When Sonia Benoit hung up the telephone, she thought her head might explode. It was her second day on a new job, and now she had no babysitter. Sonia had no idea what to do. She could not get herself to move. All she could do was cry.

Most women will have no trouble recognizing what this mother is experiencing -- it's called stress, with a capital S. Attempting to juggle child care with the demands of a full-time job, caring for an aging parent or sick family member, having financial worries or concerns about a child's behavior and school performance can be overwhelming. And holiday season, which is coming up, often adds another layer of demands.

Even though men are certainly not immune, women are twice as likely to experience stress-related conditions such as depression, anxiety, and eating disorders. At SUNY Downstate Medical Center, roughly 90 percent of the patients who come to the Anxiety Disorders Clinic are women. The same holds true at the Depression Clinic. What is going on?

Women, mood, and mental health
Dr. Steven Friedman, director of the Anxiety Disorders Clinic, believes that in their role as caretakers, women experience greater levels of life-stress than men. He points to the fact that major depressive illness occurs most frequently in women between the ages of 23 and 45, which are the peak years for childbearing and raising children.

Hormonal fluctuations also play an important role. Mood swings, dispondency, and crying jags at certain times of the month are common symptoms of premenstrual syndrome (PMS). After giving birth, as many as 50 percent of women experience postpartum "blues."

Women who have strong family support systems have an easier time coping with childbirth and other new challenges. But in large immigrant communities such as ours, newcomers may have great difficulty adjusting to significant changes in their lives. Dr. Friedman notes that "besides the normal stresses of urban life, recent immigrants may feel cut off from the traditions and the family support they enjoyed in the communities they left behind." At the same time, the Brooklyn community is exceptionally resilient. Immigrant groups such as Asian and Caribbean Americans tend to have strong, family-oriented cultures that offer support in crisis and provide good role models for coping under duress.

Another reason why more women are in treatment for emotional problems than men may be that women are more likely to seek medical help. "That is actually the good news," says Dr. Friedman. "Many women do recognize their need for help."

The "snowball effect"
An unfortunate effect of stressful situations is that an individual may lose touch with her usual ability to cope, says Dr. Ramaswamy Viswanathan, who is known to his students, patients, and colleagues at Downstate as "Dr. Vis."

"When people feel overwhelmed, they tend to become slower in their reactions they may neglect paperwork, fail to pay bills, or get behind on projects at work. Then they are faced with the 'snowball effect -- a cascade of new problems that makes everything worse."

Important personal relationships often suffer. A common problem is diminished sexual desire. The loss of sexual interest is nearly universal among people who are depressed and is one of its earliest symptoms, says Marian Dunn, director of Downstate's Center for Human Sexuality. "Depression is the great 'killer' of sex in women and men, but women are more likely to overlook this symptom because they don't realize that lack of desire is abnormal."

The key to coping with stress, Dr. Vis says, is to be aware when you are experiencing stress, and to act on that knowledge, instead of feeling helpless.

Stress awareness
Stress is not just a temporary, uncomfortable fact of life -- it can be dangerous. Not only can stress contribute to family strife and the breakdown of marriages and friendships but, over the long term, unmanaged stress, anxiety, and depression can lead to serious mental and physical illnesses. One difficulty in recognizing emotional problems, however, is that the physical symptoms -- hypertension, insomnia, back and stomach pains, chronic fatigue, to name just a few -- often mask the root cause.

In cultures that stress self-reliance, individuals may try to hide or deny their emotional pain. Downstate therapists note that this is true of many Caribbean-American patients who are referred to them for mental health evaluation only after their primary care physicians can find no other explanation for their physical complaints.

Take action against stress
Once stress is recognized, what can be done? The common advice, to reserve time for relaxation, may not seem possible to someone who feels she already is too busy. And such a passive approach may actually generate more anxiety for those pressed for time. "I believe a person must first address the cause of her stress," Dr. Vis says. He recommends two types of actions: instrumental and palliative. Both are important.

Instrumental actions are those that deal with worries directly. You might ask yourself, 'What can I do to change this situation?' and then act, for example, by getting a mammogram if you are worried about a lump in your breast, talking to your boss about a problem on the job, or applying for a loan to resolve a financial difficulty. Just the fact of doing something helps, because it makes you feel more in control.

Palliative actions are those that make you feel better through their calming or distracting effects, and by putting you back in touch with the core you. They are beneficial in combination with direct actions, and they can be helpful in situations, such as the illness of a loved one, in which there really is nothing you can do. Palliative actions include exercise, meditation, and deep-breathing relaxation techniques, as well as hobbies, gardening, or any activity that can calm you down and help you think straight.

"If a person is spiritually inclined, I would also advise her to tap into that resource," Dr. Vis says. "Things happen in life that are beyond our control. It helps to be optimistic, and religious teachings provide many people with a philosophical structure and sense of meaning by which they can understand these events."

The advice and companionship provided by members of a support group or religious community can help tremendously. A recent study demonstrated that women with breast cancer who participated in support groups actually lived much longer, and with better quality of life, than did women with comparable disease who did not have such a support system.

Getting professional help
If taking some of these actions on your own provides little relief, then professional help should be obtained. In treating stress and anxiety in women, mental health professionals find that anxiety symptoms, such as panic attacks, often cloak an underlying depression. This is frequently the case at the Crisis Intervention Program at Kings County Hospital, directed by Dr. Constantine Ioannan. "We see that once people have the opportunity to tell their story, the symptoms of depression start to come out," he says.

A major obstacle to getting people into treatment is the view that having a psychological problem is somehow shameful or something that should be overcome alone. Dr. Carl Cohen, director of the mental health outpatient programs at Downstate, is concerned that too many people who could benefit from treatment are failing to receive it. Chinese Americans, for example, do not even have a word for depression in their vocabulary and often do not recognize when they have a problem.

Dr. Vis offers this general advice to anyone who may feel reluctant about seeking professional help: "When you go to see someone, you are not committing yourself to anything. The first visit is like an interview. If you find you are uncomfortable or do not believe this person can help you, then don't go back. But talking to someone about your problems, even once, usually will help clarify some things for you."

Treatment is usually effective
In recent years, scientists have learned that psychological disorders are often associated with changes in biochemical processes in the brain. Furthermore, vulnerability to some psychological disorders, including anxiety and depression, runs in families. While many questions still remain about the biological basis for many mental disorders, cures for anxiety and depression can and often do occur. These cures may involve the use of prescriptive drug treatments to correct a biochemical imbalance. Currently a number of different types of antidepressant and mood-enhancing drugs are widely prescribed for psychological problems, and new and potentially more effective drugs are under development.

In cases of minor depression or anxiety, talk therapy alone, without the use of drugs, often works. Or it can be used in combination with drug therapy for more serious disorders. Talk therapy helps the patient examine her thoughts and become aware of the fears and worries that influence her behavior. The goal is to boost self-esteem and to change the negative thought patterns that contribute to her difficulties.

Dr. Cohen points out that "all women should pay attention to stress and watch for signs of anxiety and depressive disorders in themselves and their families. Help exists and cures are available. We urge women to take advantage of the support available to them."