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Serotonin Transporter Occupancy of Five Selective Serotonin Reuptake Inhibitors at Different Doses: An [^sup 11^C]DASB Positron Emission Tomography Study

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Serotonin is a chemical that has a wide variety of functions in the human body. It is sometimes called the happy chemical, because it contributes to wellbeing and happiness.

The scientific name for serotonin is 5-hydroxytryptamine, or 5-HT. It is mainly found in the brain, bowels, and blood platelets.

Serotonin is used to transmit messages between nerve cells, it is thought to be active in constricting smooth muscles, and it contributes to wellbeing and happiness, among other things. As the precursor for melatonin, it helps regulate the body's sleep-wake cycles and the internal clock.

It is thought to play a role in appetite, the emotions, and motor, cognitive, and autonomic functions. However, it is not known exactly if serotonin affects these directly, or if it has an overall role in co-ordinating the nervous system.

It appears to play a key role in maintaining mood balance. Low serotonin levels have been linked to depression.

Fast facts on serotonin

Serotonin is an important chemical and neurotransmitter in the human body.

It is believed to help regulate mood and social behavior, appetite and digestion, sleep, memory, and sexual desire and function.

There may be a link between serotonin and depression. If so, it is unclear whether low serotonin levels contribute to depression, or if depression causes a fall in serotonin levels.

Drugs that alter serotonin levels are used to treat depression, nausea, and migraine, and they may have a role in obesity and Parkinson's disease.

Other ways to increase body serotonin levels may include mood induction, light, exercise, and diet.

What is serotonin?

Can serotonin boost happiness, or is it more complex than that?

Serotonin is created by a biochemical conversion process that combines tryptophan, a component of proteins, with tryptophan hydroxylase, a chemical reactor. Together, they form 5-hydroxytryptamine (5-HT), or serotonin.

Serotonin is most commonly believed to be a neurotransmitter, although some consider it to be a hormone. It is produced in the intestines and the brain. It is also present in the blood platelets and the central nervous system (CNS).

As it occurs widely throughout the body, it is believed to influence a variety of body and psychological functions.

Serotonin cannot cross the blood-brain barrier, so any serotonin that is used inside the brain must be produced inside the brain.

Function

As a neurotransmitter, serotonin relays signals between nerve cells, or neurons, regulating their intensity.

It is believed to play a key role in the central nervous system (CNS) and in the general functioning of the body, and especially the gastrointestinal (GI) tract. Studies have found links between serotonin and bone metabolism, breast milk production, liver regeneration, and cell division.

Serotonin influences most brain cells both directly and indirectly.

Bowel function: Most of the body's serotonin is found in the GI tract, where it regulates bowel function and movements. It also plays a part in reducing the appetite while eating.

Mood: In the brain, serotonin impacts levels of mood, anxiety, and happiness. Illicit mood-altering drugs such as Ecstasy and LSD cause a significant rise in serotonin levels.

Clotting: Serotonin contributes to the formation of blood clots. It is released by platelets when there is a wound. The resulting vasoconstriction, or narrowing of the blood vessels, reduces blood flow and helps blood clots to form.

Nausea: If you eat something that is toxic or irritating, the gut produces more serotonin to increase transit time and expel the irritant in diarrhea. This also stimulates the nausea area in the brain, resulting in nausea.

Bone density: Some scientists have linked high levels of serotonin in the bones to an increase in osteoporosis, but others have challenged these results.

Sexual function: Serotonin appears to inhibit sexual activity. Selective serotonin reuptake inhibitors (SSRIs) boost serotonin levels in people with depression, but between 20 and 70 percent of people who take them experience a range of symptoms related to sexual dysfunction.

Serotonin and depression

It is not clear precisely what causes depression, but a key theory in the last 50 years is that it may involve an imbalance of neurotransmitters or hormones in the body.

Depression has been linked to low levels of serotonin, but whether this contributes to depression or results from it remains unclear.

SSRIs are approved by the Food and Drug Administration (FDA) to treat depression. They are the most commonly prescribed antidepressants. Examples include fluoxetine (Prozac), citalopram (Celexa) and sertraline (Zoloft).

Normally, once a neurotransmitter has transmitted its neural impulse is reabsorbed into the body. SSRIs prevent the serotonin from being reabsorbed, leading to higher levels of serotonin in the synapses.

However, scientists are now questioning the role of serotonin or any single neurotransmitter in triggering depression.

Serotonin deficiency symptoms

Low levels of serotonin have been linked with:

They may also lead to the following symptoms:

craving for sweet or starchy foods

difficulty sleeping

low self-esteem

anxiety

aggression

Some recreational drugs increase serotonin levels.

These are common symptoms of depression, but there appears to be little evidence linking them directly to low serotonin levels.

It may also be that this is only true for people who are already susceptible to the symptoms of depression.

When people use recreational drugs, such as MDMA and ecstasy, large amounts of serotonin are released. This can lead to serotonin depletion and a low mood, confusion, and other symptoms that last several days.

Studies have also shown that these drugs may also damage the nerves that contain serotonin, with possible long-lasting adverse effects.

Treatment: SSRIs

SSRIs increase serotonin levels by preventing serotonin neurotransmitters from being reabsorbed. Serotonin levels remain high in the brain. This is believed to elevate mood.

SSRIs that the FDA has approved to treat depression are:

Citalopram (Celexa)

Escitalopram (Lexapro)

Fluoxetine (Prozac)

Paroxetine (Paxil, Pexeva)

Sertraline (Zoloft)

Vilazodone (Viibryd)

Does serotonin really relieve depression?

SSRIs have been used since the 1980s to treat depression by boosting serotonin levels.

Medication such as SSRIs are believed to relieve the symptoms of depression by boosting serotonin levels in the body, but exactly how this works is unclear.

Some scientists have suggested that, while SSRIs seem to work for some people, increasing serotonin levels is unlikely to directly improve symptoms of depression.

One problem is that it is possible to measure serotonin levels in the bloodstream, but not in the brain. Researchers do not know whether serotonin levels in the bloodstream reflect the serotonin levels in the brain, or if SSRIs can really affect the brain.

In 2014, a mouse study suggested that serotonin may not play a role in depression. Researchers created some mice that were not able to produce serotonin in their brains. The mice showed no signs of depression, even when placed under stress.

In 2015, however, other scientists found that mice that lacked serotonin were more susceptible to social stressors than healthy control mice.

While SSRIs appear to help some people with depression, some scientists now argue that "simple biochemical theories that link low levels of serotonin with depressed mood are no longer tenable."

One editorial published in the BMJ in 2015 refers to the use of SSRIs to treat depression as "the marketing of a myth."

SSRIs are also used to treat symptoms of anxiety, panic disorder, and obsessive-compulsive disorders.

Adverse effects of SSRIs

SSRIs have some side effects, but these usually decrease after 2 to 4 weeks of use.

SSRIs and suicide

SSRIs do not begin to work on depression for a couple of weeks. During the first month of treatment it is possible for symptoms of depression to worsen before positive changes are noticed. Report any suicidal thoughts immediately.

There are reports of some younger users of Zoloft experiencing suicidal ideation.

The FDA requires all antidepressants to carry a black-box warning about the danger of suicide during the initial stages of treatment, especially in children.

Other uses of SSRIs

SSRIs have been used for conditions other than depression.

Treatment with serotonin may help relieve migraine

Antiemetics: The antiserotonergic drugs that act on the serotonin receptors, such as ondansetron (Zofran), are important for treating nausea caused by chemical toxins, including drugs used in chemotherapy and general anesthesia. They act centrally on the part of the brain involved with nausea.

Migraine: Serotonergic vasoconstrictive antimigraine drugs, or triptans, such as almotriptan (Axert), can reduce migraine symptoms and are well tolerated.

Appetite suppressants: Serotonergic appetite suppressants, such as fenfluramine (Pondimin) and chlorphentermine, have been used for reducing appetite, but they are no longer licensed for this purpose.

Parkinson's disease: The serotonergic system has been linked to cognition, emotion, and motor behavior. Changes in this system may therefore have an effect on the motor and non-motor features commonly associated with Parkinson's disease. Serotonergic drugs have been used to treat Parkinson's disease. They are no longer licensed, but research continues in this area.

Premenstrual syndrome (PMS): The cause of this condition is unknown, but an oversensitivity to one of the female hormones, progesterone, seems to reduce the level of serotonin in the brain. Serotonin inhibitors are sometimes used to relieve symptoms around the time when they occur.

Other possible uses of SSRI-type drugs include the treatment of obesity and irritable bowel syndrome (IBS).

Serotonin syndrome

Serotonin syndrome, or serotonin toxicity, can happen if a person takes two serotonin-boosting drugs at the same time.

There is excessive stimulation of the CNS and peripheral serotonin receptors. It is usually the result of a drug interaction, but at least one medical condition can trigger it.

Drug interactions: The use of prescribed medications, illegal drugs, or dietary supplements can lead to serotonin syndrome, for example, if a person is susceptible or if two drugs that affect serotonin levels are taken at the same time. Symptoms can appear 6 to 8 hours after taking the drug.

The FDA have warned, for sample, against taking SSRIs with triptans, a medication to treat migraine, because of the risk of serotinin syndrome.

Drugs that target serotonin levels cannot be given with MAOI's. MAOIs are another approach to treating depression and work on different neurotransmitters and their receptors.

Recreational drugs: The use of recreational drugs, such as ecstasy and MDMA, leads to a high and sudden release of serotonin. If used with prescribed serotonergic drugs, this can increase the risk of serotonin syndrome.

Carcinoid tumors: These cancerous tumors, commonly found in the GI tract, can cause too much serotonin to be released. Most carcinoid tumors have no symptoms. They are often found during tests or procedures for other conditions.

Serotonin syndrome leads to excessive nerve activity.

Signs and symptoms include:

agitation and restlessness

confusion

increased heart rate and blood pressure

pupil dilation

diarrhea

headaches

shivering

sweating

loss of muscle co-ordination

goosebumps

muscle rigidity

Severe serotonin syndrome is life-threatening in 2 to 12 percent of cases.

Symptoms include a high fever, irregular heartbeat, seizures and unconsciousness.

The use of a single drug does not usually result in serotonin toxicity.

Treatment

Treatment focuses on managing symptoms and attempting to restore normal serotonin levels.

Discontinuing the medication may be enough to stop the symptoms.

Severe serotonin syndrome may need hospital treatment. Medications can be given to relax or paralyze the muscles, control heart rate and blood pressure, and, in some cases, to block the production of serotonin.

Oxygen and intravenous fluids may be given to maintain normal levels of oxygen in the bloodstream and to treat fever and dehydration.

Boosting serotonin levels

As well as SSRIs and illegal drugs, there may be other ways of increasing serotonin levels in the body.

Mood induction: Alterations in thought, either through psychotherapy or self-induction, could increase levels of serotonin if the interaction between serotonin synthesis and mood is a two-way relationship.

Light: Already used as a treatment for seasonal affective disorder (SAD), a few studies have suggested that it can be used to treat depression as well.

Exercise: Exercise has an antidepressant effect, and some research has suggested that it can increase brain serotonin function.

Diet: Foods that have higher levels of tryptophans could be linked to improved mood and cognition, possibly due to increased serotonin levels. Also serotonin is available as a supplement, which can be purchased online.

These are all areas that require further study, as current knowledge remains speculative.

Foods

Tryptophans are an amino acid that can be found in food. Some research has linked a higher intake of dietary tryptophan with more positive mood scores, possibly because tryptophan boosts serotonin levels.

Bananas are said to contain serotonin, but can this boost happiness in whose who eat them?

High-protein foods: Some foods, such as turkey, eggs, and cheese, are believed to contain tryptophan and to increase tryptophan levels in the blood.

Bananas: These contain serotonin, and they have been recommended for lifting mood. But they can only improve a person's mood if the serotonin they contain will reach the brain.

Tryptophan is a precursor, a main ingredient that the body needs to make serotonin. Eating foods high in this essential chemical doesn't mean that the body will absorb and use it. But making tryptophan available when needed will improve serotonin synthesis.

In some studies, however, older people who were given tryptophan supplements performed better on cognitive tests than they had before.

There is a growing interest in the idea that gut microbiota might influence the CNS and cognition through a link known as the gut-brain access. In this case, serotonin in the digestive system may be able to influence mood.

The following foods are said to contain tryptophans:

However, while foods may contain tryptophan, it may be in too small an amount to make a difference. Most studies have used supplemental forms of tryptophan.

A protein known as α-lactalbumin, for example, is found in milk. It contains more tryptophan than most proteins. However, scientists suggest that it is probably not practical to consume the amount that would be needed to make a difference.

In the 1980s, corn that was bred with a higher tryptophan content was successful in preventing pellagra. Population studies suggest that people for whom this corn was a major part of the diet showed fewer aggressive tendencies, although this could have been for other reasons. It is possible that the tryptophans in the corn increased people's serotonin levels.

Studies in which people consumed tryptophan-enriched drinks and other nutrient-based treatments have produced mixed results.

Until now, there is little evidence that a specific diet can affect mood or depressive symptoms.

However, following a healthful and varied diet has been found to produce a range of health benefits and to boost overall wellbeing.

The 2015-2020 Dietary Guidelines for Americans urge people to focus on a varied diet and to aim to obtain nutrients from food sources as far as possible.

Tryptophan supplements are available online, but they should not be used without first speaking to a doctor, because of the risk of serotonin syndrome.

Much remains unknown about serotonin. The difficulties surrounding the study of brain functions means that it will be some time before a full knowledge of serotonin can be acquired.

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Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT

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Serotonin: Facts, uses, SSRIs, and sources

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Serotonin is a chemical that has a wide variety of functions in the human body. It is sometimes called the happy chemical, because it contributes to wellbeing and happiness. The scientific name for serotonin is 5-hydroxytryptamine, or 5-HT. It is mainly found in the brain, bowels, and blood platelets.

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Updated May 31, 2017 10:26:25

Australian men aged over 85 have the highest suicide rate in Australia, and more than double that of teenagers, Australian Bureau of Statistics 2015 data shows.

The suicide rate for men aged 85 and older was 39.3 per 100,000 people. In women of the same age, it was 5.7.

Among males aged 15-19 years old the suicide rate was 11.8 deaths per 100,000 people, but suicide accounted for 28.6 per cent of all deaths in that age group.

The highest female suicide rate was within the 45-49 year age group, at 10.4 deaths per 100,000. The lowest death rate for females was among those aged 65-69 years - 4.5 deaths.

Monash University Professor Paul Komesaroff said a lack of support was partly to blame for poor mental health in many older Australians.

"Elderly people have often been blamed for soaking up disproportionate quantities of our healthcare resources," he said.

"This has become a harsher and crueller society over the years.

"There's been a reduction in the support that has been made available for elderly people."

He said many older Australians had a mindset that not being as productive as they once were meant they had little to live for.

"They may well express to their doctor the view that they don't want care to be prolonged," he said.

"Not because they fear losing their capabilities or their capacities, but because they don't want to impose on the rest of society, it's their sense of responsibility.

"And of course that's a terrible tragedy because these are the people who have actually created the wealth."

Stoicism and pride have their downsides

Professor Henry Brodaty, from the Centre for Healthy Brain Ageing, said many elderly people had what he called "passive suicide thoughts" such as "I would be quite happy if I didn't wake up in the morning".

He said he was also concerned about the stoicism and pride of the so-called "greatest generation".

"They're less likely to see a psychologist, they're less likely to receive psychological treatments," he said.

"If they do see a doctor for their depression they're more likely to receive medication for that.

"Older people are much more likely to be in pain, which is a risk factor for dementia.

"They're more likely to be isolated and bereaved, which is another risk factor."

And he said many elderly people were particularly reluctant to enter nursing homes.

"They feel that their life is not very full and they even feel imprisoned at times, but feel they have no other options for their care," he said.

Nursing homes 'should be more like a hotel'

But within many migrant cultures, Professor Brodaty said it was common for the children of elderly migrants to insist on looking after them in their own homes.

"Some of my patients are Greek patients, or Chinese patients for example - the bonds of kinship, or filial duty, are very strong," he said.

"In many cultures there's a shame incurred if you put your person into a home - even if you use services and bring services into the home."

However, Professor Brodaty said there was no evidence that going to a nursing home worsened mental health for the elderly.

But he said improving conditions in facilities could help their mental health.

"One of the things in nursing homes that we've been strongly advocating for is this whole notion of person-centred care, where we treat the person as a person, try and respect their rights and their wishes," he said.

"As if you were going to a resort hotel and you had a menu of activities you would like to do - you have options of when you want to eat, what you want to do and where you want to do.

"Rather than everyone being regimented to get up at a certain time, be showered, be fed, be sat in the day room with all the other residents."

First posted May 30, 2017 14:11:09

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Australian men aged over 85 have the highest rate of suicide

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Updated May 31, 2017 10:26:25 Australian men aged over 85 have the highest suicide rate in Australia, and more than double that of teenagers, Australian Bureau of Statistics 2015 data shows. The suicide rate for men aged 85 and older was 39.3 per 100,000 people. In women of the same age, it was 5.7.

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Seventy-nine cents on the dollar. That's how much money women in 2015 are making when compared alongside their male counterparts. The gender gap is an ever-present issue in the global workforce, with further wage inequities present when comparing salaries for minority females. In the last eight years, the gap has shrunk by just two pennies per dollar, illustrating the need for more women and their allies to join together and demand fairness. While much has changed since the signing of the Equal Pay Act in 1963, there remains much to be done. Dig into the causes, explore the history of fair pay movements, and get actionable tips on how women can fight to close the gender gap.

What Causes the Gender Gap?

The gender gap is a complicated issue with many factors contributing to an overall lower rate of pay for women. While critics argue the disparity boils down to personal decisions, the American Association of University Women dispelled this notion. In a survey of men and women who graduated college a year prior, females still earned only 82 percent of their male peers. Even after taking into account factors such as choice of major, geographical location, marital status, grades, and economic status, a seven percent gap remained. Women who have risen above the wage gap realize it's not a question of if it still exists, but rather how they can use their knowledge to combat its effects. The following review of causes arms female professionals with valuable insights to ensure they are one step ahead of common challenges to equal pay.

Education

Though higher education access for some women has improved in recent years, several issues still exist. Although more and more females are attaining postsecondary degrees, this increase is not equal across races and ethnicities.

While White and Asian American women are outpacing their male counterparts in terms of attending college, the number of female minorities attending and completing their degrees still lags behind. Reasons for this are varied, though much of it comes down to the accessibility of college for female minority students.

A 2011 report by the National Center for Educational Statistics found that, while 82 percent of high-school students from high income families enroll in college, that number plummets to 52 percent for students from low income families. Given that African American and Hispanic families alone account for 52 percent of all low income families, it quickly becomes evident that minority women face additional challenges in obtaining educations.

The second issue revolves around the disparity between how degrees earned by men and women are seen differently by employers. A report by The American Center for Progress found that women must earn an additional degree to make the same amount as a male co-worker over the course of their professional careers. For example, it's projected that a woman with a doctoral degree will earn the same as a man with a bachelor's degree.

Family

When it comes to taking care of a family, expectations placed on women often go beyond simply being responsible for producing children. Although a shift is currently taking place and more men are staying home to take care of children, historically women have either been expected to stop working entirely or at least take a number of years off work to raise offspring.

This pressure rises exponentially for single mothers, as they must take into consideration questions of childcare and balancing an ever-growing set of responsibilities. Even for women who happily stay home during their child's first few years, they face the issue of lagging behind male counterparts in areas of skills and experience.

A Stanford University report found that when holding the same qualifications and experience and going for the same job as a man, mothers were discriminated against in both perceived competence and starting salaries. Men, conversely, often receive wage premiums if they are fathers.

Segregation in Occupations

In industries or fields historically dominated by men, women face additional pressures to prove themselves and compete in an outnumbered environment. This issue has been seen in STEM fields for decades, where women may feel unwelcome. The gap begins early in education and is clearly evident by college.

While reports about male-centric workforces and occupational segregation are valuable for highlighting a continuing problem, these issues must be addressed at the educational level to see change. Some industries are slowly turning the boat around, but there is still much work to be done to accomplish equality in both workforce balance and salaries.

Discrimination

Most recent studies are able to account for approximately 60 percent of the reasons for pay inequality between men and women, leaving 40 percent open to interpretation. A report by the National Women's Law Center suggests a large portion of this unknown cause can be chalked up to discrimination.

While discrimination can take many forms and be rooted in the reasons discussed above, it is overwhelmingly unfounded. The Institute for Women's Policy Research is continually furthering and expanding on this conversation and offers excellent resources and research for women who feel they've been discriminated against in areas of pay, promotions or hiring practices.

Gender Gap on the Job

Be it outright or nuanced differences, women can face a number of issues within the workplace. Ranging from discrimination for promotions or taking time off to segregation within occupational sectors, the progress of the last half-decade has still not created true gender equality. While fathers are often rewarded with larger salaries or bonuses, mothers are penalized or even passed over for jobs. The following takes a look at some of the biggest issues facing working women today.

Gender Gap and an Individual Woman's Career

While the majority of reports focus on national statistics about the gender gap, every woman in America has felt its affects on her ability to provide for herself and her family. The difference between men's and women's median earnings was $10,762 annually as of 2015, with the difference widening after accounting for advanced levels of experience and education. This figure becomes all the more sobering when considering the causes and effects of such disparities on individual careers. Some of these include:

Jeopardized economic security for working mothers

A 2010 study found that women are considered breadwinners in 64 percent of American families, either as a single working mother or through earning more than her husband. While this may seem like progress, given the fact that more women attend - and graduate from - college, it doesn't necessarily mean she is earning more outright, simply that she has a higher level of education and a significantly higher role.

Location plays a large role

Depending on the state a woman resides, the gender pay gap can be even more significant than the national average. In a 2014 research project conducted by the American Association of University Women, researchers found a wide difference among the top and bottom states for working females. While Washington D.C. sat above the average, with women earning 90 percent of what men make, as the lowest ranking state, Louisiana pays female workers only 65 percent of male earnings.

Lower Wages

Though progressive thought is working to reduce the pay gap across genders, in 2014 women still made an average of 79 cents on the dollar when compared to men. If both a man and a woman are working in the exact same job, same location, and the same point in their careers, while the man would earn a salary of $50,000, the female would only take home $39,500 each year.

Lower Retirement Funds

It's been estimated that women earn nearly $450,000 less than a man following the exact same career path over the course of their working years. This sad truth not only affects women as they work, it has consequences on the amount of retirement funds they need. A report by Financial Finesse took into account the Social Security shortage, longer life expectancies, and the average expenditures of retirees. Based on these numbers, a 45-year-old man who wishes to live on 70 percent of his pre-retirement income should save an additional $270,000 by the time he is 65. Staggeringly, a woman hoping to do the same will need to save an additional $522,000.

"Pink Collar" jobs

Even with strides made in recent years, women can often feel relegated to specific careers that have come to be known as "pink collar." Of the careers where women are most prevalent, these still include "historically female" roles, such as secretaries, administrative assistants, elementary and middle school teachers, and housekeepers. All of these jobs pay significantly less than the roles historically held by men, such as bankers, lawyers and doctors.

Women earn less as they age or build families

According to a report by researchers at the University of Pennsylvania and the University of Arizona, women with children earn seven percent less than those who don't have children, further increasing the gendered pay gap. Even for women who choose not to have children, the gap continues to widen as they age. While women in their mid- to late-twenties earn an average of $1,702 less than male counterparts, the last five years before retirement sees this number skyrocket to $14,352 annually.

What the Gender Gap Means for Minorities

Female minorities in the workplace face the pressure of not only navigating gender discrimination, but also the possibility of racial discrimination. While Asian American women fare best in wage gap studies, women from minorities with historically higher rates of poverty and lower rates of education face the largest discrepancies. This is especially true for Hispanic or Latina, American Indian, and African American women, who experience gaps with men of their own race and even larger gaps when considered against white men. We take a closer look at these numbers below.

Closing the Gap

During World War II, thousands of women began working in factories and at plants to produce crucial supplies for both the war and at home. As veterans returned home, women were pushed out of these jobs and once more had to page through the gender segregated job listings in their local newspapers. As of the 1950's, women brought home an average of 40 percent less than men in the same positions. The Equal Pay Act of 1963 made it illegal to pay women less based solely on their gender, with other demonstrable qualifications such as seniority, experience or merit listed as the only reasons to enact differing pay scales.

Since that time, other rulings have helped push the conversation along: by 1990, women earned 71.6 percent of male salaries, while the year 2000 saw them earning 73.3 percent on the dollar. The last 15 years has seen this percentage rise to 79, yet this is still far from equal. To expedite the process, women must begin working to close the gender gap in their own lives.

How Women Can Make an Impact

Women seeking to bridge the gender wage gap have several options to pursue. Some of those proven most effective are outlined below.

A report by the Center for American Progress found that nearly half of all women hold the same 20 occupations. By working in female-dominated fields, it's hard to differentiate yourself and point out pay inequalities. For women with broader interests, consider a career that has been traditionally male-dominated where progressive leaders are actively trying to recruit a female workforce. STEM-related careers are a great example currently, with many companies offering incentives aimed at attracting female professionals.

Tips for Women to Become Better Negotiators

After a hacking scandal at Sony Entertainment, news broke that Jennifer Lawrence had received significantly less pay than her male co-stars in a recent blockbuster film. In October 2015, the actress penned an Op-Ed piece empowering women to become better and stronger negotiators rather than simply trusting the process will be fair. Because pay equality is still in the future, women must learn how to be confident when asking for the salaries they know they are worth. Some of the best tips for productive negotiation sessions include:

Just Do It
Perhaps the biggest obstacle is to simply negotiate, period. A 2014 book by Linda Babcock and Sara Laschever found that while 46 percent of men negotiate salary offers, this number plummets to 30 percent when considering women. If you feel the package being offered isn't fair or what you're worth, speak up.

Know Your Worth
Building off the previous idea, it's important to know the salary range you can demand based on skills, experience and previous accomplishments. It's also important to factor in your vision and ability to lead a company or team forward. In these situations, women can often feel stifled or worry they are putting too much of the spotlight on themselves. Instead, reframe the conversation in your head and remind yourself that for potential employers to receive your best work, you need to feel you're properly valued and that includes monetarily.

Develop Your Negotiation Style
Often women are told to go into negotiation meetings and fight like a man. This very idea is counterproductive to the argument, as women naturally communicate differently. Rather than feeling like you must be aggressive, go in with a strong, well-reasoned argument of why you are worth the amount you're asking. Be clear, concise and well-researched and use intelligent rhetoric to convince employers in your own way.

Don't Apologize
Whatever you do, don't apologize. Countless women have been conditioned to say they're sorry, especially in situations where they feel they are being unreasonable. Women are very concerned about the comfort and happiness of others, and often feel that, by having their own demands or needs, they are inconveniencing others. The fact of the matter is that these thoughts have no place at the negotiating table. While it's important to be fair in your ask, you must also unapologetically believe in yourself and your worth.

Present a Win-Win Scenario
Because women are attuned to the needs of others, use this to your advantage. While a fair salary is directly beneficial to you, it also enables you to produce your best work for the company and stakeholders. Women who are underpaid have no monetary incentive to continue growing and improving in their roles, whereas those who feel they are valued and respected will go to great lengths to achieve success for those they work with.

Have the Conversation a Few Times
Most women like to be prepared and know what they're walking into. This is especially true in tense settings like negotiations, which can often have several outcomes. Before going into a meeting to discuss salary expectations, role play the scene to think through what you want to say and what they are likely to say. Imagine their responses to your needs, and think about the best ways to accomplish your end goal.

Stick to Your Guns
It's easy to walk into a negotiation and worry that employers will think your demands are outrageous. Many women fall into this trap, and accept a minuscule salary raise instead of holding out for what they know they're worth. Don't settle for decent, good or better: go for best. Whether it's a percentage, a set amount, or a strategy to increase your salary over a time period, go in with valid and concrete reasons and hold to them throughout the entire process.

What Society Is Doing to Close the Gender Gap

In the following section, women and advocates of wage equality can learn more about some of the mainstream initiatives in place to reduce gender-based pay discrimination.

Federal Government Programs

The U.S. Department of Labor has set up the Office of Federal Contract Compliance Programs to reduce and eliminate discrimination amongst federal contractors and subcontractors. The OFCCP works to identify patterns of underpaid work and offer affirmative action and equal employment opportunities for everyone, regardless of gender, race, color, national origin, or religion.

Based on a recent study, only 2.7 percent of startups receiving venture capital are headed by women. Crowd funding platforms such as Kickstarter, where an estimated 44 percent of investors are female, stand to dramatically alter these numbers. Given the storytelling nature of investment sites of this nature, women have the platform to share their vision and plan for companies, in turn eliciting more response and funding.

This global movement started by UN Women is focused on engaging men in the fight to put a stop to inequalities faced by women, be they social, political, or economical. As of October 2015, nearly half a million men from every continent had pledged their support and their voices to women as they work together to end discrimination.

Though boys have historically had greater levels of access to education, especially higher education, the last 60 years have seen a dramatic shift. Women are no longer graduating high school and becoming homemakers; instead, women are outpacing men in both educational levels and overall abilities. Though women have shown greater skills in reading and English-related subjects for many years, the gap in accomplishments related to science and math fields is shrinking at a considerable rate. According to a study by a Paris-based think tank, 15-year-old boys are only about three months ahead of their female-counterparts in terms of mathematical knowledge. Given the enduring idea that these topics are better suited to boys, this awareness will likely have great impact on the future of STEM-related education and industry.

In 2014, the U.S. Department of Labor proposed a change to rules about overtime thresholds for salaried workers. The threshold, which hasn't been updated to account for inflation and rising costs since 1975, currently dictates that salaried workers are able to receive compensation for any hours over 40 per week, provided they don't make more than $23,660 annually. The newly proposed guidelines would raise this threshold to $50,440 annually, meaning millions of women would be eligible to receive overtime compensation to supplement their existing incomes.

A number of companies are now offering perks and incentives aimed at serving their female employees, including longer maternity leaves, on-site daycare services, and opportunities to work from home. Of the companies we surveyed, none of these programs were seen as penalties to women, but rather ways of recognizing unique responsibilities and empowering them to find a healthy work-life balance.

The National Committee on Pay Equity created National Equal Pay Day in 1996 to highlight the disparages between female and male salaries and to offer an annual day to review how the conversation has been moved forward in the previous year. The White House and a number of other significant national and international organizations now recognize the day each year.

Interview with Julie Holunga

How have you seen your Lean In group empower women to close the gender gap?

The group acts as a sounding board with peers - highly driven, motivated and successful women looking to up level their careers. They challenge each other if they are not stepping up to their potential, or playing small.

For example, a director of operations for a non-profit had been talking all year about becoming a certified project manager. At the year mark when we reviewed goals, her inaction. By the following meeting she had registered for a program this fall. Through the group discussions, she realized this certification propels her not only in her current role, but her career not matter where she works.

Honesty, and sometimes hard truths, allow women to try new things at work, knowing they have a dozen or more women behind them. They now seek and offer feedback.

One woman, the founder and COO of a tech company, noticed all the men at the end of the day congratulating each other on 'crushing it' that day. We challenged her to try that herself, both at work, and on the playground while picking up her kids after school. She hesitated, but realized the benefit to those around her, not just herself.

Another small business owner had an employee who was underperforming for months. She addressed her LeanIn group who advised her. She went home that night, wrote up a performance plan, and met with her employee the next day. Within 2 months, he had surpassed their annual goals and was back on track.

A partner in a law firm worked with the group to build her brand and think about how to market herself. When an opportunity presented itself to start her own firm with 2 other colleagues, she jumped at the chance. She had gained confidence and was a little less risk averse. In just the first week of opening their doors, they had 80 clients.

On a day-to-day basis, how does the gender gap affect women in the workplace? On a long term basis?

Women hold back: speaking their opinions, taking credit for their accomplishments, and influencing others without fear. A general counsel for a private equity firm noticed some red flags in a deal they were considering. She waited through four weekly meetings reviewing the deal before saying anything. She works with smart, experienced men, and thought they understood the same red flags. At the end of the fourth meeting, she exploded and pointed it out. In the end, they did not pursue the deal, and she saved her company $4 million. Her take was not that she saved them from a losing opportunity, but that she was unprepared and blurted out her thoughts. She shifted her mindset, and now uses the LeanIn group to prepare for conversations she deems potentially controversial.

In the long term, it affects the next generations of leaders. We will not raise the current 17 percent line of positions in the c-suite filled by females by sitting back, by leaning out. We need diversity of thought, experience and perspective at all levels of decision-making. Any company serving customers and clients needs to represent them in leadership roles. Consulting firms feel this pain when they sit across the boardroom table from their clients and there is a visible difference in gender representation. Their clients demand similar representation. Women are expected to control about $22 trillion of American personal wealth by 2020 and represent the primary breadwinners in 40 percent of American households.

What are some of the additional gender gap issues faced by female minorities?

Women tend not to promote their accomplishments and successes. There is also a parent discount - a woman in the LeanIn group shared that her husband's colleagues didn't know she was pregnant until she was more than six months along. Women visibly wear their status, and often are discounted for it. Meanwhile, her pregnancy had little or no impact on her husband's career trajectory. An executive director of a research organization told her, "Your career will come to a standstill once the baby is born."

Can you speak to the importance of negotiation when it comes to being a female professional?

Women tend not to negotiate; it is not their natural place of comfort. Hence why Harvard Law School has a class specifically for women on negotiating. The cost of not negotiating is that you place yourself in a 'bucket' that is hard to get out of.

Interview with Jenni Brozena

How have you seen your Lean In group empower women to close the gender gap?

The gender gap resonates with women on many levels; our members experience issues with conflict-resolution, strategic planning and negotiation strategies that help them reach their personal definition of professional happiness. Our Lean In group has ultimately given women of all professional backgrounds a safe place to practice their individually needed skills that bring them closer to this happiness. Like you would never expect an athlete to perform well without practice nor accept medical guidance from a clinician that didn't practice treatment during residencies, we believe negotiation, conflict resolution, and strategic planning skills all require the same level of disciplined practice. Many of our members have completely transformed their confidence levels in these skills. As a result, they have been empowered to close the gender gap by professional promotions, salary negotiations, starting businesses, or owning their family's definition of work-life balance.

On a day-to-day basis, how does the gender gap affect women in the workplace?

The gender gap is far from just being a woman's problem. It is often felt rather than overtly seen and occurs on a daily basis in small instances that may seem easy to overlook. Women need to present themselves as a skilled professional with the end goal of fulfilling a job successfully and be comfortable re-directing conversations that may be slipping towards their personality rather than accomplishments.

Along the same line, men need to be taught similar language skills that value women for their skills and not allow personal opinions impact their ability to work together. It's been well documented that women make certain choices to remain "nice" or "likable" but it's quite common for women to be passively put "back in their place" for acting "aggressive" when they are really voicing their worth and expectations. Both men and women need more evolved personal reflections on how to better communicate with each other to avoid these traps that have been engrained in us from generations gone by.

What are the long-term implications?

Particularly in America, parental leave is grossly underdeveloped when compared to other countries. While becoming a parent is a deeply personal decision, the fact that our country is so behind in mandating paid parental leave - both maternal and paternal - we are greatly deterring very talented women from choosing or staying in careers that lead to powerful positions. I see more resolution to gender gap issues in the future because there is a growing movement of women committed to supporting the success of each other rather than continuing a culture of female hostility and competition.

How can women work to close the gender gap in their own lives?

Men and women both need to spend more time identifying what makes them happy in their own lives. This should be a continual process rather than a stagnant declaration. Once we are able to identify our individual idea of happiness we can tailor our energy and efforts for closing the gender gap. Education, support, and resources are the key to closing the gap on a macro level. Our Lean In group is the local embodiment that will keep our members accountable to closing the gender gap in their own lives.

Can you speak to the importance of negotiation when it comes to being a female professional?

Negotiation is the ultimate lifelong verbal sport. Somehow "negotiation" has become a scary word to women particularly, in my opinion, because there is a strong possibility that one party may become aggressive in order to achieve their argument. This circles back to women needing communicative skills and strategies for negotiations but also the practice arena so they can see all possibilities during real world negotiations. The ability to negotiate is the key to shaping your professional and personal life into your version of success, but it also empowers you to be a better manager or boss.

If I, as an entrepreneur, can't negotiate with venture capitalists, then I can't get money to fund my business. If I can't negotiate with an employee then I may lose talent and be faced with turnover costs. If I can't manage a negotiation with an unhappy customer, I may lose their business as well as the business stemming from their review to their personal network. Negotiation is a trainable skill not something women should avoid.

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Closing the Gender Gap: Expert Tips & Resources

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Seventy-nine cents on the dollar. That's how much money women in 2015 are making when compared alongside their male counterparts. The gender gap is an ever-present issue in the global workforce, with further wage inequities present when comparing salaries for minority females.

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Prozac is an antidepressant. It is mainly used to treat major depression, obsessive-compulsive disorder, and panic disorder.

Also known by its generic name, fluoxetine, Prozac is a selective serotonin reuptake inhibitor (SSRI). Around 1 in 10 people in the United States (U.S.) are thought to use SSRI drugs, and 1 in 4 women in their 40s and 50s.

Prozac first appeared in the U.S. in 1988 and it became one of the most widely prescribed antidepressants in the country. It remains popular, although newer drugs are now available, such as sertraline and citalopram.

It is available as a liquid, tablet, capsule, and as a delayed-release, long-acting capsule. It is suitable for adults and it can be used in some cases for children over the age of 10 years.

Fast facts on Prozac:

Here are some key points about Prozac. More detail is in the main article.

Prozac, or fluoxetine, is a selective serotonin reuptake inhibitor (SSRI) and a widely used antidepressant.

It is considered safe and effective in treating depression, anxiety, and obsessive compulsive disorder (OCD), and bulimia.

Adverse effects include an increased risk of suicidal thoughts in some younger people.

It should not be used with monoamine oxidase inhibitors (MAOIs) and some other drugs.

Anyone who wishes to stop using Prozac should do so gradually, with a doctor's help, to prevent adverse reactions.

Side effects

Prozac can help treat depression, but it may have adverse effects.

Antidepressants, including Prozac, can have a number of possible adverse effects.

The FDA requires Prozac to come with a black box warning stating that antidepressants may increase the risk of suicide in people younger than 25 years. It can lead to suicidal thoughts, or a worsening of these, in children and young adults.

Other possible side effects include:

decreased libido and sexual dysfunction

anxiety and nervousness

abnormal dreams

sweating

asthenia, or lack of bodily strength

skin rash

tremor

flu syndrome

insomnia, drowsiness, and yawning

sinusitis, an inflammation of the mucous membrane

painful or difficult digestion, known as dyspepsia

nausea

vasodilatation, or widening of the blood vessels

Drug-drug interactions

The manufacturers warn that Prozac should not be taken together with:

monoamine oxidase inhibitors (MAOIs): Pimozide and Thioridazine

drugs metabolized by CYP2D6

tricyclic antidepressants (TCAs)

Care should be taken when used with drugs that affect the central nervous system (CNS), such as those belonging to the "benzodiazepines" class of drugs. Examples include Diazepam and Lorazepam.

It should be used with care with non-steroidal anti-inflammatories ( NSAIDs), aspirin, warfarin and other drugs that affect blood coagulation, as there is a risk that it could lead to bleeding.

Prozac should not be used with antipsychotics, other SSRIs and other serotonergic agents, including lithium and St. John's Wort.

There is also a chance that fluoxetine may activate mania in a person who is susceptible.

Pregnancy and breastfeeding

Women should only take Prozac during pregnancy if the potential benefits outweigh the possible risks to the fetus.

Studies have found that antidepressants increase the risk of neonatal maladaptation syndrome. Symptoms include jitteriness, problems with feeding and breathing, and hypoglycemia, or low blood sugar.

Breastfeeding is not advised, as fluoxetine can pass into the milk.

As with any drug, there is also a chance that a person may be allergic to the ingredients. If the patient experiences a rash, hives, swelling, or difficulty breathing, they should contact a doctor, as an allergic reaction can become a medical emergency.

Dosage

Dosage depends on the age of the patient and the purpose of treatment. Here are some examples of doses.

The normal adult dose for depression starts with 20 milligrams (mg) a day, taken by mouth, in the morning. It can be increased if symptoms do not improve after a few weeks. The maintenance dose is from 20 to 60 mg a day, and the maximum dose is 80 mg a day.

An adult who uses delayed release oral capsule to treat depression will take a 90 mg capsule once a week.

It may take 4 weeks or more to see any effects.
Each patient must follow their doctor's advice on how much to take, how often, and when.
Taking the wrong dose can be dangerous.

Withdrawal

Patients who suddenly reduce their dose or stop taking Prozac may experience a number of unwanted effects.

These include:

brain zaps

dizziness

confusion

nightmares and insomnia

nausea

tremor

gastrointestinal problems

flu-like symptoms

anxiety or agitation

spells of weeping

irritability

aggressiveness

Suddenly stopping an antidepressant that has been used for 6 weeks or more can lead to withdrawal syndrome. Reducing intake can sometimes have this effect.

These effects can normally be minimized by stopping use over at least 4 weeks.

Some patients do not experience withdrawal symptoms, while others will experience symptoms if they stop over several weeks. Some patients may need to stop suddenly, for example, due to adverse effects or pregnancy. It is important for the patient and their doctor to discuss how to stop using fluoxetine.

Uses

Prozac is selective serotonin reuptake inhibitor (SSRI). It works by blocking the absorption of the neurotransmitter serotonin in the brain.

Regulating the amount of serotonin helps brain cells transmit messages to each other. This results in a better and more stable mood. It also results in more neurons being present in a region of the brain called the "dentate gyrus," part of the hippocampal formation. The hippocampus plays a role in forming memories.

The U.S. Food and Drug Administration (FDA) currently approves Prozac for acute and maintenance treatment of major depressive disorder (MDD), obsessive compulsive disorder (OCD), bulimia nervosa, and panic disorder, with or without agoraphobia.

Prozac is normally used alone. However, fluoxetine combined with olanzapine (OFC) can also be used to treat depressive episodes in people with bipolar disorder. Fluoxetine combined with olanzapine is known as Symbyax. This combination can also help people with treatment-resistant depression.

Some doctors may prescribe Prozac "off-label" to treat anxiety, premature ejaculation, obesity, and binge-eating disorder.

Depression

Prozac can be used to treat depression in adults. It can also be used for children and adolescents from the age of 10 to 19 years with severe, persistent depression. However, the National Institute of Mental Health (NIMH) urge caution, as a small subset of adolescents have shown suicidal tendencies after using it.

A review comparing the effectiveness of Prozac with other antidepressants found that it appears to be similarly effective, and possibly better tolerated. However, the authors concluded that more research is needed, as a number of factors made an exact comparison difficult.

Findings reported in Progress in Neuro-Psychopharmacology and Biological Psychiatry have suggested that some patients' depression does not respond to treatment with the SSRIs paroxetine (Paxil) and citalopram (Celexa), because of a specific genetic factor. These patients, say the researchers, may benefit from a switch to Prozac.

Panic disorder

A number of studies have suggested that Prozac can reduce the incidence of panic attacks in people with panic disorder.

In one study, around 7 percent of patients reported experiencing increased anxiety in the first few weeks after they started using Prozac, compared with 9 percent who took a placebo. However, compared with the overall benefits, this is considered small enough that Prozac is still "safe and effective" as a treatment for anxiety and panic attacks.

Obsessive-compulsive disorder (OCD)

SSRIs normally need to be taken for at least 11 weeks before a person with OCD experiences any benefits. Patients with OCD normally use an SSRI such as Prozac for at least a year, depending on the individual's needs and situation.

A study published in the Journal of the American Academy of Child and Adolescent Psychiatry, concluded that a 20 to 60 milligram (mg) dose of fluoxetine was effective in treating children and adolescents with OCD. Participants also tolerated the drug well.

Bulimia nervosa

Researchers reported in The American Journal of Psychiatry that for patients with bulimia nervosa who had not responded to psychological treatment, fluoxetine may be a useful intervention. It may provide benefits for bulimia if it is taken for up to a year.

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Prozac (fluoxetine): Side effect, dosage, withdrawal and uses

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Prozac is an antidepressant. It is mainly used to treat major depression, obsessive-compulsive disorder, and panic disorder. Also known by its generic name, fluoxetine, Prozac is a selective serotonin reuptake inhibitor (SSRI). Around 1 in 10 people in the United States (U.S.) are thought to use SSRI drugs, and 1 in 4 women in their 40s and 50s.

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The 1970s was a time of social change; bell bottoms filled the streets, dance floors grooved to disco beats, and the women's movement was in full-swing. In a hospital ward in Wellington, New Zealand, change was also on the horizon for a group of young nurses.

A young man had enrolled to become a nurse - the only male out of 43 trainees.

Jumping forward to 2017 and that man, Andrew Cameron, is still a nurse. Throughout the years, his job has taken him to the far corners of the globe - Iraq, Afghanistan, Georgia and Sudan - not to mention the rural turn of Birdsville, Queensland, where he is now Director of Nursing.

He has risen to the top of his profession, receiving the Australian Nurse of the Year in 2004 and the Florence Nightingale Medal in 2011 for exceptional courage and devotion to victims of armed conflict. But things weren't always easy for him as a man in a predominantly female profession.

Reflecting back on his first few years in nursing, Mr Cameron describes some tough times and recalls being discriminated against for being a male nurse.

"I remember back in the 1970s as a trainee, I was not allowed near the gynaecological or maternity wards, but this was really nonsense because nearly all the obstetricians and gynaecologists were men!

"My very presence was quite a novelty, and often I felt very out of place. But that was over forty years ago. Times have changed and as the percentage of men in nursing has slowly increased and peoples' attitudes have largely changed as well, this is all for the better."

Years have passed but nursing is still a highly female-dominated occupation. Only one in 10 nurses in Australia are men and new research suggests that some men in nursing today encounter a number of the same challenges that Mr Cameron did in the 1970s.

The research, published in the Australian Journal of Advanced Nursing, looks at the challenges men face on their journey to nurse registration. A number of the men interviewed in the study reported feeling like an outsider in a 'woman's job,' encountering stereotypes that ranged from assumptions about their sexuality to their actual role.

The research calls for the profession to be de-feminised, a call underpinned by economic gains, as Australia faces a projected shortfall of nurses of approximately 85,000 nurses by 2025.

Libby Lyons, Director Workplace Gender Equality Agency, says it is beyond time to bring gender into the conversation about workforce shortages in the health sector.

"It is possible that our failure to encourage men into female-dominated roles is a symptom of gender bias: we are happy to encourage women to "step up" into male-dominated roles, but we rarely encourage men to undertake the caring."

If Mr Cameron's career is anything to go by, nursing can lead to a great range of possibilities for both women and men. Mr Cameron didn't let biases stop him from pursuing a rewarding career in nursing, he continued to buck the trend going on to train as a midwife, delivering over 500 babies and caring for disadvantaged people all over the world.

"You might not become a millionaire, but you will have a rich and fulfilling life, crowded with abundant opportunities to help others less fortunate than yourself."
Resources
Women's work│men's work: great careers are for everyone - a series of educational resources profiling women and men working in non-traditional fields

Gender segregation in Australia's workforce - this factsheet highlights the gender segregation of Australia's workforce by industry and occupation.

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The 1970s was a time of social change; bell bottoms filled the streets, dance floors grooved to disco beats, and the women's movement was in full-swing. In a hospital ward in Wellington, New Zealand, change was also on the horizon for a group of young nurses.

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Seven years on from a landmark review examining the economic implications of the gender pay gap in Australia an update report, released today by KPMG Australia, has found that sex discrimination continues to be the single largest factor contributing to the gender pay gap. And disturbingly, it's on the increase.

The gender pay gap has remained stubbornly flat for the past 20 years - currently sitting at around 16.2 percent.

Understanding the drivers of the gender pay gap is critical to designing interventions which will enable organisations to close the gap. The KPMG Australia report - She's Price(d)less: The Economics of the Gender Pay Gap - prepared for Diversity Council Australia (DCA) and the Workplace Gender Equality Agency (WGEA), aims to do just that.

The report uses structured econometric modelling to determine the factors that underpin the gender pay gap, and to what extent they contribute. The report is partnered with an Executive Companion document highlighting a range of tactical improvement opportunities for every size of business in Australia, and supported by case studies from some of Australia's leading companies.

"The drivers of the gender pay gap are complex. They include a broad range of factors including human capital and educational qualifications, on-the-job training and accreditation, work experience and tenure," said Susan Ferrier, National Managing Partner for People, Performance and Culture at KPMG Australia.

"Critically, they also include labour market discrimination - where skilled individuals may face different earning potential and employment opportunities due to discrimination by gender, values and culture," she said.

Libby Lyons, Director, Workplace Gender Equality Agency said: "The gender pay gap is a powerful symbol of lost potential for individuals, businesses and the economy. Understanding the factors that lead to women being consistently undervalued in the workforce is critical to creating change."

"Clearly we need to redouble our efforts to address the gender pay gap. And while organisations can do a lot to close the gap in their individual workplaces, there are structural inequities between industries and in the wider economy which must also be addressed. Business, government and the wider community all have a role to play," commented Lisa Annese, CEO of Diversity Council Australia.

Key Findings

Sex discrimination continues to account for the single largest component of the gap. This component of the gap is increasing over time (from 35 percent in 2009 to 38 percent in 2016). The research shows that systemic discrimination remains a persistent feature of the workforce, while the proportion of the pay gap that can be attributed to differences in skills, tenure and education between men and women decreases each year, as women continue to close the gap in terms of education and labour participation.

The proportion of the gap attributable to part-time employment has decreased from 14 percent in 2009, to 4 percent. Women are still over-represented in part-time employment, making up 71.6 percent of this workforce. Of women working part-time, the proportion of those who fall into higher income brackets has increased since 2009. These changes are significant when considered against the efforts undertaken by Australian businesses in the last several years to normalise cultures of working part-time and flexibly.

One of the most significant contributors to the gap is the influence of 'traditional' roles and industries for women and men, which accounts for almost one third of the total wage gap. Jointly, industrial and occupational segregation accounts for 30 percent of the gap. While significant gains have been made in occupational segregation in the last seven years for women (reducing from 18 percent in 2009 to 11 percent in 2016), these are countered by increases in industry segregation. In the period under review, the proportion of men in male-dominated, higher paid industries such as mining and construction has grown - as has the proportion of women in female-dominated, lower paid industries such as healthcare and social assistance.

The proportion of the gap attributable to years out of the workforce has increased from 9 percent to 21 percent. This reflects the criticality of businesses continuing to identify and address the structural barriers that prohibit women from returning to the workforce. Recent research continues to highlight the additional pressures on women in this respect, in particular in relation to the compounding effect on lifetime wealth accumulation and superannuation. Notably the 2007 HILDA survey included 'access to unpaid maternity leave' as a factor, which was subsequently omitted in 2014 as a result of the introduction of a Government funded Paid Parental Leave scheme. However, in both reports it is clear that interruptions in work history continue to play a role in explaining the gender pay gap.

KPMG has identified the following relative contribution of factors in driving the gender pay gap:

Taking Action: The Executive Companion

The Executive Companion identifies six areas with supporting actions to help businesses mature their position on addressing the gender pay gap:

1. Know the numbers - It is crucial to first understand the quantum of the pay gap in the context of a particular business and industry, including an honest assessment of the cultural, environment and business behaviours and processes which may be contributing.

2. Leverage the lifecycle - Key phases of the employee lifecycle (e.g. recruiting, performance review, remuneration setting and reporting) provide an opportunity to consider how current business processes could be amended to drive great equality in pay outcomes.

3. The 'caring conundrum' - A key focus area for workforce participation is the early to mid 30s period which often coincides with child bearing and rearing years. This is a critical juncture at which many women opt out of fulltime work, moving to part time roles. Businesses need a focus on how they can retain employees who take time out and ensure their return is sustainable.

4. Train the team - The availability of on-the-job training initiatives provide critical access to skill development and the building of professional networks which can drive women's greater participation and career progression.

5. Deal with the dollars - While remedying the processes going forward is critical to achieving pay equity, steps to redress remuneration-related gender bias which women have encountered in the past must be taken.

6. Change the culture - The right organisational culture is absolutely essential to driving out the behaviours that lead to the pay gap. It is critical to realise that intervention will be required to address the pay gap problem in a timely manner at an organisational and macro-economic level.

"While the research reveals outcomes which are disappointing, we need to keep talking about this challenging issue. It would be easy to stop talking because it seems too hard. Many Australian businesses are showing great commitment to diversity and inclusion programs and we have seen some fantastic examples of innovative programs and strong leadership addressing the gap," said Susan Ferrier.

"We are confident that this research will be a valuable contribution to keeping this conversation relevant by understanding the true factors that influence the gap. We need more purposeful, impactful action," she concluded.

About the Report

In 2009, KPMG Australia undertook a major study - Understanding the Economic Implications of the Gender Pay Gap in Australia for the Diversity Council Australia (DCA) - to develop a more rigorous evidence base around the structural factors underlying the gender pay gap, the contribution of these factors to the gap, and the potential economic implications in terms of women's participation in the labour force, and broader economic productivity and growth.

KPMG's 2009 analysis was based on data from the 2007 Household Income and Labour Dynamics in Australia (HILDA) survey, and built on research undertaken in the United Kingdom (UK) by Walby and Olsen (2002). KPMG's 2009 Report found that in 2007, of the hourly pay gap of $1.29 ($1.70 in today's dollars), approximately 35 percent was potentially attributable to gender.

Within the context of the significant public debate since 2009 around gender equity, diversity, and pay-equality, KPMG has updated its 2009 analysis with the benefit of the most recent HILDA data, from the 2014 wave of the survey. This update is intended to further contribute to the current public discussion, and drive a deeper and more holistic understanding of the social and economic factors that may contribute to the gender pay gap in Australia.

KPMG's analysis builds on the knowledge and the econometric model developed through the 2009 Report, and reflects the most recent data and information available, as well as the key developments in the research and literature since 2009.

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Why Australian women are still being paid less than men

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Seven years on from a landmark review examining the economic implications of the gender pay gap in Australia an update report, released today by KPMG Australia, has found that sex discrimination continues to be the single largest factor contributing to the gender pay gap. And disturbingly, it's on the increase.

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What is synthesising?

Synthesising is an important and complex skill required in academic writing. Synthesising involves combining ideas from a range of sources in order to group and present common ideas or arguments. It is a necessary skill used in essays, literature reviews and other forms of academic writing.

Unlike summarising and paraphrasing, which only uses one author's ideas at a time, synthesising combines ideas from more than one text or source.
Synthesising allows you to:

combine information and ideas from multiple sources to develop and strengthen your argument(s)

demonstrate that you have read widely on the topic

use and cite multiple sources.

How to synthesise

Use the following steps to synthesise information from different sources.

Read relevant material.

Make brief notes using keypoints/keywords. This makes it easier to compare and contrast relevant information.

Identify common ideas.

Cite (reference) all the authors you have used.

Note-taking for synthesising

Write down the main points. Remember to cite the references.
Topic: English is the dominant world language
Writing a synthesis from notes

Look at your notes and identify similar and contradictory arguments. Group these together to develop/support your arguments. Cite references appropriately.

Supporting the contention that English is the dominant world language, Watson (2019) and Lui (2018) point out its importance as the medium of international communication in business, technology and other global forums. However, others argue that despite its apparent dominance, English is not the global language when the number of native speakers of other languages, for example Chinese, are considered (Dowd 2019; Hannan 2017).

'Support': supporting ideas of Watson and Lui

'Reference': reference citations

'Similiarity': weaving similiar ideas that contradict the previous statement

[Support: Supporting the contention that English is the dominant world language], [reference: Watson (2019) and Lui (2018)] [Support: point out its importance as the medium of international communication in business, technology and other global forums.] [Similiarity: However, others argue that despite its apparent dominance, English is not the global language when the number of native speakers of other languages, for example Chinese, are considered] [Reference: (Dowd 2019; Hannan 2017).]

Example

In the example below, notice the way the writer has organised and referenced information from multiple sources. Several authors' ideas on extroversion are grouped in pink and the other authors' ideas on introversion are grouped in blue. References are in orange.

Individuals are classified as either an extrovert or an introvert. Extroversion describes people who are outgoing, sociable, assertive, and optimistic and are in search of excitement (McAdams 2014; McShane & Travaglione 2015 ). Extroverts are confident in their abilities to accomplish tasks effectively and have faith in themselves. They enjoy risk taking, but can be unreliable and can lose their temper easily (Mathews, Deary & Whiteman 2013). Extroverts also focus more on the positive aspects and outcomes of life and therefore they have a greater level of self confidence. On the other hand, introverts are described as being shy, quiet, withdrawn, less likely to make bad impulsive decisions and are more cautious in their actions (Matthews, Deary & Whiteman 2013; McAdams 2014; McShane & Traviglione 2015). As a consequence, introverts are more likely to place weight on the negative outcomes and aspects of social situations (McAdams 2014) and prefer to be alone, whereas extroverts have the ability to make friends quickly.

'Extroversion': Several authors' ideas on extroversion are grouped

'Introversion': O ther authors' ideas on introversion are grouped

'Reference': References made

Individuals are classified as either an extrovert or an introvert. [Extroversion: Extroversion describes people who are outgoing, sociable, assertive, and optimistic and are in search of excitement] [Reference: (McShane & Travaglione 2015; McAdams 2014). [Extroversion: Extroverts are confident in their abilities to accomplish tasks effectively and have faith in themselves. They enjoy risk taking, but can be unreliable and can lose their temper easily] [Reference: (Mathews, Deary & Whiteman 2013)]. [Extroversion: Extroverts also focus more on the positive aspects and outcomes of life and therefore they have greater level of self confidence.] [Introversion: On the other hand, introverts are described as being shy, quiet, withdrawn, less likely to make bad impulsive decisions and are more cautious in their actions] [Reference: (McAdams 2014; McShane & Traviglione 2015; Matthews, Deary & Whiteman 2013)]. [Introversion: As a consequence, introverts are more likely to place weight on the negative outcomes and aspects of social situations] [Reference: (McAdams 2014)] [Introversion: and prefer to be alone, whereas extroverts have the ability to make friends quickly.]

Please note: the above examples use Harvard in-text referencing. Please check your course handbook or speak to your teacher/lecturer on the exact referencing conventions required in your area of study.

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Synthesising is an important and complex skill required in academic writing. Synthesising involves combining ideas from a range of sources in order to group and present common ideas or arguments. It is a necessary skill used in essays, literature reviews and other forms of academic writing.

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