The University of Pittsburgh recently released a study that begins to examine the connection in women between self-silencing and a variety of health conditions. The study is an early “hypothesis-generating” project, which has only scratched the surface of these complex relationships. They presented their findings at this year’s North American Menopause Society (NAMS) 2019 Annual Meeting
Self-silencing is defined in an article from Medscape as “inhibiting one’s self-expression to avoid conflict or relationship loss” (Medscape). All 304 participants of the study completed a 12-point “Silencing the Self” scale, as well as the Center for Epidemiologic Studies Depression Scale (CES-D). One telling detail of the study is that while none of the participants reported taking antidepressants or hormone therapy, almost 14% reported depressive symptoms.
This disconnect could be a side-effect of self-silencing, especially considering the stigmas that surround mental health. Women hold back from expressing themselves for a variety of reasons, as the Medscape article broadly explains. Those reasons could include anything from societal conditioning, to religion, to something more serious. Karen Jakubowski, MS, from the University of Pittsburgh explains: “…perhaps most important, women might be using self-silencing because they are in unhealthy or abusive relationships…” Jakubowski is careful to clarify that the study is “…not intending to indicate that women are deficient in their communication or to blame them for doing something that might not be in their best interests…”
After completing the self-silencing and depression scales, participants then had their blood pressure, height, weight, and cholesterol levels measured. They all underwent an ultrasound of their carotid arteries and assigned a “plaque index score” based on the findings. Almost half of the women had plaque in their artery, while almost a quarter had an index score greater than 2 on a scale of “…0, 1, or 2 or more…” (Medscape). When researchers compared participants’ plaque scores with their self-silencing results, they found an association.
Women who reported more self-silencing were also more likely to have a high plaque score, which often means poor heart health. While the results were adjusted for age, race, educational level, blood pressure, body mass index, low-density lipoprotein cholesterol, depression, and medications use for blood pressure, cholesterol, and diabetes, the association persisted.
However, Jakubowski hesitates to declare causation between the two before conducting more research. Other researchers agree. Robert Wild, MD, Ph.D., from the University of Oklahoma in Oklahoma City says comparing psychosocial attributes with medical data and proving a correlation is extremely difficult “…because so many social and cultural factors can be involved.” Further, he explains “’…carotids are a poor surrogate for outcome” regarding heart health. This does not take into account the methods used to gather data. For instance—the self-silencing and depression information was self-reported by participants. The article does not explain whether participants knew what was being tested, which also may have affected the way they reported their behaviors.
Self-Silencing and Heart Health
Still, the connection between self-silencing and other health issues is a good jumping-off point for further research. Knowing that this relationship exists should encourage women to consider whether or not they engage in this behavior—if not for their mental health, then for the other potential risks involved.
Haelle, Tara. “Women Who Don’t Speak Up at Risk for Heart Disease.” Medscape, 30 Sept. 2019, www.medscape.com/viewarticle/919217?src=wnl_edit_tpal&uac=324042HZ&impID=2115282&faf=1#vp_2.