduced life expectancy are just some of the repercussions of poor mental health. It not only affects the individual in question but also has a ripple effect on their community, workplace, and family.

Mental Disorders: Types and Prevalence

Mental disorders are varied and can range from anxiety and mood disorders like depression and bipolar disorder to more severe conditions such as schizophrenia.

• Depression: Characterized by persistent sadness, lack of interest in activities, and fatigue.
• Anxiety Disorders: Encompass conditions like generalized anxiety disorder, panic attacks, and specific phobias.
• Schizophrenia: A complex disorder affecting a person's ability to think, feel, and behave clearly.

The prevalence of these disorders has been on the rise, underscoring the need for comprehensive mental health initiatives and awareness campaigns.

Understanding Mental Health and Its Importance

Mental health is not merely the absence of disorders but encompasses emotional, psychological, and social well-being. Recognizing the signs of deteriorating mental health, like prolonged sadness, extreme mood fluctuations, or social withdrawal, is crucial. Understanding stems from awareness and education. Societal stigmas surrounding mental health have often deterred individuals from seeking help. Breaking these barriers, fostering open conversations, and ensuring access to mental health care are imperative steps.

Conclusion: Mental Health

Mental health, undeniably, is as significant as physical health, if not more. In an era where the stressors are myriad, from societal pressures to personal challenges, mental resilience and well-being are essential. Investing time and resources into mental health initiatives, and more importantly, nurturing a society that understands, respects, and prioritizes mental health is the need of the hour.

• World Leaders: Several influential personalities, from celebrities to sports stars, have openly discussed their mental health challenges, shedding light on the universality of these issues and the importance of addressing them.
• Workplaces: Progressive organizations are now incorporating mental health programs, recognizing the tangible benefits of a mentally healthy workforce, from increased productivity to enhanced creativity.
• Educational Institutions: Schools and colleges, witnessing the effects of stress and other mental health issues on students, are increasingly integrating counseling services and mental health education in their curriculum.

In weaving through the intricate tapestry of mental health, it becomes evident that it's an area that requires collective attention, understanding, and action.

  Short Essay about Mental Health

Mental health, an integral facet of human well-being, shapes our emotions, decisions, and daily interactions. Just as one would care for a sprained ankle or a fever, our minds too require attention and nurture. In today's bustling world, mental well-being is often put on the back burner, overshadowed by the immediate demands of life. Yet, its impact is pervasive, influencing our productivity, relationships, and overall quality of life.

Sadly, mental health issues have long been stigmatized, seen as a sign of weakness or dismissed as mere mood swings. However, they are as real and significant as any physical ailment. From anxiety to depression, these disorders have touched countless lives, often in silence due to societal taboos.

But change is on the horizon. As awareness grows, conversations are shifting from hushed whispers to open discussions, fostering understanding and support. Institutions, workplaces, and communities are increasingly acknowledging the importance of mental health, implementing programs, and offering resources.

In conclusion, mental health is not a peripheral concern but a central one, crucial to our holistic well-being. It's high time we prioritize it, eliminating stigma and fostering an environment where everyone feels supported in their mental health journey.

Frequently Asked Questions

• What is the primary focus of a mental health essay?

Answer: The primary focus of a mental health essay is to delve into the intricacies of mental well-being, its significance in our daily lives, the various challenges people face, and the broader societal implications. It aims to shed light on both the psychological and emotional aspects of mental health, often emphasizing the importance of understanding, empathy, and proactive care.

• How can writing an essay on mental health help raise awareness about its importance?

Answer: Writing an essay on mental health can effectively articulate the nuances and complexities of the topic, making it more accessible to a wider audience. By presenting facts, personal anecdotes, and research, the essay can demystify misconceptions, highlight the prevalence of mental health issues, and underscore the need for destigmatizing discussions around it. An impactful essay can ignite conversations, inspire action, and contribute to a more informed and empathetic society.

• What are some common topics covered in a mental health essay?

Answer: Common topics in a mental health essay might include the definition and importance of mental health, the connection between mental and physical well-being, various mental disorders and their symptoms, societal stigmas and misconceptions, the impact of modern life on mental health, and the significance of therapy and counseling. It may also delve into personal experiences, case studies, and the broader societal implications of neglecting mental health.

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The Importance of Mental Health

It's not just a buzzword

Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences.

Akeem Marsh, MD, is a board-certified child, adolescent, and adult psychiatrist who has dedicated his career to working with medically underserved communities.

Westend61 / Getty Images

Risk Factors for Poor Mental Health

Signs of mental health problems, benefits of good mental health, how to maintain mental health and well-being.

Your mental health is an important part of your well-being. This aspect of your welfare determines how you’re able to operate psychologically, emotionally, and socially among others.

Considering how much of a role your mental health plays in each aspect of your life, it's important to guard and improve psychological wellness using appropriate measures.

Because different circumstances can affect your mental health, we’ll be highlighting risk factors and signs that may indicate mental distress. But most importantly, we’ll dive into why mental health is so important.

Mental health is described as a state of well-being where a person is able to cope with the normal stresses of life. This state permits productive work output and allows for meaningful contributions to society.

However, different circumstances exist that may affect the ability to handle life’s curveballs. These factors may also disrupt daily activities, and the capacity to manage these changes. That's only one reason why mental health is so important.

The following factors, listed below, may affect mental well-being and could increase the risk of developing psychological disorders .

Childhood Abuse

Childhood physical assault, sexual violence, emotional abuse, or neglect can lead to severe mental and emotional distress. Abuse increases the risk of developing mental disorders like depression, anxiety, post-traumatic stress disorder, or personality disorders.

Children who have been abused may eventually deal with alcohol and substance use issues. But beyond mental health challenges, child abuse may also lead to medical complications such as diabetes, stroke, and other forms of heart disease.

The Environment

A strong contributor to mental well-being is the state of a person’s usual environment . Adverse environmental circumstances can cause negative effects on psychological wellness.

For instance, weather conditions may influence an increase in suicide cases. Likewise, experiencing natural disasters firsthand can increase the chances of developing PTSD. In certain cases, air pollution may produce negative effects on depression symptoms.  

In contrast, living in a positive social environment can provide protection against mental challenges.

Your biological makeup could determine the state of your well-being. A number of mental health disorders have been found to run in families and may be passed down to members.

These include conditions such as autism , attention deficit hyperactivity disorder , bipolar disorder , depression , and schizophrenia .

Your lifestyle can also impact your mental health. Smoking, a poor diet , alcohol consumption , substance use , and risky sexual behavior may cause psychological harm. These behaviors have been linked to depression.

When mental health is compromised, it isn’t always apparent to the individual or those around them. However, there are certain warning signs to look out for, that may signify negative changes for the well-being. These include:

• A switch in eating habits, whether over or undereating
• A noticeable reduction in energy levels
• Being more reclusive and shying away from others
• Feeling persistent despair
• Indulging in alcohol, tobacco, or other substances more than usual
• Experiencing unexplained confusion, anger, guilt, or worry
• Severe mood swings
• Picking fights with family and friends
• Hearing voices with no identifiable source
• Thinking of self-harm or causing harm to others
• Being unable to perform daily tasks with ease

Whether young or old, the importance of mental health for total well-being cannot be overstated. When psychological wellness is affected, it can cause negative behaviors that may not only affect personal health but can also compromise relationships with others. 

Below are some of the benefits of good mental health.

A Stronger Ability to Cope With Life’s Stressors

When mental and emotional states are at peak levels, the challenges of life can be easier to overcome.

Where alcohol/drugs, isolation, tantrums, or fighting may have been adopted to manage relationship disputes, financial woes, work challenges, and other life issues—a stable mental state can encourage healthier coping mechanisms.

A Positive Self-Image

Mental health greatly correlates with personal feelings about oneself. Overall mental wellness plays a part in your self-esteem . Confidence can often be a good indicator of a healthy mental state.

A person whose mental health is flourishing is more likely to focus on the good in themselves. They will hone in on these qualities, and will generally have ambitions that strive for a healthy, happy life.

Healthier Relationships

If your mental health is in good standing, you might be more capable of providing your friends and family with quality time , affection , and support. When you're not in emotional distress, it can be easier to show up and support the people you care about.

Better Productivity

Dealing with depression or other mental health disorders can impact your productivity levels. If you feel mentally strong , it's more likely that you will be able to work more efficiently and provide higher quality work.

Higher Quality of Life

When mental well-being thrives, your quality of life may improve. This can give room for greater participation in community building. For example, you may begin volunteering in soup kitchens, at food drives, shelters, etc.

You might also pick up new hobbies , and make new acquaintances , and travel to new cities.

Because mental health is so important to general wellness, it’s important that you take care of your mental health.

To keep mental health in shape, a few introductions to and changes to lifestyle practices may be required. These include:

• Taking up regular exercise
• Prioritizing rest and sleep on a daily basis
• Trying meditation
• Learning coping skills for life challenges
• Keeping in touch with loved ones
• Maintaining a positive outlook on life

Another proven way to improve and maintain mental well-being is through the guidance of a professional. Talk therapy can teach you healthier ways to interact with others and coping mechanisms to try during difficult times.

Therapy can also help you address some of your own negative behaviors and provide you with the tools to make some changes in your own life.

The Bottom Line

So why is mental health so important? That's an easy answer: It profoundly affects every area of your life. If you're finding it difficult to address mental health concerns on your own, don't hesitate to seek help from a licensed therapist .

World Health Organization. Mental Health: Strengthening our Response .

Lippard ETC, Nemeroff CB. The Devastating Clinical Consequences of Child Abuse and Neglect: Increased Disease Vulnerability and Poor Treatment Response in Mood Disorders . Am J Psychiatry . 2020;177(1):20-36. doi:10.1176/appi.ajp.2019.19010020

 Helbich M. Mental Health and Environmental Exposures: An Editorial. Int J Environ Res Public Health . 2018;15(10):2207. Published 2018 Oct 10. doi:10.3390/ijerph15102207

Helbich M. Mental Health and Environmental Exposures: An Editorial. Int J Environ Res Public Health . 2018;15(10):2207. Published 2018 Oct 10. doi:10.3390/ijerph15102207

National Institutes of Health. Common Genetic Factors Found in 5 Mental Disorders .

Zaman R, Hankir A, Jemni M. Lifestyle Factors and Mental Health . Psychiatr Danub . 2019;31(Suppl 3):217-220.

Medline Plus. What Is mental health? .

National Alliance on Mental Health. Why Self-Esteem Is Important for Mental Health .

By Elizabeth Plumptre Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences.

Mental Health Essay for Students and Children

500+ words essay on mental health.

Every year world mental health day is observed on October 10. It was started as an annual activity by the world federation for mental health by deputy secretary-general of UNO at that time. Mental health resources differ significantly from one country to another. While the developed countries in the western world provide mental health programs for all age groups. Also, there are third world countries they struggle to find the basic needs of the families. Thus, it becomes prudent that we are asked to focus on mental health importance for one day. The mental health essay is an insight into the importance of mental health in everyone’s life. 

Mental Health

In the formidable years, this had no specific theme planned. The main aim was to promote and advocate the public on important issues. Also, in the first three years, one of the central activities done to help the day become special was the 2-hour telecast by the US information agency satellite system. 

Mental health is not just a concept that refers to an individual’s psychological and emotional well being. Rather it’s a state of psychological and emotional well being where an individual is able to use their cognitive and emotional capabilities, meet the ordinary demand and functions in the society. According to WHO, there is no single ‘official’ definition of mental health.

Thus, there are many factors like cultural differences, competing professional theories, and subjective assessments that affect how mental health is defined. Also, there are many experts that agree that mental illness and mental health are not antonyms. So, in other words, when the recognized mental disorder is absent, it is not necessarily a sign of mental health. 

Get the huge list of more than 500 Essay Topics and Ideas

One way to think about mental health is to look at how effectively and successfully does a person acts. So, there are factors such as feeling competent, capable, able to handle the normal stress levels, maintaining satisfying relationships and also leading an independent life. Also, this includes recovering from difficult situations and being able to bounce back.  

Important Benefits of Good Mental Health

Mental health is related to the personality as a whole of that person. Thus, the most important function of school and education is to safeguard the mental health of boys and girls. Physical fitness is not the only measure of good health alone. Rather it’s just a means of promoting mental as well as moral health of the child. The two main factors that affect the most are feeling of inferiority and insecurity. Thus, it affects the child the most. So, they lose self-initiative and confidence. This should be avoided and children should be constantly encouraged to believe in themselves.

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Home — Essay Samples — Nursing & Health — Mental Health — The Importance of Mental Health Awareness

The Importance of Mental Health Awareness

• Categories: Mental Health Social Isolation Stress Management

About this sample

Words: 1622 |

Updated: 4 November, 2023

Words: 1622 | Pages: 4 | 9 min read

Table of contents

Introduction, mental health awareness, video version, emotional well-being, psychological well‐being, social well-being.

• Health Effects of Social Isolation and Loneliness. (n.d.). Retrieved from https://www.aginglifecarejournal.org/health-effects-of-social-isolation-and-loneliness/.
• Top of Form Mental Health Myths and Facts https://www.mentalhealth.gov/basics/mental-health-myths-facts
• Mental Health Care Services by Family Physicians Position Paper. American Academy of Family Physicians Web site. http://www.aafp.org/online/en/home/policy/policies/m/mentalhealthcareservices.htm. Accessed February 11, 2013. [Google Scholar]
• Newman, T. (2017, August 24). Mental health: Definition , common disorders, and early signs. Retrieved from https://www.medicalnewstoday.com/articles/154543.php.
• Bottom of Form Rodriguez, B. D., Hurley, K., Upham, B., Kilroy, D. S., Dark, N., & Abreu, E (n.d.).Happiness and Emotional Well-Being. Retrieved from https://www.everydayhealth.com/emotional-health/understanding/index.aspx.
• World Health Organization. The Global Burden of Disease, 2004 Update. Part 4, Burden of Disease, DALYs. http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf . Accessed January 10, 2013. [Google Scholar]

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The Impact of Mental Health on Society Essay

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There is no doubt that poor mental health takes an immense toll on the lives of affected individuals. Many conditions are barely manageable if not to say debilitating, which prevents mental health patients from taking care of themselves and living their lives to the fullest. What is often left out from the discussion on mental health is how it manifests itself on a larger scale. This paper discusses the impact of mental health on society in terms of education, workforce, and safety.

Mental illnesses have a profound economic impact on society. Suffering from a mental health condition often means reduced productivity and resourcefulness in individuals. It is not to say that mental health patients lack the skills or expertise to fulfill the assigned tasks. However, they struggle to find the energy and motivation to do so. Recent studies have shown that depression reduces activity in the frontal lobe – the part of the human brain that is responsible for higher-order mental faculties such as long-term planning and decision-making. It is readily imaginable how a depressed employee could fall short in these important aspects and underperform. Apart from that, mentally ill employees not only underperform, they may also be endangering the lives of other people. To put things into perspective, a WHO-led study evaluates the losses that the global economy experiences due to depression and anxiety disorders at US$1 trillion.

An individual’s mental health affects his or her educational outcomes. Firstly, the same factors that prevent people from performing well at work – limited decision-making and the inability to plan long-term stifle academic performance. On top of that, it has been found that two other components that often accompany mental illness – anhedonia and social dysfunction’ is the most influential component – play a significant role in shaping educational outcomes. Not being able to take pleasure in learning and function in society often lead to drop-outs.

Lastly, there is a link between psychiatric disorders and criminality and violent behavior, though its nature is still debated. Admittedly, that is not to say that all people with mental conditions are dangerous – that would be a harmful generalization. However, the inability to receive timely and adequate treatment, experiencing illusions and hallucinations as well as suffering from paranoia are all risk factors for delinquent behaviors. Mentally ill individuals are arrested and sent to prisons at a disproportionate rate, primarily because the justice system has not yet figured out the best way to handle them. Conversely, this category of people is also at risk of falling victim to violent crimes. To recapitulate, unmanaged public mental health concerns reduce safety, be the problems caused by mentally ill individuals or not.

Indeed, it is not only the individuals but also society on the whole that suffers from the adverse consequences of deteriorating mental health. Poor mental health is linked to underwhelming work performance, as affected individuals are not able to be as efficient at work as they could be if they were not suffering from their conditions. Academic performance also suffers, mainly from anhedonia and social dysfunction, while the high dropout rate means fewer qualified cadres in the workforce. Mental disorders translate into not tremendous economic losses worldwide. Lastly, unmanaged mental health issues may lead to crime outbreaks as some people can no longer control themselves or put themselves in risky situations.

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IvyPanda. (2022, February 7). The Impact of Mental Health on Society. https://ivypanda.com/essays/the-impact-of-mental-health-on-society/

"The Impact of Mental Health on Society." IvyPanda , 7 Feb. 2022, ivypanda.com/essays/the-impact-of-mental-health-on-society/.

IvyPanda . (2022) 'The Impact of Mental Health on Society'. 7 February.

IvyPanda . 2022. "The Impact of Mental Health on Society." February 7, 2022. https://ivypanda.com/essays/the-impact-of-mental-health-on-society/.

1. IvyPanda . "The Impact of Mental Health on Society." February 7, 2022. https://ivypanda.com/essays/the-impact-of-mental-health-on-society/.

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Mental health problems associated with female genital mutilation

Jeroen knipscheer.

1 Arq Psychotrauma Expert Group, Diemen/Oegstgeest, and Department of Clinical and Health Psychology, Utrecht University, The Netherlands

Erick Vloeberghs

2 Pharos, Centre of Expertise on Health Disparities, Utrecht, The Netherlands

Anke van der Kwaak

3 Royal Tropical Institute and University of Amsterdam, The Netherlands

Maria van den Muijsenbergh

4 Radboud University Medical Centre, Nijmegen, The Netherlands

Aims and method

To study the mental health status of 66 genitally mutilated immigrant women originating from Africa (i.e. Somalia, Sudan, Eritrea and Sierra Leone). Scores on standardised questionnaires (Harvard Trauma Questionnaire-30, Hopkins Symptom Checklist-25, COPE-Easy, Lowlands Acculturation Scale) and demographic and psychosocial correlates were analysed.

A third of the respondents reported scores above the cut-off for affective or anxiety disorders; scores indicative for post-traumatic stress disorder were presented by 17.5% of women. Type of circumcision (infibulation), recollection of the event (a vivid memory), coping style (avoidance, in particular substance misuse) and employment status (lack of income) were significantly associated with psychopathology.

Clinical implications

A considerable minority group, characterised by infibulated women who have a vivid memory of the circumcision and cope with their symptoms in an avoidant way, reports to experience severe consequences of genital circumcision. In terms of public healthcare, interventions should target these groups as a priority.

Female genital mutilation (FGM) ‘comprises all procedures involving the partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious or other non-therapeutic reasons’. 1 The procedure is performed within a wide range of mainly African ethnic groups. Appropriate estimations are that between 100 and 140 million women and girls have undergone the practice. 2 FGM is defined as a violation of human rights, and in many countries it has been outlawed. Nonetheless, FGM is still performed in a large part of Africa, particularly in Eastern regions. Currently, FGM is also performed in small migrant girls resident in European countries. 3 The impact of FGM on social and psychological health is underresearched 4 - 9 and knowledge of the psychosocial consequences in a migration context is even scarcer. 10 - 12 Moreover, reports vary from high prevalence of trauma-related and other psychiatric symptoms such as anxiety and depression, 4 , 13 to no mental health problems at all 14 or even positive feelings. 15 , 16

The aims of this study were to explore the relationship between FGM and psychopathology in circumcised women originating from an African country who have migrated to The Netherlands. Research questions were:

• What kind of mental health problems are reported by circumcised immigrant women?
• Which factors are associated with the presented psychopathology?

Based on the literature, 4 - 12 we hypothesised potential predictors of psychopathology which could be distinguished between demographic factors (e.g. country of birth, years of residence in The Netherlands, educational level), circumcision-related factors (type of circumcision, age at the time of circumcision, vividness of recollection of the circumcision), coping mechanisms and acculturation demands.

In a cross-sectional research design, a survey among a sample of circumcised immigrant women in The Netherlands was conducted. Topics were measured in a quantitative way by means of culturally sensitive standardised questionnaires (the complete study design is described in Vloeberghs et al 17 ).

The estimated size of the target population (women who have undergone FGM living in The Netherlands) is about 26 000 women. 3 We involved representatives of this population actively in the research process, at the level of both data acquisition and data interpretation. Participants were recruited by means of snowball sampling, a sampling method that is being used to study hard-to-reach populations (see, for example, de Jong & van Ommeren 18 ).

The first stage of snowball sampling involves selecting individuals using referrals by insiders within the target population. These individuals were asked to list others with identical characteristics. From this list at least one person was randomly selected and approached for an interview. The interviewee was then asked to list others and the same procedure was repeated several times. Attempts were made to maximise sociodemographic diversity. Approximately half to a third of the solicited women (depending on the interviewer and her network) agreed to participate. It was not possible to compare those who chose to participate in the interview with those who declined.

The interviews were conducted by seven interviewers (all females coming from the participants' countries of origin). We consulted various key persons in the different communities during the development of the measures and the interpretation of the results (e.g. during ‘experts meetings’). Interrater reliability across the interviews was enhanced by means of a protocol that guided the interview process and a training concerning the way in which the interviews should be conducted, how to handle possible risks of (re-) traumatisation and ethical aspects concerning the process of personal data collection.

The respondents were informed about the aim of the study by means of an information sheet. The interviewers – who were awarded financial compensation – were instructed to read the information sheet to illiterate respondents. It was emphasised that they had to guarantee anonymity and that participation of the respondents was voluntary. Participants were reassured about confidentiality and told that they were not obliged to answer questions that they did not wish to answer. They were given the telephone number of a family doctor attached to the project (M. van den M.) whom they could contact in case of problems or questions concerning their well-being.

The interviews mainly took place at the respondents' homes. In some cases they were conducted at community centres or in public places, depending on the preference of the participant. The interviews were completed within an 18-month period in 2008/2009. The duration of the interviews varied from 40 to 180 min (mean duration about 90 min). The answers were recorded verbatim and later transcribed by the researchers (J.K. and E.V.).

Sample characteristics

A group of 66 women participated in the study ( Table 1 ). The participants' ages ranged from 18 to 69 years, averaging 35.5 years (s.d. = 10.5); 43% were married, 79% had children (mean 1.78, s.d. = 1.6). The group included 36 (54%) heavily circumcised (infibulated) women, mainly from Sudan and Somalia. The other women had undergone less invasive forms of circumcision: 9 women got an excision (type 2), whereas 21 had undergone type 1 circumcision. 19 The age at which the participants were circumcised ranged from 8 months to 16 years (mean 6.4, s.d. = 4.1).

Descriptive statistics of demographic variables of the FGM sample ( n = 66)

FGM, female genital mutilation.

Instruments

The survey consisted of four questionnaires including the Harvard Trauma Questionnaire (HTQ-30), 20 a 30-item transculturally validated screening instrument for post-traumatic stress disorder (PTSD) symptomatology (Cronbach's α = 0.96 in the current sample); the Hopkins Symptom Checklist (HSCL-25), 21 which measures anxiety (10 items) and depression symptoms (15 items) and has proven to be useful as a screening instrument in several cross-cultural studies and patient studies 22 - 25 (Cronbach's α = 0.96); the COPE-Easy, 26 which measures different coping styles by means of 32 items grouped under three theoretical head dimensions: (a) actively problem-directed coping, (b) support-seeking coping and (c) avoidance behaviour; the internal consistency of the subscales of COPE-Easy in this sample was satisfactory (Cronbach's α varying between 0.67 for avoidance behaviour and 0.91 for active problem-directed coping); and the Lowlands Acculturation Scale (LAS), 27 which assesses the level of cultural adaptation with 20 items and distinguishes between a global orientation towards the past (and land of origin) as opposed to the orientation towards the future (and country of current residence) in terms of integration skills and culture-bound traditions (Cronbach's α = 0.63). All instruments were translated into languages spoken by the participants, applying a back-translation procedure. A preliminary version of the questionnaires was pilot-tested with ten women and both content and format were revised on the basis of results.

Statistical analysis

Hierarchical regression analyses were used to test whether demographic factors (country of birth, age, years of residence in The Netherlands, marital status, educational level, source of income and number of children), circumcision-related factors (type of circumcision, age at the time of circumcision, vividness of recollection of the circumcision), coping strategies (COPE-Easy subscales) and acculturation demands (LAS subscales) predicted symptom severity of PTSD (HTQ-30 total score), anxiety and depression (HSCL-25 total score).

More than a third of the participants ( n = 24, 36%) scored above the cut-off level for indicators of psychopathology: a fifth of the total sample ( n = 13, 20%) met the criteria for PTSD (mean HTQ-30 score >2.5), a third met the criteria for depression ( n = 22, 33%), nearly a third met the criteria for an anxiety disorder ( n = 20, 30%; mean HSCL-25 score >1.75) and a sixth ( n = 11, 18%) scored above the cut-off level for all three psychopathology indicators. Almost two-thirds of all participants ( n = 42, 64%) did not report scores above the cut-off on indicators for PTSD, anxiety or depression.

Type of circumcision, country of origin, source of income, vividness of recollection and coping style were significant factors in a multivariate context concerning mental health symptoms. Infibulation, a ‘vivid recollection’ and a substance-misuse coping style were associated with enhanced PTSD scores, whereas originating from Somalia was associated with decreased post-traumatic symptoms ( R 2 = 0.67, F (4.38) = 22.04, P <0.0001; Table 2 ). Associated with higher anxiety and depression scores were infibulation, substance misuse, avoidance coping and lack of income; however, women originating from Somalia reported less anxiety and depression ( R 2 = 0.59, F (5.39) = 13.68, P <0.0001; Table 3 ).

Summary of hierarchical multiple regression analysis on HTQ-30 total score ( n = 66)

HTQ, Harvard Trauma Questionnaire.

Summary of hierarchical multiple regression analysis on HSCL total score ( n = 66)

HSCL, Hopkins Symptom Checklist.

FGM is associated with a wide range of long-term health and psychological problems (e.g. Andro et al 28 ). Circumcised immigrant women in this study are likely to report emotional disturbances that relate to FGM, with about a sixth reporting scores above the threshold for PTSD and a third reporting severe levels of depression or anxiety. Specific factors, associated partly with FGM and partly with current life stressors, influence the severity of psychopathology. In particular, infibulated immigrant women who have a vivid recollection of the circumcision, who do not have a paid job, and who cope with their problems mainly in an avoidant way (substance misuse), may form a group at risk of severe psychological problems.

The majority of the sample reported mental health problems but did not meet criteria indicative of psychopathology. These relatively low percentages could be due to the common fact that the majority of the survivors of traumatic events are able to recover without developing mental health problems. The underreporting of symptoms could also be owing to different perceptions (not the circumcision but other stressors would be responsible for the current complaints/symptoms) or taboo (being ashamed to talk about the problems, feeling a sense of stigma). In addition, the reluctance to speak out can be related to the fact that thinking or talking about the mutilation may cause the pain experienced at the time of the ritual to reappear; chronic pain and traumatisation can have a mutually reinforcing effect. 29 Nonetheless, it may also be true that the majority of the women experience no substantial traumatic symptoms as a consequence of FGM (see Lockhat, 12 who showed that women who were circumcised according to the mild sunna variant (type 4) did not report PTSD-related problems).

The finding that infibulation and a vivid recollection may enhance symptomatology may not come as a surprise. Still, some findings do puzzle us, such as the finding that Somali background appears to have a protective effect.

Speaking openly about the trauma may only be beneficial when this is appropriate within a culture of recognition of the trauma and its psychological consequences. Somali respondents may have more problems communicating about FGM in their culture. Another explanation may be that Somali women assess the event less negatively than women from other countries. According to the Lockhat model, 12 a negative judgement is predictive of PTSD development. In fact, some Somali women refer to the Islamic teachings saying that sunna is not prohibited. To them sunna has a normative and positive connotation within Islam, whereas, for instance, Sudanese respondents reject the Somali reinterpretation (Idjtihad) of what is being said in the Holy Writings. 11

Another finding concerns the relationship between symptoms, avoidant coping and substance misuse. Avoidance plays a pivotal role in PTSD symptom maintenance. 30 Accordingly, it is not surprising that avoidant coping is associated with PTSD symptom severity. Participants may develop substance misuse problems in an attempt to manage distress associated with the effects of FGM and related stress symptoms, or to numb themselves from the remembrance or experience of intense emotions. In our sample this coping style seems to exacerbate the problems in those experiencing anxiety and depression.

Our study has a unique character. The active participation of the target population and the way we obtained data provide sufficient ground for answering the research questions validly. For HTQ and HSCL excellent cross-cultural psychometric results have been reported. Some caution, however, is warranted in interpreting the results. Using a cross-sectional design, we can only employ a relatively passive approach to making causal inferences based on the findings – we may only speak about potential predictors. Moreover, the small group size, which is an inherent consequence of studying such a precarious topic, presents an important limitation as do the composition characteristics of the group (i.e. the high level of education and low marital state).

Incorporated in the clinical treatment of circumcised immigrant women should be providing them with coping mechanisms to help them come to terms with their experiences. Using therapy to equip women with instrumental skills to help them cope in day-to-day life and promote social integration to avoid social isolation (e.g. by enrolling the women in education/training) is also a good starting point for improving mental health (see also Summerfield 31 ). In addition, when treating women who experienced FGM one must be able to discern the various types of FGM, be knowledgeable about the related symptoms and the effects these may have on the woman, and have awareness regarding the taboo surrounding the practice. Finally, mental healthcare providers should be attentive to the fact that FGM is but one of a range of possible traumatising experiences the patient may have been subjected to. They should not only focus on FGM but check whether there are other factors, such as social or financial circumstances, that may be causing the symptoms presented by the patient.

On the basis of the empirical findings presented, our study shows that FGM is associated with psychological health problems for a substantial group of immigrant women. However, a considerable number of women are capable of coping with most impediments and may regard the ritual as ‘normal’ and therefore not sickening. Our data thus underline the diversity in interpreting the events and the level of remembrance as crucial for experiencing psychopathology. For future studies, it is important to elucidate the contextual factors that influence decisions about service utilisation. Prevention and clinical efforts should focus on the individual within its context and should be aware of potential hesitation among some women to seek psychological help. Clinicians are encouraged not to pathologise the consequences of FGM but to focus on the urgent psychological, social and psychosexual needs identified among a significant number of circumcised women.

Declaration of interest None.