Women and Depression

The Many Dimensions of Depression
in Women: Women at Risk

Investigators are focusing on the following areas in their study of depression in women:

The issues of adolescence

Studies show that the higher incidence of depression in females begins in adolescence, when roles and expectations change dramatically. The stresses of adolescence include forming an identity, confronting sexuality, separating from parents, and making decisions for the first time, along with other physical, intellectual, and hormonal changes. These stresses are generally different for boys and girls, and may be associated more often with depression in females.

Adulthood: relationships and work roles

It is known that stress in general can contribute to depression in persons biologically vulnerable to the illness. Some have theorized that higher incidence of depression in women is not due to greater vulnerability, but to the particular stresses that many women face. These stresses include major responsibilities at home and work, single parenthood, and caring for children and aging parents, and are areas currently under study. How these factors may uniquely effect women is not yet fully understood.

Reproductive events

Women's reproductive events include the menstrual cycle, pregnancy, the postpregnancy period, infertility, menopause, and sometimes, the decision not to have children. These events bring fluctuations in mood that for some women include depression. Researchers have confirmed that hormones have an effect on the brain chemistry that controls emotions and mood; a specific biological mechanism explaining hormonal involvement is not known, however.

Many women experience certain behavioral and physical changes associated with phases of their menstrual cycles. In some women, these changes are severe, occur regularly, and include depressed feelings, irritability, and other emotional and physical changes. Called premenstrual syndrome, its relation to depressive disorders is not yet understood. Some have questioned whether it is, in fact, a disorder. Further research will no doubt add to our understanding of this long-ignored condition.

Postpartum depressions

can range from transient "blues" following childbirth to severe, incapacitating, psychotic depressions. Studies suggest that women who experience depression after childbirth very often have had prior depressive episodes. However, for most women, postpartum depressions are transient, with no adverse consequences.

Pregnancy

(if it is desired) seldom contributes to depression, and having an abortion does not appear to lead to a higher incidence of depression. Women with infertility problems may be subject to extreme anxiety or sadness, though it is unclear if this contributes to a higher rate of depressive illness. In addition, young motherhood may be a time of heightened risk for depression, due to the stress and demands it imposes.

Personality and psychology

Studies indicate that individuals with certain characteristics-- pessimistic thinking, low self-esteem, a sense of having little control over life events, and proneness to excessive worrying-- are more likely to develop depression. These attributes may heighten the effect of stressful events or interfere with taking action to cope with them. Some experts have suggested that the traditional upbringing of girls might foster these traits and that may be a factor in the higher rate of depression.

Others have suggested that women are not more vulnerable to depression than men, but simply express or label their symptoms differently. Women may be more likely to admit feelings of depression, brood about their feelings, or seek professional assistance. Men, on the other hand, may be socially conditioned to deny such feelings or to bury them in alcohol, as reflected in the higher rates of alcoholism in men. Current research may provide some answers about which of these theories is correct.

Victimization

Studies show that women molested as children are more likely to have clinical depression at some time in their lives than those with no such history. In addition, several studies show a higher incidence of depression among women who were raped as adults. Since far more women than men were sexually abused as children, these findings are relevant. Women who experience other commonly occurring forms of abuse, such as physical abuse and sexual harassment on the job, also may experience higher rates of depression. Abuse may lead to depression by fostering low self-esteem, a sense of helplessness, self-blame, and social isolation. At present, more research is needed to understand whether victimization is connected specifically to depression.

Poverty

Women and children represent seventy-five percent of the U.S. population considered poor. Some researchers are therefore exploring the possibility that poverty is one of the "pathways to depression." Low economic status brings with it many stresses, including isolation, uncertainty, frequent negative events, and poor access to helpful resources. Sadness and low morale are more common among persons with low incomes and those lacking social supports. But research has not yet established whether depressive illnesses are more prevalent among those facing environmental stressors such as these. One very large study has shown that these illnesses tend to equally effect the poor and the rich.

Depression in later adulthood

Once, depression at menopause was considered a unique illness known as "involutional melancholia." Research has shown, however, that depressive illnesses are no different, and no more likely to occur, at menopause than at other ages. In fact, the women most vulnerable to change-of-life depression are those with a history of past depressive episodes. An old theory, the "empty nest syndrome", stated that when children leave home, women may experience a profound loss of purpose and identity that leads to depression. However, studies show no increase in depressive illness among women at this stage of life.

As with younger age groups, more elderly women than men suffer from depressive illness. Similarly, for all age groups, being unmarried (which includes widowhood) is also a risk factor for depression. Despite this, depression should not be dismissed as a normal consequence of the physical, social and economic problems of later life. In fact, studies show that most older people feel satisfied with their lives.

About 800,000 persons are widowed each year, most of them are older, female, and experience varying degrees of depressive symptomatology. Most do not need formal treatment, but those who are moderately or severely sad appear to benefit from self-help groups or various psychosocial treatments. Remarkably, a third of widows/widowers meet criteria for major depressive episode in the first month after the death, and half of these remain clinically depressed 1 year later. These depressions respond to standard antidepressant medications, although there is relatively little research on when to start medications or how medications should be combined with psychosocial treatments.

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