Introducing Prof. Dr. med. Anita Riecher-Rössler 

I am a psychiatrist and psychotherapist and was the director of the Psychiatric University Outpatient Department Basel, until I retired some years ago. Right now, I am the editor-in-chief of the Archives of Women’s Mental Health, and I’m still engaged in publishing. I also like teaching, mentoring, and counselling. 

How would you define mental health?  

The World Health Organization (WHO) conceptualizes mental health as a “state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” This is quite a good definition. One could also say that a person is mentally healthy when he/she does not suffer from any mental illness. 

Why is mental health important in society? 

Well, I think mental health is the most important prerequisite for happiness in a society. And is not what we all long for, happiness? Also, societies depend on the contributions of individuals and mentally healthy people can contribute to the well-being of all.  

What led you to go into the field of mental health?   

When I was 16 years old, I read Sigmund Freud and was very impressed by his thoughts about the unconscious and all the psychological processes driving human beings. Then, during my training in psychoanalysis and psychiatry, I got more interested in scientific evidence and therefore started to do research in addition to clinical work. 

What type of scientific/clinical research have you conducted?  

I always was especially interested in sex and gender differences of mental disorders on the one hand, and in the development of psychosis on the other hand. I did clinical and epidemiological studies mainly in these fields.  

What do you think are some of the most important facets of mental health that need to be addressed?   

There are so many! And many facets have been quite neglected until recently. In the last decades, we have achieved a lot regarding early detection and prevention of psychosis, and this should now be achieved for other mental disorders as well. Also, sex- and gender influences of mental disorders are so far still widely neglected, although I notice a growing interest recently. We need much more research on sex- and gender related factors, which can influence mental health – biological factors such as sex hormones as well as psychosocial factors.  

Are there gender disparities between biological males and females with regards to mental health and what are they?  

Oh sure, sex and gender differences in mental disorders are among the most intriguing and stable findings in psychiatry. Differences exist regarding prevalence, symptomatology, risk factors and course of disorders. Thus, it is for example well known that women suffer from mood or anxiety disorders 2-3 times more often than men. On the other hand, men have a much higher risk of suicide as compared to women. 

Another example for well-established sex-differences we see in schizophrenic psychoses: these disorders start on average 4-5 years later in women than in men. And women have an increased risk after menopause. 

This is interesting. What are the reasons for these sex and gender differences?  

Unfortunately, we still do not really understand the causes of these differences and comparatively little research has been done to explain them. This lack of research is more than surprising since explanations of these findings could give us important insights into the aetiological and pathogenetic mechanisms of mental disorders in general. At the same time, they would most likely improve our therapeutic approaches for both women and men. 

What are some examples to explain these gender-based differences? 

The gender gap in depression is probably mainly due to psychosocial reasons. In fact, many psychosocial risk factors for depression are more common in women, for example sexual abuse, domestic violence, discrimination – and certain personality factors such as girls’ and women’s lower self-esteem and higher tendency for rumination. Around menopause also fluctuating sex hormones probably play a role for increasing the depression risk. 

Gender differences in psychosis are probably mainly due to the protective effect of the female sex hormone estradiol. It seems to protect women from the outbreak of this disease during midlife when the level of this oestrogen is high. 

Can sex hormones influence mental well-being?  

Surely! Especially the female sex hormone estradiol can obviously modulate neurotransmitters in our brain and thereby influence emotion and cognition. We would need much more research in psycho-endocrinology to better understand these mechanisms. 

How has mental health in the general population changed in the pandemic? 

Stress, anxiety, and depressive symptoms have increased during the pandemic, especially in the vulnerable groups including people with pre-existing mental problems, those young, lonely, living alone, all those working in affected businesses – above all health care workers especially those in intensive care or in contact with COVID patients. In some groups, such as in the young people, this seems not to have completely normalised yet. 

You have published a number of books, book chapters, and research articles with Karger focusing on women’s mental health in particular. Tell us about the importance of these topics.  

Well, in my clinical practise as a psychiatrist and psychotherapist I realised very early on that you cannot offer the same sort of diagnostics and therapy to each individual, but you have to tailor it to their personal needs. I suppose nowadays it is called personalised medicine. Sex, gender, and cultural background are amongst the most important characteristics of an individual. Thus, with gender-sensitive and culture-sensitive psychiatry, I have always tried to consider the basic and most important personal needs of men and women or of patients from different cultural backgrounds. The needs of women are different in many areas, for example, if you look at psychopharmacology or psychotherapy, especially if you consider sex specific disorders such as peripartum disorders, or disorders around menopause. If you look at the high suicide risk in men, it is also clear that they need a specific psychotherapeutic approach. 

What is the best way to address mental illness? 

I realised quite quickly that prevention is the best therapy. This interest mainly started with a big research project in which we interviewed almost 400 patients with first episodes of psychosis and their relatives. These interviews showed me that the illness, in fact, had started many years before the outbreak of the first episode, and that one possibly could have prevented this serious disorder by intervening much earlier in the so-called prodromal phase. This and further projects laid the ground for an, in the meantime, worldwide movement for early detection and prevention of psychosis. This should also stimulate similar research and movements for other mental disorders. 

In conclusion, I would say that I published not only to publish our own research but also to stimulate other research and above all to improve and individualise the diagnostic process and therapeutic approaches for our patients. 

Anita Riecher-Rössler is Professora emerita of Psychiatry at the University of Basel, Switzerland. She has specialized in psychiatry, psychotherapy/psychoanalysis, consultation/liaison psychiatry, and geronto-psychiatry. In 1998, she was the first woman to be appointed to a full chair for psychiatry in a German-speaking country. 

Her research interests include schizophrenic psychoses, gender differences in mental disorders, and mental disorders in women. In the field of schizophrenic psychoses, she has mainly worked on the onset and early detection of these disorders, but also on late-onset schizophrenia. In the field of women’s mental health, she is particularly interested in the peripartum and the menopausal transition and in psycho-neuroendocrine and psychosocial risk factors.  

She was a founding member/president of several interdisciplinary societies for women’s mental health. In 2018, she was awarded the Constance Pascal – Helen Boyle Prize by the European Psychiatric Association for outstanding achievements by a woman in working to improve mental health care in Europe. According to the Web of Science, she belongs to the most highly cited researchers.  

Currently, she is Editor-in-Chief of the “Archives of Women’s Mental Health” and is active in publishing, teaching, counselling, and mentoring, and in many national and international societies and advisory boards.