Worry-YING and Worry-YANG: A Critical Feminist Study with Women Who Worry

Abstract

Gender is a critical determinant of mental health and well-being. Women are at greater risk of mental illness due to gender-based violence, economic disadvantage, and low social status. Women experience higher levels of acute and chronic stress and are twice as likely to be diagnosed with anxiety disorder. Anxiety disorder is a serious public health problem affecting 1:3 people worldwide, and according to WHO's International Classification of Diseases (ICD-10), a key symptom of anxiety is excessive worry. Few studies, however, have explored worry as a precursor to anxiety, and fewer have explored worry in relation to gender. This critical feminist study aimed to explore this phenomenon and identify the impact of worry on women and their mental health and well-being. Methods: Forty-five women living in Melbourne, Australia, participated in this qualitative study. They attended a 1-h semi-structured interview with the researcher to define and discuss worry and identify any impact or effect worry or worrying has had on their life as women. Results: The findings revealed that women worry about children, money, work, study, and violence against women. Conclusions: This study builds on the existing knowledge of the mental health and well-being of women, supports early intervention strategies to prevent anxiety disorder and long-term health risks; and meets the core objectives of the National Women’s Health Strategy 2020-2030 to ‘Improve the health and wellbeing of all women and girls in Australia’.

Introduction

Gender significantly impacts mental health and wellbeing (Matud et al., 2019; Mizock & Brubaker, 2021; Morehouse, 2020; Rosenfield & Mouzon, 2013; van der Vegt & Kleinberg, 2020; WHO, 2024). Women are at greater risk of mental illness due to gender-based violence (Chandan et al., 2020; Leskošek, 2019; Sewalem & Molla, 2022); the cultural divisions of labour, economic disadvantage, childbearing, parenting responsibilities, low social status and discrimination (WHO, 2024; MacDonnell et al., 2024); Asselmann et al., 2020; Australian Government: Department of Health, 2019; Sewalem & Molla, 2022).

Women experience higher levels of acute and chronic stress and are twice as likely to be diagnosed with an anxiety disorder (Australian Bureau of Statistics, 2024; Hoge et al., 2024; WHO, 2024; Yarrington et al., 2021). According to WHO’s International Classification of Diseases (ICD-10), a key symptom of Anxiety is excessive worry (WHO, 2024). Worry has been defined as overthinking, a repetitive sequence of negative thoughts and images, resulting in an inability to control feelings and emotions.

Research indicates that worry affects more women than men (Herbert et al., 2020) and represents a precursor to anxiety disorder and depression. Understanding worry in relation to gender aims to build on the existing knowledge of the mental health and wellbeing of women; contribute to the practice of mental health nursing, support early intervention strategies to prevent anxiety disorder and long-term health risk, and meet the objectives of the National Women’s Health Strategy 2020-2030 to ‘Improve the health and wellbeing of all women and girls in Australia’ (Australian Government: Department of Health, 2019, p. 55).

Background

The phenomena of worry

The phenomena of worry as described by Borkovec et al. (1983, p. 10) as;

…a chain of thoughts and images, negative affect-laden and relatively uncontrollable. The worry process represents an attempt to engage in mental problem-solving on an issue whose outcome is uncertain but contains the possibility of one or more negative outcomes; consequently, worry relates closely to the fear process.

Worry is a known component of fear and a short-term cognitive response to an impending threat (Im et al., 2021). It is situation-specific and is characterised by aversive, repetitive thinking that is uncontrollable and may lead to distress if the threat is not averted. Worry that is catastrophic, however, may prevent a positive response and result in a reduced cognitive capacity to deal with the situation (Hazlett-Stevens et al., 2019; Mirón-Juárez et al., 2022).

Worry is linked to the symptoms of rumination and perseverance (American Psychiatric Association, 2013). It is associated with uncertainty and the assumption that negative events will occur in the future. It has been attributed to the depletion of working memory, procrastination, and exhaustion (Stefanopoulou et al., 2020). Research also confirms that worry can have a positive function and improved performance. Worry has been reported as motivating and constructive when solving a problem (Sweeny & Dooley, 2017). Individuals who worry show increased activity in the brain associated with executive function that involves planning and reasoning (Sweeny & Dooley, 2017).

Excessive worry, however, and the inability to control it are key symptoms of generalised anxiety disorder (American Psychiatric Association, 2013). Anxiety disorder affects 1:9 people worldwide (WHO, 2024; Fancourt et al., 2020) 21.5% of people had a 12-month mental disorder, with Anxiety being the most common group (17.2% of people aged 16–85 years), with reported 3.2 million Australians (13.1%) experiencing an anxiety-related condition 2017-18, an increase from 11.2% in 2014-15 (Australian Bureau of Statistics, 2024). Excessive worry represents a core characteristic associated with generalised anxiety disorder (GAD). One in three women will experience Anxiety during their lifetime (Australian Bureau of Statistics, 2024), and according to the Global Burden of Disease, anxiety disorders are the sixth leading cause of disability in high and low-income countries. Women are twice as likely than men to experience and be diagnosed with anxiety disorder and or depression (Altemus et al., 2014; Asher & Aderka, 2018; Australian Government: Department of Health, 2019).

This study aimed to better understand how women define worry and to identify any impact worry or worrying has had on their life.

Methods and approach

A critical feminist approach was used for this study. Following ethical approval from the University Ethics Committee, 45 women from three different and distinct cohorts were recruited to ensure a cross-section of women were represented. The 45 women were recruited into the study via posters, flyers, word of mouth, and a snowballing approach within the School of Nursing & Midwifery at the University (for staff and students) and at a local community centre, in Melbourne, Australia. Understanding what women students, academics, and local community members worry about was thought to be potentially important information for the University sector, health education, and clinical nursing practice. The 45 women who consented to participate in the study all completed the study, no one asked to withdraw, and no ethical issues were identified.

The participants

A cross-section of women of various ages, occupations, stages in careers (nurse academic), years of study (nursing students), and socio-economic status chose to take part. In total 45 participants (who self-identified as women) were recruited into the research. They comprised 15 women undergraduate nursing students, 15 women nurse academics working at an Australian metropolitan University, and 15 women living in the local community. All of the women recruited did not have an existing relationship with the researcher. The mean age of the 45 participants was 42, with an age range (of 20-72). The first 15 women (from each group) to contact the researcher and sign consent to participate were included in the study. The decision to recruit 15 women from each group was based on a study undertaken by Francis et al. (2010), who found that data saturation occurs after 13 to 15 interviews and that following interview number 10, three further interviews should be conducted to see if any new insights are being produced. Based on this, interviewing 15 women from each group was considered appropriate.

Design

The study adopted a critical feminist framework to ensure a supportive, considered research process that valued the individual and collective good of the women in the study. Feminist research acknowledges the influence of gender, places a strong focus on consciousness-raising, and aims to transform and empower the research participants (Klostermann, 2019). This study aimed to equalise any power relations between researcher and participant through a process of reciprocity, reflexivity, trust and the respect for diversity and one’s own life experience as a woman. The research was undertaken ‘with the women, not on them (Glass, 2000). The research process supported safe discussion and allowed for consciousness-raising and space to give voice to women and their worries.

The process of reflexivity places the researcher in the foreground with the participants. It involves intersubjectivity, the attempt to understand another person’s life experience. building rapport, and supporting participant disclosure (Klostermann, 2019). Through this reflective process, the researcher can remain acutely aware of their own values, beliefs, and perceptions, leading to a shared dialogue with the research participant and the generation of new knowledge (Glass, 2000).

Procedure

The participants were asked to attend a one-hour individual interview with the researcher to define and discuss worry and identify any impact or effect worry or worrying has had on their life as women. The individual interviews were held at a location agreed to by the participant. The academic nurse participants were interviewed in a private office on the University campus; the nursing student participants were interviewed in a private meeting room in the library on the university campus, and the community participants were interviewed at the community centre in a private meeting room. The researcher took additional notes in their journal during the interview to record certain observations, such as a change in tone, volume, and or intensity of the participant’s voice. During the interview, it was interesting that each participant drew reference to worry and the close relationship it had to their understanding of Anxiety. All participants reported that they did not have a formal diagnosis of Anxiety and did not take medication to manage their worries. The women in the study reported they did not experience the common symptoms of Anxiety such as racing heart or restlessness when they worried; however, they (n = 34) could relate to worry that initiated a sense of panic (another common symptom of Anxiety) to solve a problem and or resolve an issue.

The individual interview focused on five main questions (Table 1). The interviews were audio-taped and transcribed verbatim by the researcher, deidentified with personal identifiers removed and pseudonyms assigned to each participant. Participants checked their transcripts for accuracy, a technique known as member checking to ensure the researcher’s analysis was correct and accurate. No participant withdrew from the study. The interview data was stored securely on a password-protected computer. No repeat interviews were carried out.

Table 1. Research questions.

How would you define ‘worry’?

Do you have any worries? Can you share a recent worry? Can you share an old worry?

Does worry impact on your life as a woman?

Do you experience personal and or professional worries? Can you provide an example?

Table 2. Research questions and responses.

Question 1: How would you define ‘worry’?

Self-talk time to think a list of concerns nagging thoughts rumination persistent thinking in my head constant thinking looping racing thoughts SPEED stuck working through problems a FORM OF PRAYING

Question 2: Do you have any worry? Can you share a recent worry?

Can you share an old worry?

UNI money parents health, getting cancer work family money children, world affairs, environment getting home from work safely

Question 3: Does worry impact on your life as a woman?

We are silenced. Worrier as winger you can’t say you do it WOMEN ARE CARERS holding it together women’s work worry is negative media portray worry as ‘less of’ worry is normal worry make me conscious SOMEONE HAS TO DO IT! stigma associated with talking about worry worry wort,

Question 4: Do you experience personal and or professional worries? Can you provide an example?

Children being good enough study WORKPLACE career success making people proud of me getting sick, cancer, violence against women

Question 5: is worry a ‘good thing’ or is a negative aspect of your life?

A Motivator KEEPS ME IN CHECK a conscious awareness about responsibility! Positive as it keeps me present for those I care about worrying is part of how we keep safe. Looking over my should VIOLENCE AGAINST WOMEN IN OUR COMMUNITY an alert warning against danger surviving a lifetime of worry-RESILIENCE nurses worry contributes to resilience worriers are warriors. Wise women

Thematic analysis was used to analyse the data in accordance with the guidelines of Braun & Clarke (2006). The transcripts were read several times and then re-read to ensure a comprehension understanding of meaning. The participants shared rich descriptions of themselves and engaged in critique of the gendered experience. Any patterns that emerged from the words or phrases used by participants were tabled and any links to thoughts, feelings and behaviour identified. The responses to the questions were also tabled and grouped, and any similarities, repetition, or differences were noted. Immersion in the data allowed the researcher to identify emerging themes and remain curious to meaning, questioning, clarifying and then checked back in with the participants to ensure accuracy.

The analysis of the interview data was completed when there were no new ideas or themes emerging. Extracts from the transcripts were organised into themes. The themes were then reviewed and further refined (Braun & Clarke, 2006). Upon completion of data analysis, the themes were presented back to each participant to ensure accuracy of meaning and confirmation of research findings.

Results

The results of this study revealed two key themes: Worry-yin and worry-yang.

Key themes

In Chinese philosophy, yin and yang are used to describe the opposite aspects of phenomena that appear contradictory on the surface but are instead complementary and interconnected. Yin is thought to be personal, negative, dark, and feminine. Yang is described as public, positive, bright, and masculine. The concept of Yin and Yang has been adopted to illustrate the findings of this study. The key themes-Worry-yin and worry-yang represent the participants different experiences that at times were expressed clearly, were forthright and strong and at other times emotional, self blaming and withdrawn. Research questions and common responses are outlined in Table 2. Worry-yin was worry that the women had trouble speaking about, it was thinking that bought distress. Worry-yang was talked about openly and publicly with energy, anger, and motivation. It was outward and political.

Worry-yin

Worry-yin worries were the ‘private, personal worries’ that the participants considered they were less likely to talk about. The worry-yin worries were described as ‘emotional and irrational,’ thoughts of ‘impending negativity.’ Worry-yin worries were related to caring for those they loved, family, and ‘keeping everyone safe’. The women believed that disclosing worry-yin worries created a risk of being stigmatised or of being labelled as ‘unable to cope’ and ‘less of.’ The participants commented that they chose to remain silent and keep their worry-yin worries to themselves, sharing only with like-minded women.

Ella a nurse academic said;

I told someone at work that I was worried about my son as he was still living at home and having difficulty finding a job. They made a comment that I was a worry wart and that was why he wasn’t achieving. They said I should make him stand on his own 2 feet, and that I should move him on. I felt embarrassed and judged. I will never share any of my personal worries at work again.

The women participants spoke about the emotional pressure they experienced managing and caring for family. They reported a level of stress balancing study, family and work and were reflective on how this created worry. Again, these worries were considered ‘private and less talked about’. Student Jenny commented;

As a woman I feel responsible for everyone I care about, my family and my friends. I worry about them. Going back to study was important to me and really has given me opportunity for my future and my children but it’s hard to balance it all and I worry about that. I don’t talk about these worries though because then I could be seen as whinging, or struggling, unable to cope. I keep them to myself.

Nurse academic Bridget mirrors this thinking stating;

Women juggle work, and family and I think they worry about that. I did and still do. The way I mother is different to how my mother mothered. My mother stayed at home. I often worried that my children were not getting the best childhood because I compared it to mine. Sometimes I can still worry about that. I don’t feel that I can share these worries as I feel they are very personal, and others may see them as my deficit.

Women felt disclosing worry-yin worries made them vulnerable to being stigmatised. Terms such as ‘worry wart’ were thought belittling, and condescending. The women talked about the times they chose not to disclose their worry-yin worries for fear of being judged as ‘less of ‘and ‘unable to cope’. Ella’s comment reflects the group response;

If you are thought of as a worrier then it’s like you are emotional, extreme, irrational. People treat you differently. I don’t share my worries anymore because this is not how I want to be perceived.

Stigmatising people can lead to detrimental outcomes, including delay or avoidance of help seeking, stressful social interaction, feelings of reduced self-worth and poorer quality of life (Busby et al., 2023). The impact of stigma on mental health and wellbeing is significant with research confirming that stigma can be detrimental to both psychological and physical health (Roach & Tadesse, 2023).

Tyerman et al. (2021) confirm that for people with mental illness, stigma can have a substantial impact on their lives, and they can experience systemic barriers, reducing their likelihood of follow-up on physical health concerns. In this study the women spoke about being stigmatised and labelled a ‘worrier’. They believed that this label created more stress and silenced them. Clark & Bosse (2022) confirm that language can contribute to feelings of shame and negative feelings, resulting in a delay in seeking treatment.

Recognising that women can feel stigmatised in relation to ‘being a worrier’ is important because if women feel judged and discriminated against, they may not feel they can speak out and access support if required. The stigma associated with mental illnesses, such as Anxiety, is widely known and one of the biggest barriers to people seeking help (Adu et al., 2021). Women choosing not to speak about certain worries for fear of being labelled could result in greater psychological distress. Providing women with greater opportunity to share their worries in a safe space is critical. The women recognised that the research process provided an opportunity to reflect on worry in a safe space.

Worry-yin was described as a form of deep reflection and rumination. It was described as distracted thinking that could cause distress. Student Wendi said

Reflecting or worrying about my family and their issues turns into ruminating. If I can’t solve the problems, I end up feeling stuck. If I worry about something for too long, I start telling myself to change the record, change the topic. I consciously must park my worry and chose to come back to it later. This process can then be a bit crazy, so I don’t talk about it with anyone.

The women participants (n = 45) disclosed feeling stressed and a sense of panic when worrying for too long about an issue that was personal and in most cases about someone they loved.

Tina said;

I think we all worry about the people we love. You don’t want them to be hurt and sometimes worrying about them feels like you are keeping them safe. I know if I keep worrying out loud to my family-they think I am over worrying and making things worse-so now I don’t worry out loud!

Worry-yang

Worry-yang worries were worries that the participants felt they could speak about, and for many participants, worry-yang worries were very political. The five most reported worry-yang worries included issues that significantly impact women, such as violence, economic disadvantage, childbearing, parenting responsibilities, low social status, and discrimination. Worry-yang was reported as a motivation and commitment to remain present, attentive, responsive, and responsible to things happening in the community and society at large. Worry-yang worries aligned to the women participants’ capacity to ‘speak up’, develop problem-solving skills, and build resilience.

The women participants all reported worry in relation to violence against women. The participants were enthusiastic about ‘speaking out’ about this issue. They shared their personal experience of violence and the significant impact the threat of violence had had on their mental health and wellbeing. The participants all expressed concern over the level of violence being perpetrated and reported on by the media.

Manda student participant said;

I see and hear about women being attacked every day in Melbourne and I get angry and I do worry about it. I know my worry then is about alerting everyone I know to be safe when going home late, being mindful on public transport. I’m very vocal about women putting their safety first.

Nurse academic Linda said;

Violence is a part of life for women. I think we all worry about it. I am angry it has become such a reality in our everyday.

The undergraduate students worried about violence against women in the community. They reported experiencing violence in their everyday, on public transport, when out at night and students revealed they had experienced Intimate Partner Violence. This experience and or fear of violence made them moderate their behaviour, choosing not to travel on public transport late at night. They also raised questions as to the lack of security provided on public transport late at night. They felt vocal and politically charged about the situation. They expressed concern that large organisations such as Public Transport Victoria, did not acknowledge the potential risk to women in the community.

A nursing student, Kate, expressed anger about the amount of violence against women in the community. She said;

I worry about my children, my girls living in Melbourne, coming home late. I know I can’t do anything more than warn them, but should we have to be worried about men hurting women all the time? That worry impacts on us.

The community participants reported worrying about violence against women. They feared home invasion, travelling on public transport, and walking alone at night. The women participants referred to the regular reporting of violence against women in the media as ‘a worry’ and made many comments on the legal system and the process of dealing with perpetrators. Community member Sue said,

I attend the council meetings and voice my concerns, but I don’t see any real change in our community. People (men) have been arrested carrying guns at our shopping centre. It’s bad.

The community participants also identified worry in relation to women and workplace violence. The nurse academics identified horizontal violence, and a lack of career trajectory and were very vocal about what they saw was workplace discrimination. The women participants recognised the anger they felt about violence against women and how this worry over time (although stressful) had helped them develop greater resilience and ways of coping. This anger was referred to by one student as ‘fire in the belly’.

The women spoke about economic hardship. They worried about women being disadvantaged in retirement due to having inadequate superannuation and financial savings. Superannuation is a regular payment made by an employee or an employer towards a person’s future pension. Superannuation can be accessed at 65-67 years of age. The women reported that due to several interruptions in their career pathways and employment (as a result of being pregnant and or raising children) they had less money invested into superannuation therefore less money saved for retirement. Less money meant additional stress, and this raised additional concerns about how to maintain a healthy lifestyle on limited budget.

Nurse academic Bridget stated;

I started late with my super, so I am way behind. I stopped work to have our kids but I’m now by myself after the divorce and it is like starting over financially. It has been a very unfair system for women.

When participants spoke about worry in relation to economic disadvantage, they demonstrated anger towards government legislation. Community participant Amy made comment;

I think women have had it tougher financially and have been disadvantaged for centuries because we have had to stop work and have children, and this then makes you dependant on your partner. In my case we broke up when the kids were 4 and I virtually had to start again. He wasn’t working so I had to rely on centre link and part-time employment.

The women participants spoke about the gender pay gap and the potential for women to be financially disadvantaged. Community participant Tina said she worried about women who experienced relationship break down later in life and the impact that that could have on their mental health and wellbeing. She said;

Women that I know are doing it tough because they have no super and no savings. One I know lost her house and had to start again and find work to survive. She didn’t have any skills. Finding work has been hard for her.

As the women unpacked their concerns, they also made comment on what that meant for them personally. In relation to women struggling to find work, they were acutely aware of their own vulnerability and the need to keep their employment and remained skilled.

A nurse academic participant, Alec, said;

I worry about my own problems and then I worry about the older women in our community. Those that don’t have financial security and no superannuation. They are a growing group who are vulnerable to being homeless.

This worry and concern resulted in the women expressing gratitude for their current situation however angry and concerned about women less fortunate. Amy said;

I’m just grateful I have had an education and work prospects are good for me. I feel lucky compared to some, but it does make me angry that women who have been financially disadvantaged or experience and escape family violence could end up homeless. It is not fair.

Worry-yang was identified as a process of being present, analysing and evaluating situations, speaking up, managing the problem and or challenging the status quo. Nurse academic Linda said;

I worry about lots of things that make me angry, and as an older woman I’m becoming more noisy about it. I’ve become less accepting of the poor treatment of women, in this country and across the world. Look at Julia Gillard. She was treated like that because she was a woman, no other reason.

The impact of worry on women

The women participants confirmed that worry has a significant impact on their life as women. Worry was described by Rosie a student participant as;

…a way of staying vigilant to the things happening around me! I worry about the violence in Melbourne and travelling on public transport. This makes me mindful about where I am and the risks I take-which are few.

Karla a community participant, said;

Worrying is about safeguarding, protecting the people I love. I worry about my daughter who recently separated from her partner. She has two children and she is doing it tough. Worrying about her is about thinking how I can help her.

Managing worry was identified by participants as a process of resilience building that helped them cope and manage stress. Nurse academic Alec said;

My worrying about everything has helped me build a form of personal resilience, a way of coping with difficult situations in my life. If I ‘worry’ something through, I tend to resolve the problem.

The results of the study were shared with the participants. The participants confirmed an accurate representation of the research findings.

Discussion

The results of this study reveal that the three groups of women in this study, nursing students, nurse academics, and community participants, define worry differently. But they report similar worries, and they all agree that worry does impact their life. The women participants worry about violence against women, the cultural divisions of labour, economic disadvantage, the low social status of women and discrimination. The issues that the women participants worry about are a direct result of a patriarchal society that oppresses women politically, economically, socially, and culturally.

The participants reported violence against women as their most common worry. The participants shared their personal experiences dealing with violence in their everyday. Some participants recounted Intimate Partner, and others shared their experience of managing workplace violence. Findings from a qualitative feminist study undertaken by Mao et al. (2023) identified the need for interventions to prevent violence against women (undergraduate nursing students) to target the gender power gap evident in the education space. An environment that is significantly influenced by the social-cultural elements of nursing and society at large. This study supports this recognising the need to challenge the patriarchal frameworks that still exist. These frameworks are at the core of women’s worries.

A study undertaken in the UK found a strong association between exposure to Intimate Partner Violence (IPV) and developing a mental illness (Chandan et al., 2020). IPV is a prevalent global public health issue currently affecting 1 in 3 women (WHO, 2024). Australian Bureau of Statistics (2022) reports that 22% of Australian women have experienced sexual assault (Australian Government: Department of Health, 2019; Australian Bureau of Statistics, 2021–22), and 62% of women experienced their most recent incident of physical assault by a male in their home (Australian Bureau of Statistics, 2021). The WHO reports that 67% of women experience Anxiety or fear after a sexual assault and are at a greater risk of Anxiety, and post-traumatic stress (PTSD), and are then more likely to develop eating disorders (WHO, 2024; Australian Government: Department of Health, 2019).

The participants in this study raised concern over the disadvantage women experience in the workplace and many participants acknowledged the gender pay gap in Australia. These concerns were related to their worries in relation to their own career pathways. Statistics confirm that women comprise 47% of employees nationally; however, they receive $251.20 less than men each week (Australian Department of Health, 2024). The full-time average weekly ordinary earnings for women are 13.8% less than for men. This has decreased by 0.4 percentage points since May 2021 (Australian Bureau of Statistics, 2024).

Women, on average, receive smaller final superannuation payouts as their career pathways are often interrupted due to childbearing and parenting responsibilities (Clare, 2017). In 2015-2016 the average Australian woman was retiring with $113,660 less superannuation than the average male (Clare, 2017), and women spend twice as many hours in their life attending to unpaid care work then men and account for 68% of primary carers for older people (Australian Bureau of Statistics, 2024).

The findings of this study and the worries women report in response to economic insecurity align with the following facts. Australian women are underrepresented in senior positions, and women on the Australian Securities Exchange (ASX) 200 boards is as low as 29.7%. At the end of September 2019, the percentage of women on ASX 200 boards fell to 29.5%. Women spend, on average 64% of their working week performing unpaid care work, which is twice that of men. In this study the participants spoke about worry in relation to work and financial security. Employment, wage parity and financial security were considered a gender issue (Clare, 2017).

The participants reported that disclosing their worries was stressful and stigmatising. They reported that being perceived as a ‘worrier’ was a negative. It is well documented that negative judgement can have a significant impact on people’s lives and their mental health and wellbeing. Language has the potential to create and maintain power dynamics (Llorens et al., 2021) that can lead to oppression and discrimination. Interestingly, this fear and shame related to discussing worry leads to women not speaking out. Feminist researchers have long emphasised the socio-political nature of voice and silence, and this study contributes to this argument by providing example of how they are silenced and by whom.

The participants also recognised that their worries had helped them build coping skills and personal resilience. Cleary et al. (2014) refer to personal resilience as,

The concept of personal resilience overlaps with the associated notions of having self-efficacy, tolerating ambiguity, having self-awareness, making meaning out of disorder; demonstrating realistic perseverance; and having the ability to analyse and appraise a situation… (p. 36)

Foster et al. (2018) defines resilience as “a process of positive adaptation to stress and adversity” (p. 71). The participants in this study recognised that worry over time had helped them build skills such as how to analyse and evaluate situations. The act of worrying was thought of as “A form of reflection, rumination and problem solving”, a way of managing life stressors and combating discrimination. These findings recognise the importance of early intervention strategies to prevent anxiety disorder and long-term health risk; and the need to meet the objectives of the National Women’s Health Strategy 2020-2030 to ‘Improve the health and wellbeing of all women and girls in Australia’ (Aisenberg-Shafran & Shturm, 2022; Australian Government: Department of Health, 2019, p, 55).

Coping mechanisms provide a mediator between effective performance as a health professional and work-related stress (Cleary et al., 2018). A study undertaken by Zetterström et al., 2023 revealed how patients could be supported by nurses and encouraged to be active participants in their own anxiety management and care. The nurses played a critical role in getting the patient to think about what was happening during their anxiety attack and how to support them to gain better coping skills.

The participants spoke about the benefits of positive self-talk, breathing, mindfulness, and sharing their worries with like-minded women, which were strategies that assisted them in managing their worries. They described a process like Cognitive Behaviour Therapy (CBT). CBT is an intervention that aims to reframe thinking, beliefs and behaviour reducing anxieties and worries. Research supports the use of Cognitive Behavioural Therapy (CBT) for the treatment of anxiety disorder (Dimidjian et al., 2006; Hunot et al., 2007; Querstret & Cropley, 2013) confirms that cognitive behaviour therapy may be useful in the treatment or reduction of worry.

Apart from the participants recognising ways to manage their stress and reduce their worries, it is imperative that the structures that oppress women are identified and held accountable for women’s health and wellbeing. A paper by Hastings (2023); shows how the complex interconnection of systems of work and care ‘render Australian women vulnerable to homelessness in older age’. Although equal pay and anti-discrimination laws are being addressed, there still remain a number of social and structural inequalities that result in women having an interrupted career progression and, subsequently, less superannuation and long-term financial security. As this study has identified, women worry about this. It is critical that the gender roles and responsibilities and our patriarchal structures within capitalist economies be scrutinised to make way for more change. Women do most of the unpaid caring work, participate less in paid labour, and when they do, are more likely to land in informal, insecure and lower-waged jobs (Ferguson et al. 2023).

Research impact

Understanding women and worry builds on existing knowledge of the mental health and wellbeing of women and contributes to the practice of nursing. Recognising that women worry about gender-based issues may assist us with supporting them better, empowering them to speak out and instigate change in their communities, workplaces and society at large.

Further studies undertaken using a feminist methodology are required to draw attention to gendered histories and the ongoing discrimination and mistreatment of women in society. As supported by Lebold (2024), feminist methodologies have the potential to advance our ‘important collective critical nursing work and scholarship.’

Conclusion

The results of this study reveal that the three groups of women in this study, nursing students, nurse academics, and community participants, define worry differently; they report similar worries, and they all agree that worry does impact their lives. The women participants worry about violence against women, the cultural divisions of labour, economic disadvantage, the low social status of women and discrimination. This study revealed the way in which worry could be deep reflection and rumination, not spoken about and perceived as a short coming or alternatively a process of being present, analysing and evaluating situations, speaking up, managing the problem, and or challenging the status quo. This study gives voice to women who worry and makes real the ongoing disadvantage and gender inequity that exists in our society. These inequities have a direct impact on an individual’s mental health and wellbeing.

Disclosure statement

No potential conflict of interest was reported by the author.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.