Recent commentary reflects on research equity in women’s mental health

To mark International Day of Women and Girls in Science, we are shining a spotlight on this recently published commentary co-authored by the Equality, Diversity and Inclusion (EDI) Leads and the Directors of the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre (BRC) and the NIHR Oxford Health BRC, on how women should be at the heart of mental health research.

International Day of Women and Girls in Science, which is held annually on 11 February, aims to promote access and equal participation for women and girls in science and related fields.

The commentary, published in The British Journal of Psychiatry, highlights how women’s mental health is shaped by the combined influence of rights, cultural norms and stigma. These influences form a largely invisible structure that shapes women’s vulnerability and resilience across societies.

Restrictions on education, employment and healthcare, along with gendered expectations around emotional expression, continue to limit women’s autonomy. Gendered expectations dictate how distress may be expressed, often silencing women’s experiences.

Stigma around mental illness further discourages help seeking, reinforcing marginalisation. The authors argue that addressing women’s mental health requires social change that advances gender equality and dismantles discriminatory cultural narratives.

The commentary also responds to concerns raised in a recent editorial about moves in the United States to restrict the use of terminology relating to sex and gender in research. The authors suggest such limitations directly threaten scientific progress by excluding women.

Historically, women have been underrepresented in research participation, authorship and leadership, leading to a knowledge base disproportionately shaped by the experience of men. This bias affects the diagnosis and treatment of mental health conditions, with important sex-and gender- specific issues still poorly understood.

Evidence gaps are also evident in clinical trials. The authors argue that sex-balanced recruitment and examining data that is categorised by sex to identify disparities, is essential to ensure treatments are safe and effective for everyone. The commentary highlights recruitment inclusivity frameworks as practical routes for integrating sex, gender and wider social identities into research.

Pregnant and breastfeeding women remain routinely excluded from clinical trials. As a result, there is limited evidence to guide care for mental health conditions in pregnancy. The authors call for stronger preclinical work, better use of observational data, adaptive trial designs and ethically robust approaches that support responsible inclusion rather than automatic exclusion. They note that when conducted appropriately, randomised controlled trials involving pregnant women are both ethical and acceptable to potential participants.

The commentary also emphasises the need to better understand reproductive transitions such as the onset of menstruation, pregnancy, postpartum and menopause. These life stages have profound biological and cultural dimensions that influence mental health, yet they remain understudied. Menopause is often framed negatively, despite cross-cultural evidence that positive interpretations can reduce distress. Greater attention to hormonal changes, neurobiological shifts and lived experience is needed to support culturally responsive research and care.

Importantly, the commentary highlights the importance of women’s leadership and involvement across the research landscape. Women remain underrepresented in clinical academic roles, despite their essential contribution to inclusive science. Meaningful involvement must draw on women’s expertise and lived experience and include strong patient and public involvement. The recent NIHR policy on sex and gender represents a positive step, requiring research teams to consider sex and gender at all stages of the research lifecycle. The authors hope that similar policies will be adopted internationally.

Lead author Dr Mariana Pinto da Costa, (pictured above, left) Research Inclusion Champion, NIHR Maudsley BRC, said:

“Across the world, restrictions on women’s rights limit opportunity, autonomy and progress. Inclusive mental health research needs women’s voices - not only in the data, but in leadership, authorship, and in the decisions that shape science.”

Dr Angharad de Cates, (pictured above, right) NIHR Oxford Health BRC EDI Academic Lead and commentary co-author said:

“Equity in mental health research begins with recognising women’s experiences not as exceptions but as essential to the evidence base. When we design studies that truly reflect the diversity of those we serve, we move closer to science that is both accurate and just.”

Pinto da Costa M, de Cates AN, Dhamala E, McAlonan GM, Upthegrove R, Comasco E. Women at the heart of mental science: commentary, The British Journal of Psychiatry. Published online 2026:1-3. doi:10.1192/bjp.2025.10516